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"There is an identifiable syndrome which occurs on withdrawal
drawal from tobacco. The tobacco withdrawal syndrome is charac-
terized objectively by changes in the EEG and cardiovascular
function, by decrements in psychomotor performance, and by
weight gain. Subjective symptoms of irritability, anxiety, In-
ability to concentrate, and disturbances of arousal are charac-
teristic of tobacco users in withdrawal, and intense craving for
tobacco is almost universally reported. Although reports vary
regarding the prevalence, severity, and course of these symptoms,
there is nevertheless sufficient consensus to justify the conclu-
sion that a withdrawal syndrome occurs in habitual tobacco users.
Among the factors which affect the severity of the tobacco with-
drawal syndrome are the smoker’s sex and habitual dose. Other
factors, such as motivation for smoking and motivation for
178quitting, remain to be Investigated. At least one symptom --
craving for tobacco -- shows diurnal variation. The early
course of the withdrawal syndrome depends on the smoker’s de-
gree of deprivation. Totally abstinent smokers show a marked
decrease in all symptoms in the first week of abstinence, with
subsequent leveling off or increase in symptoms. Smoking among
partially abstinent smokers appears to prevent this early drop
and to maintain symptoms at their high initial levels, prolong-
ing the withdrawal symptoms. This may explain the ineffective-
ness of gradual withdrawal as a method of smoking cessation.
More research on, the tobacco withdrawal syndrome is warranted
because of the relation between withdrawal symptoms and relapse
in smoking cessation. Research in this area must consider a
number of methodological issues, including awareness of sources
of variability in symptoms. Standardized assessment of symptoms
would be a boon to research on the abstinence syndrome, making
results more comparable across studies. Much could be gained
from simply assessing and reporting withdrawal symptoms in smoking
cessation studies. Most studies in the literature are based on
retrospective self-reports of exsmokers, with all the limitations
attending to such data. More prospective, randomized experiments
using control groups and multiple measures are needed.
Ultimately, the goal of research on the tobacco withdrawal syn-
drome should be the development of applications in clinical tech-
nology for smoking control. Currently, three out of four smokers
who succeed in stopping smoking will relapse, most of them be-
cause of withdrawal symptoms. A better understanding of tobacco
withdrawal phenomena may help us to identify high risk populations
of smokers and match them to maximally efficient treatments. A
major focus for research should be on developing effective treat-
ments which specifically attack tobacco withdrawal symptoms and
thereby discourage relapse. The health of millions of people depends on it."