, Volume 229, Issue 1, pp 209–218 | Cite as

Cigarette craving and withdrawal symptoms during temporary abstinence and the effect of nicotine gum

  • Jamie Brown
  • Peter Hajek
  • Hayden McRobbie
  • Jo Locker
  • Fiona Gillison
  • Andy McEwen
  • Emma Beard
  • Robert West
Original Investigation



It is widely believed that nicotine withdrawal symptoms appear within a few hours of stopping smoking, but few data exist documenting their emergence in naturalistic settings. In several countries, nicotine replacement products are licensed for relief of withdrawal symptoms during temporary abstinence, but again, there are no data supporting this from naturalistic settings.


To examine the emergence of cigarette craving and withdrawal symptoms during temporary abstinence in a naturalistic setting while using either nicotine or placebo gum.


Double-blind, randomised, placebo-controlled study in which 132 dependent smokers abstained for 6 h with the assistance of either nicotine (2 mg, n = 42 or 4 mg, n = 24) or placebo (n = 66) gum while travelling on a non-smoking train. Outcome measures were ratings of craving and mood withdrawal symptoms prior to treatment and at regular intervals during abstinence.


In a multivariate analysis of all symptoms, there was no interaction between treatment and time [F(21,110) = 1.28, p = 0.20, \( \eta_{\mathrm{p}}^2 \) = 0.20] nor an effect of treatment [F(7,124) = 0.45, p = 0.87, \( \eta_{\mathrm{p}}^2 \) = 0.03]. There was an effect of time [F(21,110) = 11.59, p < 0.001, \( \eta_{\mathrm{p}}^2 \) = 0.69) and univariate analyses revealed that the majority of symptoms increased linearly throughout the period of abstinence with detectable onsets typically between the first 60 and 180 min of abstinence.


Smokers who temporarily abstain in naturalistic settings experience craving and withdrawal symptoms that emerge linearly over the first 6 h of abstinence. Changes in craving and several mood withdrawal symptoms can be detected within the first 3 h. Nicotine gum may not have an acute effect on the development of these symptoms.


