Correlates of nicotine withdrawal severity in smokers during a smoke-free psychiatric hospitalization

Abstract

Psychiatric hospitals are increasingly adopting smoke-free policies. Tobacco use is common among persons with mental illness, and nicotine withdrawal (NW), which includes symptoms of depression, anxiety, anger/irritability, and sleep disturbance, may confound psychiatric assessment and treatment in the inpatient setting. This study aimed to characterize NW and correlates of NW severity in a sample of smokers hospitalized for treatment of mental illness in California. Participants (N = 754) were enrolled between 2009 and 2013, and averaged 17 (SD = 10) cigarettes/day prior to hospitalization. Though most (70%) received nicotine replacement therapy (NRT) during hospitalization, a majority (65%) reported experiencing moderate to severe NW. In a general linear regression model, NW symptoms were more severe for women, African American patients, and polysubstance abusers. Though invariant by psychiatric diagnostic category, greater NW was associated with more severe overall psychopathology and greater cigarette dependence. The full model explained 46% of the total variation in NW symptom severity (F [19, 470] = 23.03 p < 0.001). A minority of participants (13%) refused NRT during hospitalization. Those who refused NRT reported milder cigarette dependence and stated no prior use of NRT. Among smokers hospitalized for mental illness, NW severity appears multidetermined, related to cigarette dependence, demographic variables, psychiatric symptom severity, and other substance use. Assessment and treatment of NW in the psychiatric hospital is clinically warranted and with extra attention to groups that may be more vulnerable or naïve to cessation pharmacotherapy.

Editorial: 3rd Special Issue on behavior change, health, and health disparities

“…Similarly, Soyster et al (2016—in this issue) provide evidence for differences in nicotine withdrawal severity corresponding to the confluence of many of those same independent predictors for being a smoker that Higgins and colleagues discuss.…”

Tobacco craving and withdrawal symptoms in psychiatric patients during a motivational enhancement intervention based on a 26-hour smoking abstinence period

“…Evaluation of nicotine withdrawal symptoms in psychiatric patients has encountered methodological difficulties, owing to the overlap of these symptoms with those common in several mental health disorders (e.g. anxiety, depression, and sleep disturbance) 23 . In a sample of smokers with attention-deficit hyperactivity disorder (ADHD) assessed before any cessation attempt, nicotine withdrawal symptoms (difficulty concentrating, restlessness or impatience, and anxiety or nervousness) positively correlated with current ADHD symptoms.…”

Improving patient education about tobacco withdrawal and nicotine gum use by registered nurses in inpatient psychiatry: A feasibility study

“…Abstinence from tobacco products results in a pattern of withdrawal symptoms that begins as wanting, progresses to craving and ends with a need to use again (DiFranza, Ursprung, & Biller, ). These symptoms can begin as rapidly as a few hours after nicotine abstinence, peak between 2 and 7 days, and may continue for 10 days to 1 month (APA, ; McLaughlin, Dani, & De Biasi, ; Paolini & De Biasi, ; Soyster, Anzai, Fromont, & Prochaska, ). Cravings—which involve a persistent desire to use tobacco, unpleasant physical sensations, and disrupted concentration—are at their most intense shortly after a quitting attempt but can linger for years even for those who have successfully quit using tobacco (Carpenter et al., ; Hughes, ).…”

“…Having a mental illness increases the likelihood of experiencing symptoms of withdrawal when abstaining from tobacco (APA, 2013;Ameringer & Leventhal, 2015;Leventhal, Ameringer, Osborn, Zvolensky, & Langdon, 2013;Smith, Homish, Giovino, & Kozlowski, 2014;Soyster et al, 2016). Individuals with psychiatric disorders may be unusually sensitive to tobacco cessation, leading to withdrawal symptoms that occur sooner after abstinence than in those without psychiatric diagnoses (Ameringer & Leventhal, 2015).…”

“…Staff working with patients in inpatient psychiatric settings need to be aware that symptoms attributed to psychiatric disorders can be caused by tobacco withdrawal, and vice versa; it is common for symptoms of the two to be confounded during the assessment process (APA, 2013;Ameringer & Leventhal, 2015;Leventhal et al, 2013;McLaughlin et al, 2015;Robson et al, 2017;Smith et al, 2014;Soyster et al, 2016). As a result, when tobacco withdrawal is treated inadequately during hospitalization, psychiatric diagnoses may be incorrect or incomplete (Soyster et al, 2016). Tobacco withdrawal also introduces the possibility that inaccurate assessment of treatment efficacy will occur.…”