Abstract
Rationale
Subthreshold smokers (who smoke ≤5 cigarettes/day) experience withdrawal symptoms, yet they smoke less than is required to maintain serum nicotine levels.
Objectives
For study 1, our aim was to determine (1) if adult subthreshold smokers report withdrawal symptoms; (2) how they rate symptom severity; (3) the length of their latency to withdrawal symptoms; (4) and the relationship between level of cigarette consumption and latency to withdrawal. The aim of study 2 was to attempt to replicate the results of study 1 in a nationally representative sample and to compare subthreshold and threshold (≥6 cigarettes/day) smokers.
Methods
Study 1 was conducted through telephone interviews. Study 2 was conducted through secondary analysis of data from the National Youth Tobacco Survey (self-administered in schools).
Results
In study 1, all subjects experienced withdrawal symptoms. The mean number of symptoms was 4.3; mean intensity of each symptom was >6 (1–10 scale). A quarter of the subjects could go for ≥2 days before experiencing withdrawal. More frequent smokers had a shorter latency to withdrawal (r=−0.43, p<0.001, n=36). In study 2, 63% of subthreshold smokers reported feeling at least one withdrawal symptom. Median latency to withdrawal was 168 h for subthreshold and 2 h for threshold smokers. A negative correlation between level of cigarette consumption and latency to withdrawal was observed for both groups.
Conclusions
Although subthreshold smokers experience significant withdrawal symptoms, they can smoke infrequently because symptoms may not appear for one to several days. Consistent with the sensitization–homeostasis theory, low doses of nicotine can suppress withdrawal symptoms over long periods.
Similar content being viewed by others
References
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision: DSM-IV-TR. American Psychiatric Association, Washington, DC, pp 192, 265
An L, Lein E, Bliss R, Pallonen U, Hennrikus D, Farley D, Hertel A, Perry C, Lando H (2004) Loss of autonomy over nicotine use among college social smokers. In: Proceedings of the 10th annual meeting of the Society for Research on Nicotine and Tobacco, Scottsdale, Arizona, p 71 (POS2-035 abstract)
Balfour DJ (2004) The neurobiology of tobacco dependence: a preclinical perspective on the role of the dopamine projections to the nucleus. Nicotine Tob Res 6:899–912
Balfour DJK, Benwell MEM, Birrell CE, Kelly RJ, Al-Aloul M (1998) Sensitization of the mesoaccumbens dopamine response to nicotine. Pharmacol Biochem Behav 59:1021–1030
Barker D (1994) Reasons for tobacco use and symptoms of nicotine withdrawal among adolescent and young adult tobacco users—United States, 1993. MMWR Morb Mortal Wkly Rep 43:745–750
Benowitz NL (1988) Pharmacologic aspects of cigarette smoking and nicotine addiction. N Engl J Med 319:1318–1329
Benowitz NL, Henningfield JE (1994) Establishing a nicotine threshold for addiction. N Engl J Med 331:123–125
Benowitz NL, Jacob P, Kozlowski LT, Yu L (1986) Impact of smoking fewer cigarettes on tar, nicotine, and carbon monoxide exposure. N Engl J Med 315:1310–1313
DiFranza JR, Wellman RJ (2005) A sensitization-homeostasis model of nicotine craving, withdrawal and tolerance: integrating the clinical and basic science literature. Nicotine Tob Res 7:9–26
DiFranza JR, Rigotti NA, McNeill AD, Ockene JK, Savageau JA, St Cyr D, Coleman M (2000) Initial symptoms of nicotine dependence in adolescents. Tob Control 9:313–319
DiFranza JR, Savageau JA, Fletcher K, Ockene JK, Rigotti NA, McNeill AD, Coleman M, Wood C (2002) The development of symptoms of tobacco dependence in youths: 30-month follow-up data from the DANDY study. Tob Control 11:228–235
Evans NJ, Gilpin E, Pierce JP, Burns DM, Borland R, Johnson M, Bal D (1992) Occasional smoking among adults: evidence from the California Tobacco Survey. Tob Control 1:169–175
Fredrickson P, Boules M, Yerbury S, Richelson E (2003) Blockade of nicotine-induced locomotor sensitization by a novel neurotensin analog in rats. Eur J Pharmacol 458:111–118
Girod R, Role LW (2001) Long-lasting enhancement of glutamatergic synaptic transmission by acetylcholine contrasts with response adaptation after exposure to low-level nicotine. J Neurosci 21:5182–5190
Goddard E (1990) Why children start smoking. Office of Population Censuses and Surveys, HMSO, London, UK
Gritz ER, Carr CR, Marcus AC (1991) The tobacco withdrawal syndrome in unaided quitters. Br J Addict 86:57–69
Grottick AJ, Corrigall WA, Higgins GA (2001) Activation of 5-HT2C receptors reduces the locomotor and rewarding effects of nicotine. Psychopharmacology (Berl) 157:292–298
Hamid S, Dawe GS, Gray JA, Stephenson JD (1997) Nicotine induces long-lasting potentiation in the dentate gyrus of nicotine primed rats. Neurosci Res 29:81–85
Jorenby DE, Hatsukami DK, Smith S, Fiore MC, Allen S, Jensen J, Baker TB (1996) Characterization of tobacco withdrawal symptoms: transdermal nicotine reduces hunger and weight gain. Psychopharmacology (Berl) 128:130–138
Levin ED (1992) Nicotinic systems and cognitive function. Psychopharmacology (Berl) 108:417–431
