William S. Middleton Memorial Veterans Hospital, Madison, WI.
Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health (UW-CTRI), Madison, WI.
Nicotine Tob Res. 2021 Jun 8;23(7):1239-1247. doi: 10.1093/ntr/ntaa242.
The high smoking prevalence amongst individuals with psychiatric disorders constitutes a major public health disparity. Negative reinforcement models of addiction posit that severe tobacco withdrawal symptoms, related to the affective vulnerabilities of these smokers, may thwart their quitting smoking successfully. However, relatively few studies have prospectively examined the effects of nicotine deprivation on withdrawal symptoms in these groups.
This study compared the level of withdrawal symptoms both before and after nicotine deprivation in those diagnosed with posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) and in those without psychiatric diagnoses. Participants were US veterans who smoked (≥10 cigarettes/day) and met diagnostic criteria for PTSD (n = 38), MDD (n = 43), or no psychiatric diagnosis ("controls" n = 44). Participants attended study visits before and during 48-hour nicotine deprivation to report tobacco withdrawal symptoms. Analyses evaluated withdrawal symptom levels (baseline and during nicotine deprivation) and the change in symptoms related to nicotine deprivation and compared (1) participants with a psychiatric diagnosis versus controls, and (2) participants with PTSD versus MDD.
Contrary to hypotheses, nicotine deprivation produced greater increases in most withdrawal symptoms amongst controls than in those with psychiatric diagnoses. Compared with controls, those with PTSD or MDD reported elevated symptom levels both before and after tobacco deprivation for most withdrawal symptoms.
These findings suggest that chronically high levels of distress and craving, rather than acute increases in withdrawal symptoms because of nicotine deprivation, may account for the quitting difficulties of those with comorbid conditions such as PTSD and MDD.
Severe tobacco withdrawal may account for the higher quitting difficulties of smokers with either posttraumatic stress disorder (PTSD) or major depressive disorder (MDD). Paradoxically, this study showed that individuals with no psychiatric diagnosis had greater increases in tobacco withdrawal severity because of nicotine deprivation than did those with either PTSD or MDD. Those with either PTSD or MDD showed high stable levels of withdrawal symptom severity both before and during two days of abstinence, suggesting that their quitting difficulties may be related to their chronically high levels of distress rather than nicotine deprivation per se.
精神障碍患者的高吸烟率构成了一个主要的公共卫生差异。成瘾的负强化模型认为，严重的烟草戒断症状，与这些吸烟者的情感脆弱性有关，可能会阻碍他们成功戒烟。然而，相对较少的研究前瞻性地检查了尼古丁剥夺对这些人群戒断症状的影响。
本研究比较了诊断为创伤后应激障碍（PTSD）或重性抑郁障碍（MDD）的患者与无精神诊断的患者在尼古丁剥夺前后戒断症状的水平。参与者为吸烟（≥10 支/天）且符合 PTSD（n=38）、MDD（n=43）或无精神诊断（“对照”n=44）诊断标准的美国退伍军人。参与者在尼古丁剥夺前后的研究访视中报告烟草戒断症状。分析评估了戒断症状水平（基线和尼古丁剥夺期间）以及与尼古丁剥夺相关的症状变化，并比较了（1）有精神诊断的参与者与对照组，以及（2）PTSD 与 MDD 患者。
与假设相反，尼古丁剥夺在对照组中引起的大多数戒断症状的增加大于在有精神诊断的患者中。与对照组相比，PTSD 或 MDD 患者在烟草戒断前后报告的大多数戒断症状的症状水平均升高。
这些发现表明，慢性高水平的痛苦和渴望，而不是由于尼古丁剥夺而导致的戒断症状急性增加，可能是 PTSD 和 MDD 等合并症患者戒烟困难的原因。
严重的烟草戒断可能是 PTSD 或 MDD 患者戒烟困难的更高原因。具有讽刺意味的是，本研究表明，无精神诊断的个体因尼古丁剥夺而导致的烟草戒断严重程度增加大于 PTSD 或 MDD 患者。PTSD 或 MDD 患者在两天的禁欲期间，无论是在之前还是期间，都表现出较高的稳定的戒断症状严重程度，这表明他们的戒烟困难可能与其慢性高水平的痛苦有关，而不是尼古丁剥夺本身。
