Anxiety disorders make it harder to quit smoking

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More than one-third of smokers who participated in a free intervention program to help them quit had at least one anxiety diagnosis in their lifetime; a factor that makes successful cessation less likely, study results published this week in Addiction suggest.

 “Anxiety diagnoses were common among treatment-seeking smokers and were related to increased motivation to smoke, elevated withdrawal, lack of response to pharmacotherapy and impaired ability to quit smoking,” wrote researchers from the Center for Tobacco Research and Intervention at the University of Wisconsin School of Medicine and Public Health, in Madison.

Megan E. Piper, PhD, and colleagues enrolled 1,504 people who smoked at least 10 cigarettes daily to study the relationship between patient history of panic attack (n=455), social anxiety (n=199) and general anxiety disorder (n=99), and four tobacco-related outcomes: dependence, withdrawal symptoms, treatment response and cessation success.

Structured clinical interviews and questionnaire administered at baseline and throughout the study revealed that smokers who experienced any of the three anxiety disorders (n=753) reported higher levels of nicotine dependence and pre-quit withdrawal symptoms than those without an anxiety diagnosis (n=891).

Results from one of several questionnaires administered revealed that elevated perceptions of pre-quit withdrawal symptoms among those with anxiety disorders had nothing to do with being a heavy smoker – a factor commonly associated with nicotine dependence – but instead with dependency motives.

Patients with anxiety may smoke for “instrumental reasons,” like affect regulation and improved cognition, or as a “symptom management function,” the researchers suggested. Study participants who met criteria for panic attacks and social anxiety disorder may have experienced nicotine dependence and withdrawal symptoms simply because they knew they were about to attempt to quit.

“The greater increases in cessation fatigue both before and after the quit day suggest that these smokers have reduced coping resources and resilience to deal with the challenge of quitting,” the researchers wrote.

Surprisingly, typical medications like nicotine lozenges and the patch also had no apparent benefit for patients who had anxiety. Tobacco abstinence rates six months after the quit date were poor for each treatment group: 27.8%, placebo; 24.8%, lozenge; 32.6%, patch; 25.7%, buproprion and lozenge; 34.5%, patch and lozenge.

It is unclear exactly why pharmacologic interventions were ineffective, but the researchers suggested that patients with anxiety might benefit more from intensive counseling approaches.

“These findings have considerable clinical relevance,” they wrote. “This work suggests that clinicians and researchers should assess anxiety disorder status if they wish to predict patients' withdrawal and likelihood of achieving abstinence.”

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