Littleton J (2001) Receptor regulation as a unitary mechanism for drug tolerance and physical dependence-not quite as simple as it seemed! Addiction 96:87–101
Mansvelder HD, Keath JR, McGehee DS (2002) Synaptic mechanisms underlie nicotine-induced excitability of brain reward areas. Neuron 33:905–919
McNeill AD, West RJ, Jarvis M, Jackson P, Bryant A (1986) Cigarette withdrawal symptoms in adolescent smokers. Psychopharmacology (Berl) 90:533–536
Moss RA, Prue DM (1982) Research on nicotine regulation. Behav Ther 13:31–46
Niaura R, Britt DM, Borrelli B, Shadel WG, Abrams DB, Goldstein MG (1999) History and symptoms of depression among smokers during a self-initiated quit attempt. Nicotine Tob Res 1:251–257
OCR Macro (2005) 2004 NYTS methodology report. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Available at http://www.cdc.gov/tobacco/NYTS/nyts2004.htm
O’Loughlin J, Kishchuck N, DiFranza J, Tremblay M, Paradis G (2002) The hardest thing is the habit: a qualitative investigation of adolescent smokers’ experience of nicotine dependence. Nicotine Tob Res 4:201–209
O’Loughlin JO, DiFranza J, Tyndale RF, Meshefedjian G, McMillan-Davey E, Clarke PBS, Hanley J, Paradis G (2003) Nicotine-dependence symptoms are associated with smoking frequency in adolescents. Am J Prev Med 25:219–225
Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S (1994) The validity of self-reported smoking: a review and meta-analysis. Am J Public Health 84:1086–1093
Pidoplichko VI, DeBiasi M, Williams JT, Dani JA (1997) Nicotine activates and desensitizes midbrain dopamine neurons. Nature 390:401–404
Presson CC (2006) Stability of light and intermittent smoking (LITS) patterns and transitions to and from LITS: how smokers become LITS and how often and why LITS smoking patterns change. In: Proceedings of the 12th annual meeting of the Society for Research on Nicotine and Tobacco, Orlando, FL, p 9 (SYM7B abstract)
Quick MW, Lester RAJ (2002) Desensitization of neuronal nicotinic receptors. J Neurobiol 53:457–478
Riedel BW, Robinson LA, Klesges RC, McLain-Allen B (2003) Ethnic differences in smoking withdrawal effects among adolescents. Addict Behav 28:129–140
Russell MAH (1980) Nicotine intake and its regulation. J Psychosom Res 24:253–264
Shiffman S (1989) Tobacco “chippers”—individual differences in tobacco dependence. Psychopharmacology (Berl) 97:539–547
Shiffman S, Zettler-Segal M, Kassel J, Paty J, Benowitz NL, O’Brien G (1992) Nicotine elimination and tolerance in non-dependent cigarette smokers. Psychopharmacology (Berl) 109:449–456
Shiffman S, Paty JA, Gnys M, Zettler-Segal M (1994) Smoking behavior and smoking history of tobacco chippers. Exp Clin Psychopharmacol 2:126–142
Shiffman S, Paty JA, Gnys M, Elash C, Kassel JD (1995) Nicotine withdrawal in chippers and regular smokers: subjective and cognitive effects. Health Psychol 14:301–309
Shiffman S, West RJ, Gilbert DG, SRNT Working Group on the Assessment of Craving and Withdrawal in Clinical Trials (2004) Recommendation for the assessment of tobacco craving and withdrawal in smoking cessation trials. Nicotine Tob Res 6:599–614
Slawecki CJ, Ehlers CL (2002) Lasting effects of adolescent nicotine exposure on the electroencephalogram, event related potentials, and locomotor activity in the rat. Dev Brain Res 138:15–25
Smith KM, Mitchell SN, Joseph MJ (1991) Effects of chronic and subchronic nicotine on tyrosine hydroxylase activity in noradrenergic and dopaminergic neurones in the rat brain. J Neurochem 57:1750–1756
Strong DR, Kahler CW, Ramsey SE, Abrantes A, Brown RA (2004) Nicotine withdrawal among adolescents with acute psychopathology: an item response analysis. Nicotine Tob Res 6:547–557
Upadhyaya HP, Drobes DJ, Wang W (2006) Reactivity to in vivo smoking cues in older adolescent cigarette smokers. Nicotine Tob Res 8:135–140
Wellman RJ, McMillen RC, DiFranza JR (2006a) Assessing college students’ autonomy over tobacco with the hooked on nicotine checklist. In: Proceedings of the 12th annual meeting of the Society for Research on Nicotine and Tobacco, Orlando, FL, p 81 (POS 1-107 abstract)
Wellman RJ, DiFranza JR, Pbert L, Fletcher KE, Flint A, Young MH, Druker S (2006b) A comparison of the psychometric properties of the hooked on nicotine checklist and the modified Fagerström tolerance questionnaire. Addict Behav 32:486–495
Wetter DW, Fiore MC, Baker TB, Young TB (1995) Tobacco withdrawal and nicotine replacement influence objective measures of sleep. J Consult Clin Psychol 63:658–667
Acknowledgement
Funding provided by National Institutes on Drug Abuse grant # 5 RO1 DA14666-01 (JR DiFranza, PI). The ideas expressed are not necessarily those of the funding agency.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fernando, W.W.S.A., Wellman, R.J. & DiFranza, J.R. The relationship between level of cigarette consumption and latency to the onset of retrospectively reported withdrawal symptoms. Psychopharmacology 188, 335–342 (2006). https://doi.org/10.1007/s00213-006-0497-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00213-006-0497-x