Temporary abstinence Craving Withdrawal symptoms Nicotine gum Smoking 


  1. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, WashingtonGoogle Scholar
  2. Baker TB, Piper ME, McCarthy DE, Majeskie MR, Fiore MC (2004) Addiction motivation reformulated: an affective processing model of negative reinforcement. Psychol Rev 111(1):33–51. doi:10.1037/0033-295x.111.1.33 PubMedCrossRefGoogle Scholar
  3. Baker TB, Breslau N, Covey L, Shiffman S (2012) DSM criteria for tobacco use disorder and tobacco withdrawal: a critique and proposed revisions for DSM-5*. Addiction 107(2):263–275. doi:10.1111/j.1360-0443.2011.03657.x PubMedCrossRefGoogle Scholar
  4. Beard E, West R (2012) Use of nicotine replacement therapy for smoking reduction and temporary abstinence: an update of Beard et al. (2011). Addiction 107(6):1186–1187. doi:10.1111/j.1360-0443.2012.03839.x PubMedCrossRefGoogle Scholar
  5. Beard E, Aveyard P, McNeill A, Michie S, Fidler JA, Brown J, West R (2012) Mediation analysis of the association between use of NRT for smoking reduction and attempts to stop smoking. Psychol Health 27(9):1118–1133. doi:10.1080/08870446.2012.685739 PubMedCrossRefGoogle Scholar
  6. Beard E, Aveyard P, Michie S, McNeill A, West R (2013a) Does use of nicotine replacement therapy while continuing to smoke undermine cessation?: a systematic review. J Smok Cessat. doi:10.1017/jsc.2012.21
  7. Beard E, Michie S, Fidler J, West R (2013b) Use of nicotine replacement therapy in situations involving temporary abstinence from smoking: a national survey of English smokers. Addict Behav 38: 1876–1879. doi: 10.1016/j.addbeh.2012.09.013 Google Scholar
  8. Bedi G, Preston KL, Epstein DH, Heishman SJ, Marrone GF, Shaham Y, de Wit H (2011) Incubation of cue-induced cigarette craving during abstinence in human smokers. Biol Psychiatry 69(7):708–711. doi:10.1016/j.biopsych.2010.07.014 PubMedCrossRefGoogle Scholar
  9. Brose LS, West R, McDermott MS, Fidler JA, Croghan E, McEwen A (2011) What makes for an effective stop-smoking service? Thorax 66(10):924–926. doi:10.1136/thoraxjnl-2011-200251 PubMedCrossRefGoogle Scholar
  10. Edwards G, Gross MM, Keller M, Moser J (1976) Alcohol-related problems in the disability perspective. A summary of the consensus of the WHO group of investigators on criteria for identifying and classifying disabilities related to alcohol consumption. J Stud Alcohol 37(9):1360–1382PubMedGoogle Scholar
  11. Fidler JA, Shahab L, West R (2010) Strength of urges to smoke as a measure of severity of cigarette dependence: comparison with the Fagerstrom Test for Nicotine Dependence and its components. Addiction 106:631–638. doi:10.1111/j.1360-0443.2010.03226.x PubMedCrossRefGoogle Scholar
  12. Freeman TP, Morgan CJ, Beesley T, Curran HV (2012) Drug cue induced overshadowing: selective disruption of natural reward processing by cigarette cues amongst abstinent but not satiated smokers. Psychol Med 42(1):161–171. doi:10.1017/s0033291711001139 PubMedCrossRefGoogle Scholar
  13. Gross J, Lee J, Stitzer ML (1997) Nicotine-containing versus de-nicotinized cigarettes: effects on craving and withdrawal. Pharmacol Biochem Behav 57(1–2):159–165PubMedCrossRefGoogle Scholar
  14. Harakeh Z, Engels RCME, Van Baaren RB, Scholte RHJ (2007) Imitation of cigarette smoking: an experimental study on smoking in a naturalistic setting. Drug Alcohol Depend 86(2–3):199–206. doi:10.1016/j.drugalcdep.2006.06.006 PubMedCrossRefGoogle Scholar
  15. Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, Robinson J (1989) Measuring the heaviness of smoking—using self-reported time to the 1st cigarette of the day and number of cigarettes smoked per day. Br J Addict 84(7):791–800PubMedCrossRefGoogle Scholar
  16. Hendricks P, Ditre J, Drobes D, Brandon T (2006) The early time course of smoking withdrawal effects. Psychopharmacology 187(3):385–396. doi:10.1007/s00213-006-0429-9 PubMedCrossRefGoogle Scholar
  17. Hughes JR (2007a) Effects of abstinence from tobacco: valid symptoms and time course. Nicotine Tob Res 9(3):315–327. doi:10.1080/14622200701188919 PubMedCrossRefGoogle Scholar
  18. Hughes JR (2007b) Measurement of the effects of abstinence from tobacco: a qualitative review. Psychol Addict Behav 21(2):127–137. doi:10.1037/0893-164x.21.2.127 PubMedCrossRefGoogle Scholar
  19. Hughes JR, Higgins ST, Hatsukami DK (1990) Effects of abstinence from tobacco: a critical review. In: Kozlowski LT, Annis HM, Cappell HD, Glaser FB, Goodstat MS, Israel Y, Kalant H, Seelera EM, Vingilis ER (eds) Research advances in alcohol and drug problems. Plenum, New York, pp 317–398CrossRefGoogle Scholar
  20. Hughes JR, Gust SW, Skoog K, Keenan RM, Fenwick JW (1991) Symptoms of tobacco withdrawal. A replication and extension. Arch Gen Psychiatry 48(1):52–59PubMedCrossRefGoogle Scholar
  21. Hughes JR, Higgins ST, Bickel WK (1994) Nicotine withdrawal versus other drug withdrawal syndromes: similarities and dissimilarities. Addiction 89(11):1461–1470PubMedCrossRefGoogle Scholar
  22. Hughes JR, Baker T, Breslau N, Covey L, Shiffman S (2011) Applicability of DSM criteria to nicotine dependence. Addiction 106(5):894–895. doi:10.1111/j.1360-0443.2010.03281.x PubMedCrossRefGoogle Scholar
