Are tobacco dependence and withdrawal related amongst heavy smokers? Relevance to conceptualizations of dependence

Abstract

Measured tobacco dependence is typically only modestly related to tobacco withdrawal severity among regular smokers making a quit attempt. The weak association between dependence and withdrawal is notable because it conflicts with core theories of dependence and because both measures predict cessation outcomes, suggesting they both index a common dependence construct. This study used data from a smoking cessation comparative effectiveness trial (N = 1504) to characterize relations of tobacco dependence with craving and negative affect withdrawal symptoms using multiple dependence measures and analytic methods to detect both additive and interactive effects and to determine whether withdrawal meaningfully mediates the influence of dependence on smoking cessation. We conclude: (a) Although univariate analyses suggest dependence and withdrawal measures are only modestly interrelated, more powerful analytic techniques show they are, in fact, meaningfully related and their shared variance is associated with cessation likelihood; (b) there are clear differences between craving and negative affective withdrawal symptoms, with the former more related to smoking heaviness and the latter related to trait measures of negative affect; moreover, craving more strongly mediates dependence effects on cessation; and (c) both craving and negative affect withdrawal symptoms are strongly related to a pattern of regular smoking that is sensitive to the passage of time and powerfully affected by smoking cues. These findings support models that accord an important role for associative processes and withdrawal symptoms, especially craving, in drug dependence. The findings also support the use of withdrawal variables as criteria for the evaluation of dependence measures.

Figure 1

Figure 1a. Regression tree predicting mean post-quit negative affect. Figure 1b. Regression tree predicting mean post-quit craving.

Figure 1

Figure 1a. Regression tree predicting mean post-quit negative affect. Figure 1b. Regression tree predicting mean post-quit craving.

Figure 2

Figure 2a. Mediation model showing craving withdrawal symptoms mediating the effect of WISDM Tolerance and NDSS Drive subscale scores on cessation outcome. “Smoking” is a binary variable reflecting smoking during the 2-week post-quit period when withdrawal symptoms were assessed. It reflects average smoking rates during this period of 5 cigarettes/day or less vs. more than this amount. It is intended to control for any influence of moderate or heavy smoking during this period on withdrawal symptoms and relapse. Figure 2b. Mediation model showing craving withdrawal symptoms mediating the effect of WISDM Tolerance and Cue Exposure subscale scores on cessation outcome. The variable “Smoking” is a binary variable reflecting smoking during the 2-week post-quit period when withdrawal symptoms were assessed. It reflects average smoking rates during this period of 5 cigarettes/day or less vs. more than this amount. It is intended to control for any influence of moderate or heavy smoking during this period on withdrawal symptoms and relapse.

Figure 2

Figure 2a. Mediation model showing craving withdrawal symptoms mediating the effect of WISDM Tolerance and NDSS Drive subscale scores on cessation outcome. “Smoking” is a binary variable reflecting smoking during the 2-week post-quit period when withdrawal symptoms were assessed. It reflects average smoking rates during this period of 5 cigarettes/day or less vs. more than this amount. It is intended to control for any influence of moderate or heavy smoking during this period on withdrawal symptoms and relapse. Figure 2b. Mediation model showing craving withdrawal symptoms mediating the effect of WISDM Tolerance and Cue Exposure subscale scores on cessation outcome. The variable “Smoking” is a binary variable reflecting smoking during the 2-week post-quit period when withdrawal symptoms were assessed. It reflects average smoking rates during this period of 5 cigarettes/day or less vs. more than this amount. It is intended to control for any influence of moderate or heavy smoking during this period on withdrawal symptoms and relapse.