Michael Belcher

Breath-holding endurance as a predictor of success in smoking cessation☆

A pretreatment test of breath-holding endurance predicted end-of-treatment outcome in 56 Smokers Clinic clients (r = .44; p less than .001). The cut off points derived by discriminant analysis were 32 seconds for men and 20 seconds for women, which correctly classified 78.6% of cases. The breath-holding test might sample the type of endurance necessary to withstand the discomfort associated with cigarette withdrawal and may also be relevant to success in quitting other addictive behaviours. However, alternative explanations are possible and more data are needed.

TIME COURSE OF CIGARETTE WITHDRAWAL SYMPTOMS WHILE USING NICOTINE GUM

Ratings of withdrawal symptoms were provided at weekly intervals by 147 smokers clinic clients who managed complete abstinence for 4 weeks. The ratings followed a similar temporal pattern regardless of amount of nicotine gum used. Irritability, depression, difficulty concentrating and restlessness peaked in the 1 st week or two and returned to baseline by week 4. Hunger was more persistent. Craving was reported to be the most troublesome withdrawal symptom at first, although by the 4th week hunger was cited almost as often. Across all subjects,e venings were cited most often as the worst time of day for craving but among heavier smokers and those who used more nicotine gum mornings were considered worst.

Time course of cigarette withdrawal symptoms during four weeks of treatment with nicotine chewing gum

Ratings of withdrawal symptoms were obtained from 52 Smokers Clinic clients who abstained throughout a four week group treatment programme involving use of nicotine chewing gum. Mean ratings of irritability, depression, hunger, restlessness, and inability to concentrate were significantly higher in the first week of abstinence than at baseline, although only a minority of smokers experienced severe withdrawal symptoms. Disturbance of mood and concentration returned to baseline within four weeks while increases in hunger persisted. The average amount of time spent with the urge to smoke started to decline early in treatment, but the average strength of urges and overall difficulty not smoking did not decline until the fourth week. At the end of treatment 35% were still experiencing strong urges to smoke and 23% reported finding it difficult keeping themselves from smoking. The findings have practical implications for preparing smokers for cessation with the aid of nicotine gum.

Effect of smoke-free cigarettes on 24 h cigarette withdrawal: a double-blind placebo-controlled study

In a double-blind randomised trial, 40 cigarette smokers used either nicotine-containing or placebo smoke-free cigarettes during 24 h abstinence from smoking. Subjects in the nicotine group experienced smaller increases in irritability and difficulty concentrating and fewer urges to smoke than those who received placebo. Nicotine smoke-free cigarettes were rated as more satisfying, more helpful and more effective in relieving craving than placebo. After 24 h use nicotine smoke-free cigarettes provided average blood nicotine levels of 6.3 ng/ml, i.e., 29.2% of smoking levels. The most frequent side effects were irritation of the throat and coughing. Overall, side effects were rated as not serious. Although the smoke-free cigarette in its present form is not very efficient in delivering nicotine, it was effective in alleviating initial tobacco withdrawal. It is possible that by providing both nicotine and “behavioural” replacement it may be particularly useful in the first stages of stopping smoking. The product is worth further investigation.

Which smokers report most relief from craving when using nicotine chewing gum

Seventy-seven smoker clinic clients who managed at least 2 weeks of smoking abstinence while chewing 2 mg nicotine gum reported the degree to which the gum reduced their craving for cigarettes, their daily gum consumption and the extent of urges to smoke despite the gum. Greatest relief from craving by the gum was reported by smokers with higher pre-abstinence expired-air carbon monoxide (CO) concentrations and higher “stimulant” and “dependent” scores on a smoking motivation questionaire but not greater usual daily cigarette consumption. Gum consumption correlated positively with expired-air CO, usual daily cigarette consumption, and “stimulant” and “dependent” smoking scores. Despite the gum, urges to smoke and difficulty not smoking were reported and the severity of these was associated with “indulgent”, “stimulant” and “dependent” smoking scores but not CO or usual daily cigarette consumption. The results are discussed in terms of the possible role of pharmacological and non-pharmacological factors in craving.