Study Finds Connection Between Smoking Withdrawal and Fear, Anxiety

Researchers asked participants to stop smoking for one day, then used a novel combination of subjective, psychophysiological, and neuroimaging approaches to see what happened. Results published in PLOS One demonstrated that 24 hours of smoking abstinence potently increased fear and anxious mood.

The researchers, from the University of Maryland, Wisconsin, and colleagues said this finding could aid in future treatments to help people quit smoking.

Dr. Megan Piper
Dr. Megan Piper

Researchers enrolled and scanned 78 daily tobacco smokers from the DC-Baltimore metropolitan region. They determined eligibility using a multi-stage procedure that included online, telephone, and face-to-face assessments. The participants were 18 to 40 years old and had smoked at least 10 cigarettes per day for at least the last six months.

They used several scales, including the Wisconsin Inventory of Smoking Dependence Motives (WISDM) and Wisconsin Smoking Withdrawal Scale (WSWS) developed at UW-CTRI, to assess dependence and withdrawal symptoms. They also implemented a threat-anticipation paradigm and neuroimaging.

The researchers, led by Dr. Hyung Cho Kim, confirmed participants had abstained from smoking with a CO test.

“These participants reported significantly greater smoking urges, general withdrawal symptoms, and had strong reactions to the threat cues,” said co-author and UW-CTRI Research Director Dr. Megan Piper.

Notably, compared to the group who smoked as usual, the group who quit for a day reported significantly more intense fear and anxiety when they were anticipating receiving an uncomfortable electric shock, seeing a distressing photo, and hearing a related unpleasant noise (that is, when they were anticipating threats) compared to when they were anticipating safe situations. However, researchers did not see activity in the brain region closely related to anxiety and threat in animals—the central extended amygdala.

Withdrawal and anxiety

“We’re excited that this research might help us better understand anxious withdrawal, with implications for basic, translational, and clinical science,” Piper said. “And it also illustrates the need for more research on how to translate animal models of addiction to human experience.”

Kim HC, Kaplan CM, Islam S, Anderson AS, Piper ME, Bradford DE, Curtin JJ, DeYoung KA, Smith JF, Fox AS, Shackman AJ. Acute Nicotine Abstinence Amplifies Subjective Withdrawal Symptoms and Threat-Evoked Fear and Anxiety, but Not Extended Amygdala Reactivity. PLOS One.