Does nicotine withdrawal affect smoking cessation? Clinical and theoretical issues.

Pharmacological theories of smoking relapse emphasize the role of nicotine withdrawal in the maintenance of smoking behavior and general failure of treatment interventions. In this article, prospective studies are reviewed which examine the relationship of nicotine withdrawal to unsuccessful smoking cessation and relapse. The relative effectiveness of smoking treatments that directly address nicotine withdrawal is also discussed. It is concluded that the research to date does not appear to strongly implicate nicotine withdrawal in adversely affecting smoking cessation or maintenance of abstinence. Some major obstacles to our understanding of the predictive validity of nicotine withdrawal are addressed including: (a) measurement problems, (b) exclusion bias, and (c) insufficient research on nicotine withdrawal in certain subgroups of highly nicotine-dependent smokers. Other factors which may account for smoking relapse, including behavioral and psychosocial variables, as well as their possible interaction with nicotine withdrawal, are also considered. Recommendations for further research are offered.