Tobacco withdrawal components and their relations with cessation success

Megan E. Piper, Tanya R. Schlam, Jessica W. Cook, Megan A. Sheffer, Stevens S. Smith, Wei Yin Loh, Daniel M. Bolt, Su Young Kim, Jesse T. Kaye, Kathryn R. Hefner, Timothy B. Baker

Research output: Contribution to journalArticlepeer-review

97 Scopus citations


Rationale: Tobacco withdrawal is a key factor in smoking relapse, but important questions about the withdrawal phenomenon remain. Objectives: This research was intended to provide information about two core components of withdrawal (negative affect and craving): (1) how various withdrawal symptom profile dimensions (e.g., mean level, volatility, extreme values) differ between negative affect and craving; and (2) how these dimensions relate to cessation outcome. Methods: Adult smokers (N=1,504) in a double-blind randomized placebo-controlled smoking cessation trial provided real-time withdrawal symptom data four times per day for 4 weeks (2 weeks pre-quit and 2 weeks post-quit) via palmtop computers. Cessation outcome was biochemically confirmed 8-week point-prevalence abstinence. Results: Examination of craving and negative affect dimensions following a cessation attempt revealed that craving symptoms differed from negative affect symptoms, with higher means, greater variability, and a greater incidence of extreme peaks. Regression analyses revealed that abstinence was associated with lower mean levels of both craving and negative affect and fewer incidences of extreme craving peaks. In a multivariate model, the increase in mean craving and negative affect scores each uniquely predicted relapse. Conclusions: Real-time reports revealed different patterns of abstinence-related negative affect and craving and that dimensions of both predict cessation outcome, suggesting that negative affect and craving dimensions each has motivational significance. This underscores the complexity of withdrawal as a determinant of relapse and the need to measure its distinct components and dimensions.

Original languageEnglish
Pages (from-to)569-578
Number of pages10
Issue number4
StatePublished - Aug 2011

Bibliographical note

Funding Information:
Acknowledgments This research was conducted at the University of Wisconsin, Madison and was supported by grant #P50 DA019706 from NIH/NIDA and by grant #M01 RR03186 from the General Clinical Research Centers Program of the National Center for Research Resources, NIH. Dr. Piper was supported by grant 1UL1RR025011 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources (NCRR), National Institutes of Health (NIH). Dr. Cook was supported by K08DA021311. Dr. Baker was supported via NCI 1K05CA139871. Dr. Loh was partially supported by U. S. Army Research Office grant W911NF-09-1-0205. Medication was provided to patients at no cost under a research agreement with GlaxoSmithKline (GSK); no part of this manuscript was written or edited by anyone employed by GSK.


  • Craving
  • Negative affect
  • Nicotine
  • Smoking cessation
  • Tobacco
  • Withdrawal


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