NEW YORK, Jun 08 (Reuters Health) -- Despite what cigarette smokers have been led to believe, nicotine withdrawal symptoms do not always fade away. Instead, they may plague smokers months to years after they thought they had kicked the habit, researchers report.
In fact, smokers are as likely to experience significant ups and downs in their withdrawal symptoms as they are to experience the more traditional course of recovery, Timothy Baker from the University of the Wisconsin-Madison Center for Tobacco Research and Intervention, told Reuters Health.
Baker, just back from his symposium on addiction motivation at the 1999 annual meeting of the American Psychological Society in Denver, Colorado, likened the variability in nicotine withdrawal symptoms to the variability people show in mourning behavior. "Some people get over it fairly quickly," he said. "Others never manage to."
Baker and his colleagues have identified several patterns of withdrawal that differ from the conventional withdrawal pattern. Only about half of the smokers who quit see a gradual decline in their symptoms, he said. Many experience a temporary decline, followed by a rise to levels worse than when they first quit. Others encounter symptoms that start out severe and worsen, reaching a plateau after a variable period. Most, he said, experience ups and downs in sync with environmental stressors.
"People who go through these atypical withdrawal cycles," Baker said, "are two or three times more likely to relapse than those who don't. Frequently, they'll have increased withdrawal symptoms just before they relapse."
The best treatment strategy relies on vigilance, Baker suggested. "Smokers need to track their withdrawal symptoms on a regular basis," he said, "and intervene when their symptoms worsen but before their first lapsed cigarette. Eighty percent of those who smoke a single cigarette will return to full-time smoking."
There is no perfect treatment, according to Baker. Nicotine patches and drug therapies reduce the severity but not the "shape" of the withdrawal profile, so smokers can still face late exacerbations of symptoms and relapses even on therapy.
Baker also counsels smokers to know what to expect. "Be familiar with the classic withdrawal symptoms -- difficulty concentrating, trouble sleeping, and hunger, as well as the mood symptoms -- irritability and depression," he advised. "Think of strategies to deal with the mood problems. Think, 'How would a nonsmoker solve this problem?'"
"Still," Baker concluded, "the unfortunate reality is, most smokers in any treatment program will relapse."
