A recently developed network perspective on tobacco withdrawal posits that withdrawal symptoms causally influence one another across time, rather than simply being indicators of a latent syndrome. Evidence supporting a network perspective would shift the focus of tobacco withdrawal research and intervention toward studying and treating individual withdrawal symptoms and inter-symptom associations. Yet, key questions remain to be addressed, including whether withdrawal symptoms and their interactions are moderated by abstinence and by cessation treatment. Here we examine the evidence for a network perspective on tobacco withdrawal. First, we use data from 668 participants (40% female, 78.29% African American) reporting on their experiences of withdrawal after 16 hours of smoking abstinence and during a non-abstinent state to examine the extent to which individual withdrawal symptoms are differentially impacted by smoking deprivation. Second, we estimate the symptom network structure of tobacco withdrawal during states of smoking satiety and abstinence. Third, we use experience-sampling data from 1210 participants (58.35% female, 86.24% white) undergoing smoking cessation treatment to estimate dynamic symptom networks that describe the interplay among withdrawal symptoms across time. Results indicate (i) differential impact of smoking deprivation on individual withdrawal symptoms, suggesting that symptoms are not interchangeable, (ii) substantial interplay among withdrawal symptoms that shows no evidence of change across periods of smoking satiety and abstinence, and (iii) reductions in the interplay among withdrawal symptoms during smoking cessation treatment. Overall, findings suggest the utility of a network perspective and encourage a greater consideration of the individual symptoms of tobacco withdrawal.
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