  23. Killen JD, Fortmann SP (1997) Craving is associated with smoking relapse: findings from three prospective studies. Exp Clin Psychopharmacol 5(2):137–142PubMedCrossRefGoogle Scholar
  24. Koob GF, Le Moal M (2008) Addiction and the brain antireward system. Annu Rev Psychol 59:29–53. doi:10.1146/annurev.psych.59.103006.093548 PubMedCrossRefGoogle Scholar
  25. McCarthy DE, Piasecki TM, Fiore MC, Baker TB (2006) Life before and after quitting smoking: an electronic diary study. J Abnorm Psychol 115(3):454–466. doi:10.1037/0021-843x.115.3.454 PubMedCrossRefGoogle Scholar
  26. Medicines and Healthcare Products Regulatory Agency (2010) MHRA public assessment report: the use of nicotine replacement therapy to reduce harm in smokers.
  27. Moore D, Aveyard P, Connock M, Wang D, Fry-Smith A, Barton P (2009) Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis. BMJ 338:b1024. doi: 10.1136/bmj.b1024
  28. Parrott AC, Garnham NJ, Wesnes K, Pincock C (1996) Cigarette smoking and abstinence: comparative effects upon cognitive task performance and mood state over 24 hours. Hum Psychopharmacol Clin Exp 11(5):391–400. doi:10.1002/(sici)1099-1077(199609)11:5<391::aid-hup780>;2-z CrossRefGoogle Scholar
  29. Piasecki TM, Niaura R, Shadel WG, Abrams D, Goldstein M, Fiore MC, Baker TB (2000) Smoking withdrawal dynamics in unaided quitters. J Abnorm Psychol 109(1):74–86PubMedCrossRefGoogle Scholar
  30. Russell MA (1988) Nicotine replacement: the role of blood nicotine levels, their rate of change, and nicotine tolerance. Prog Clin Biol Res 261:63–94PubMedGoogle Scholar
  31. Sayette MA, Shiffman S, Tiffany ST, Niaura RS, Martin CS, Shadel WG (2000) The measurement of drug craving. Addiction 95(Suppl 2):S189–S210PubMedGoogle Scholar
  32. Schuh KJ, Stitzer ML (1995) Desire to smoke during spaced smoking intervals. Psychopharmacology (Berl) 120(3):289–295CrossRefGoogle Scholar
  33. Shiffman S, Paty JA, Gnys M, Kassel JA, Hickcox M (1996) First lapses to smoking: within-subjects analysis of real-time reports. J Consult Clin Psychol 64(2):366–379PubMedCrossRefGoogle Scholar
  34. Shiffman S, Gwaltney CJ, Balabanis MH, Liu KS, Paty JA, Kassel JD, Gnys M (2002) Immediate antecedents of cigarette smoking: an analysis from ecological momentary assessment. J Abnorm Psychol 111(4):531–545PubMedCrossRefGoogle Scholar
  35. Skinner MD, Aubin HJ (2010) Craving's place in addiction theory: contributions of the major models. Neurosci Biobehav Rev 34(4):606–623. doi:10.1016/j.neubiorev.2009.11.024 PubMedCrossRefGoogle Scholar
  36. Stead, L. F., Perera, R., Bullen, C., Mant, D., & Lancaster, T. (2008). Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev (1): Art. No. CD000146Google Scholar
  37. Swan GE, Ward MM, Jack LM (1996) Abstinence effects as predictors of 28-day relapse in smokers. Addict Behav 21(4):481–490PubMedCrossRefGoogle Scholar
  38. Tiffany ST (1990) A cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes. Psychol Rev 97(2):147–168PubMedCrossRefGoogle Scholar
  39. Tiffany ST, Drobes DJ (1991) The development and initial validation of a questionnaire on smoking urges. Br J Addict 86(11):1467–1476PubMedCrossRefGoogle Scholar
  40. Ussher M, Beard E, Abikoye G, Hajek P, West R (2012) Urge to smoke over 52 weeks of abstinence. Psychopharmacology (Berl). doi:10.1007/s00213-012-2886-7 Google Scholar
  41. West R (2006) Theory of addiction. Blackwells, OxfordGoogle Scholar
  42. West R (2009) The multiple facets of cigarette addiction and what they mean for encouraging and helping smokers to stop. J Chron Obstruct Pulmon Dis 6(4):277–283CrossRefGoogle Scholar
  43. West R, Hajek P (2004) Evaluation of the mood and physical symptoms scale (MPSS) to assess cigarette withdrawal. Psychopharmacology (Berl) 177:195–199CrossRefGoogle Scholar
  44. West R, Schneider N (1987) Craving for cigarettes. Br J Addict 82(4):407–415PubMedCrossRefGoogle Scholar
  45. West R, Ussher M (2010) Is the ten-item Questionnaire of Smoking Urges (QSU-brief) more sensitive to abstinence than shorter craving measures? Psychopharmacology (Berl) 208(3):427–432CrossRefGoogle Scholar
  46. West R, Jarvis MJ, Russell MAH, Carruthers ME, Feyerabend C (1984) Effect of nicotine replacement on the cigarette withdrawal syndrome. Br J Addict 79(2):215–219. doi:10.1111/j.1360-0443.1984.tb00265.x PubMedCrossRefGoogle Scholar
  47. World Health Organisation (1992) International classification of diseases. WHO, GenevaGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Jamie Brown
    • 1
    • 5
  • Peter Hajek
    • 2
  • Hayden McRobbie
    • 2
  • Jo Locker
    • 3
  • Fiona Gillison
    • 4
  • Andy McEwen
    • 1
    • 3
  • Emma Beard
    • 1
  • Robert West
    • 1
    • 3
  1. 1.Cancer Research UK Health Behaviour Research CentreUniversity College LondonLondonUK
  2. 2.Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen MaryUniversity of LondonLondonUK
  3. 3.National Centre for Smoking Cessation and TrainingLondonUK
  4. 4.Department for HealthUniversity of BathBathUK
  5. 5.Health Behaviour Research Centre, Department of Epidemiology and Public HealthUniversity College LondonLondonUK

Personalised recommendations