Smoking Withdrawal in Smokers With and Without Posttraumatic Stress Disorder

Abstract

Results of this preliminary investigation suggested that after overnight abstinence, PTSD smokers experienced worse withdrawal symptoms and greater urges to smoke for both positive and negative reinforcement. Research on smoking withdrawal early in the course of smoking abstinence in PTSD could inform interventions targeting abstinence early in the quit attempt.

Cigarette smoking and 9/11-related posttraumatic stress disorder among World Trade Center Health Registry enrollees, 2003–12

“…Consistent with previous studies, we found a high prevalence of smoking and decreased odds of quitting among those with PTSD over time (Cook et al, 2014;Fu et al, 2007;Lawrence et al, 2011;Morris et al, 2014;Vanable et al, 2003). Dedert et al, (2012) found that smokers with PTSD were more likely to report increased cravings and negative affect than those without PTSD during early phases of abstinence, which may explain why enrollees with PTSD were less likely to quit smoking. As a stimulant, nicotine may exacerbate PTSD symptoms; reduced nicotine exposure may lead to decreased hyperarousal symptoms as well as reactivity and avoidance related to traumatic cues (Calhoun et al, 2011;Dedert et al, 2014).…”

“…As a stimulant, nicotine may exacerbate PTSD symptoms; reduced nicotine exposure may lead to decreased hyperarousal symptoms as well as reactivity and avoidance related to traumatic cues (Calhoun et al, 2011;Dedert et al, 2014). Smokers with PTSD may be reluctant to consider quitting because they are more likely to believe that smoking will alleviate negative affect (Calhoun et al, 2011) and be concerned with cravings (Dedert et al, 2012).…”

“…Smoking and the reduced probability of quitting among trauma exposed persons with PTSD are characterized by two distinct smoking motivations (Feldner et al, 2007). Trauma exposed persons with PTSD may smoke in response to trauma-related cues (Beckham et al, 1996, Beckham et al, 2005 and may be more likely smoke in order to reduce negative affect (e.g., anger, contempt, guilt, fear) (Calhoun et al, 2011;Dedert et al, 2012;Feldner et al, 2007).…”

PTSD and Risk of Incident Cardiovascular Disease in Aging Veterans

“…Biologically, PTSD and cardiovascular dysfunction have been related to the dysregulation of the hypothalamic-pituitary-adrenal axis, 33 and alterations to pathways in the autonomic nervous system caused by PTSD symptoms have also been implicated in the development of vascular problems such as high blood pressure and blood coagulation. 34,35 Many behavioral risk factors for cardiovascular disease in those with PTSD have been proposed as well, with studies showing that persons with PTSD have more difficulty with tobacco cessation, 36 have an increased risk of obesity, 37,38 and are less physically active. 39,40 Finally, there are several psychosocial risk factors that are likely involved in the relationship between PTSD and cardiovascular disease, including low social support 41 and low socioeconomic status.…”

Nicotine Addiction and Psychiatric Disorders

“…In addition, following trauma, smoking initiation and daily smoking rates also increased (Breslau et al, 2003, 2004). PTSD patients also showed lower rates of quitting (Hapke et al, 2005; Lasser et al, 2000), suffered from worse nicotine withdrawal symptoms (Dedert et al, 2011), and as a result showed shorter times to first smoking lapse (Beckham, Calhoun, Dennis, Wilson, & Dedert, 2012) than non-PTSD population. Similarly, patients with social phobia have also demonstrated increased rates of smoking initiation (Sonntag, Wittchen, Höfler, Kessler, & Stein, 2000).…”