Anxiety diagnoses in smokers seeking cessation treatment: relations with tobacco dependence, withdrawal, outcome and response to treatment.
OBJECTIVE
To understand the relations among anxiety disorders and tobacco dependence, withdrawal symptoms, response to smoking cessation pharmacotherapy and ability to quit smoking.


METHODS
Randomized placebo-controlled clinical trial. Participants received six 10-minute individual counseling sessions and either: placebo, bupropion SR, nicotine patch, nicotine lozenge, bupropion SR + nicotine lozenge or nicotine patch + nicotine lozenge.


METHODS
Two urban research sites.


METHODS
Data were collected from 1504 daily smokers (>9 cigarettes per day) who were motivated to quit smoking and did not report current diagnoses of schizophrenia or psychosis or bupropion use.


METHODS
Participants completed baseline assessments, the Composite International Diagnostic Interview and ecological momentary assessments for 2 weeks.


RESULTS
A structured clinical interview identified participants who ever met criteria for a panic attack (n = 455), social anxiety (n = 199) or generalized anxiety disorder (n = 99), and those who qualified for no anxiety diagnosis (n = 891). Smokers with anxiety disorders reported higher levels of nicotine dependence and pre-quit withdrawal symptoms. Those ever meeting criteria for panic attacks or social anxiety disorder showed greater quit-day negative affect. Smokers ever meeting criteria for anxiety disorders were less likely to be abstinent at 8 weeks and 6 months post-quit and showed no benefit from single-agent or combination-agent pharmacotherapies.


CONCLUSIONS
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. These findings could guide treatment assignment algorithms and treatment development for smokers with anxiety diagnoses.
Piper
Megan E
ME
Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53711, USA. mep@ctri.medicine.wisc.edu
Cook
Jessica W
JW
Schlam
Tanya R
TR
Jorenby
Douglas E
DE
Baker
Timothy B
TB
D000293:Adolescent; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology; D016642:Bupropion / Q000008:administration & dosage; D003376:Counseling; D018765:Dopamine Uptake Inhibitors / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D016015:Logistic Models; D008297:Male; D009538:Nicotine / Q000008:administration & dosage; D018722:Nicotinic Agonists / Q000008:administration & dosage; D012008:Recurrence; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology*; D014029:Tobacco Use Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D016896:Treatment Outcome
D018765:Dopamine Uptake Inhibitors; D018722:Nicotinic Agonists; D016642:Bupropion; D009538:Nicotine