ABSTRACT
Smoking is highly prevalent across most anxiety disorders. Tobacco use increases risk for the later development of certain anxiety disorders, and smokers with anxiety disorders have more severe withdrawal symptoms during smoking cessation than smokers without anxiety disorders. The authors critically examined the relationships among anxiety, anxiety disorders, tobacco use, and nicotine dependence and reviewed the existing empirical literature. Future research is needed to better understand the interrelationships among these variables, including predictors, moderators, and mechanisms of action. Increased knowledge in these areas should inform prevention efforts as well as the development and improvement of smoking cessation programs for those with anxiety and other psychiatric disorders.
Subject(s)
Anxiety Disorders/epidemiology , Nicotine/adverse effects , Smoking/epidemiology , Substance Withdrawal Syndrome/epidemiology , Substance Withdrawal Syndrome/etiology , Tobacco Use Disorder/epidemiology , Anxiety/epidemiology , Anxiety/psychology , Anxiety Disorders/psychology , Humans , Prevalence , Tobacco Use Disorder/psychologyABSTRACT
Epidemiological data suggest that early smoking increases the risk for emergence of certain anxiety disorders (e.g., panic disorder, generalized anxiety disorder (GAD)), and that presence of certain anxiety disorders (e.g., social anxiety) increases the risk for later development of nicotine dependence. Although some studies report a high prevalence of smoking among anxiety disorders, the extent to which smokers with anxiety disorders differ from their nonsmoking counterparts remains uncertain. Differences between smokers and nonsmokers with anxiety disorders (N=527) were examined with respect to multiple measures of theoretical and clinical interest. Compared to nonsmokers, smokers with anxiety disorders reported greater anxiety sensitivity, anxiety symptoms, agoraphobic avoidance, depressed mood, negative affect, stress and life interference; however, these differences were largely accounted for by panic disorder. No differences were found between smokers and nonsmokers regarding social anxiety, worry, obsessive-compulsive symptoms or positive affect. Differential patterns were observed when evaluating constructs within anxiety disorder diagnoses.
Subject(s)
Anxiety Disorders/epidemiology , Anxiety Disorders/psychology , Smoking/epidemiology , Smoking/psychology , Adult , Anxiety Disorders/diagnosis , Demography , Female , Humans , Male , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/epidemiology , Obsessive-Compulsive Disorder/psychology , Panic Disorder/diagnosis , Panic Disorder/epidemiology , Panic Disorder/psychology , Severity of Illness Index , Stress, Psychological/epidemiology , Stress, Psychological/psychology , Surveys and QuestionnairesABSTRACT
This article reviews cigarette smoking in patients with psychiatric disorders (PD) and substance use disorders (SUD). Rates of smoking are approximately 23% in the U.S. population but approximately two- to four-fold higher in patients with PD and SUD. Many remaining smokers have had repeated smoking cessation failures, possibly due to the presence of co-morbid PD and SUDs. There is modest, evidence-based support for effective treatment interventions for nicotine addiction in PD and SUD. Further research is needed to increase our understanding of nicotine addiction in PD and SUD and develop more effective treatment interventions.
Subject(s)
Mental Disorders/epidemiology , Smoking/epidemiology , Substance-Related Disorders/epidemiology , Comorbidity , Diagnosis, Dual (Psychiatry) , Forecasting , Humans , Neurotransmitter Agents , Smoking/genetics , Smoking/therapy , Time Factors , United States/epidemiologyABSTRACT
In a 2 (patch) x 2 (smoking) x 2 (anxiety) mixed design, 52 undergraduate smokers randomly received a nicotine (21 mg) or placebo patch. After a 4-hr nicotine absorption/deprivation period, participants imagined several scenarios varying in cue content: (a) anxiety plus smoking, (b) anxiety, (c) smoking, and (d) neutral. Although smoking urge increased in both the nicotine and placebo conditions after the absorption/deprivation period, those who received the placebo reported significantly greater urge. During the cue reactivity trials, a significant Patch x Smoking x Anxiety interaction effect was observed for urge. However, participants who received nicotine still experienced moderate urges, indicating that nicotine did not attenuate cue-elicited urge. Transdermal nicotine did not diminish anxiety during the absorption/deprivation period or in response to the cues.
