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

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Abstract

Rationale

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.

Objectives

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

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

We are grateful to Pharmacia for funding this study and to Björn Landfeldt and his Pharmacia colleagues for their help in designing the study. JB’s post is funded by the National Prevention Research Initiative. RW is funded by Cancer Research UK. The research team is part of the UK Centre for Tobacco Control Studies. We thank Leonie Brose, Kristjan Laane and Lion Shahab for providing comments on a draft of this manuscript.

Statement of competing interests

Pharmacia both funded the study and manufactured the smoking cessation medication that was investigated. Pharmacia have since merged with Pfizer. Individuals at Pharmacia provided advice on study design and data collection; however, final decisions were taken by the investigators and were unrestricted. RW, AMcE, PH and HM have undertaken research and consultancy for companies that develop and manufacture smoking cessation medications. RW and AMcE have a share of a patent for a novel nicotine delivery device. There are no other relationships or activities that could appear to have influenced the submitted work; in particular, the delay between data collection and publication was not a result of a sponsorship clause.

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Authors and Affiliations

  1. Cancer Research UK Health Behaviour Research Centre, University College London, London, UK

    Jamie Brown, Andy McEwen, Emma Beard & Robert West

  2. Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK

    Peter Hajek & Hayden McRobbie

  3. National Centre for Smoking Cessation and Training, London, UK

    Jo Locker, Andy McEwen & Robert West

  4. Department for Health, University of Bath, Bath, UK

    Fiona Gillison

  5. Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK

    Jamie Brown

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  1. Jamie Brown
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Correspondence to Jamie Brown.

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Brown, J., Hajek, P., McRobbie, H. et al. Cigarette craving and withdrawal symptoms during temporary abstinence and the effect of nicotine gum. Psychopharmacology 229, 209–218 (2013). https://doi.org/10.1007/s00213-013-3100-2

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  • DOI: https://doi.org/10.1007/s00213-013-3100-2

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