Withdrawal Symptoms as Predictors of Relapse

Project Description

The objectives of this project were to investigate the physiological, cognitive, and emotional changes that occur during smoking withdrawal and the extent to which these changes predict relapse. To meet these goals, previous pilot data were analyzed and two new studies were completed. Analyses of previous pilot data found that heart rate and diastolic blood pressure across the waking day declined significantly after cessation and that smokers showed significantly more heart rate variability across repeated ambulatory monitoring sessions than did nonsmokers.
 
The first study of the current project intensively studied 16 quitters daily for the first week after smoking cessation. Subjects wore ambulatory blood pressure and heart rate monitors on alternate days and rated withdrawal symptoms multiple times each day. Results indicated a substantial heart rate decline of 12 bpm over the first 6 hours after cessation, with a parallel significant increase in withdrawal symptoms.
 
For a second, larger study, 77 quitters wore ambulatory monitors and completed diaries and withdrawal symptom scales and cognitive testing on three occasions: before cessation, during the first 24 hours after cessation, and 1 month later. Withdrawal symptoms were also reported daily for the first 3 days after cessation and weekly for the first month. A daily smoking diary was kept, and subjects were weighed and had biochemical verification of abstinence conducted weekly. A comparison group of 30 nonsmokers were assessed on the same schedule. Analyses examined the time course of heart rate and blood pressure changes after cessation and identified, for the first time, a dramatic short-term dip in systolic blood pressure levels over the first 12 hours after cessation, along with the expected steady decline in heart rate levels. Analyses also identified a subset of symptoms that met the criteria for nicotine withdrawal and investigated the relationship between these withdrawal symptoms and relapse.

The 23 smokers who relapsed in the first week were compared with the 54 who remained abstinent for the withdrawal phase. Early relapsers did not differ on any baseline variables, but surprisingly had significantly lower depression and anger before quitting than abstainers. However, over the first three days after quitting, early relapsers had significantly greater average increases in depression, anger, frustration, and difficulty concentrating, and a greater average decrease in fatigue. This study is one of the first to intensively examine physiological and emotional changes during withdrawal and to identify a cluster of nicotine withdrawal symptoms that is predictive of relapse during the first week after cessation.