title: The developmental sequence of tobacco withdrawal symptoms of wanting, craving and needing.
abstract: OBJECTIVE
  The first case series on tobacco addiction suggested that withdrawal symptoms evolve through a clear developmental sequence both over the clinical course and during an episode of abstinence. The objective of the current study was to determine if this observation would be confirmed by a second case series.
  
  
  METHODS
  The subjects were 25 adolescent and adult smokers. Subjects were provided with operational definitions of the withdrawal symptoms of wanting, craving and needing. Using nondirective techniques, detailed histories of subjects' experiences with these three symptoms during abstinence from tobacco were obtained in individual interviews.
  
  
  RESULTS
  All 25 subjects identified the operational definitions of wanting and craving as symptoms they had experienced, and 21 subjects indicated that the definition of needing described a symptom they had experienced. All 25 subjects reported that wanting was the first symptom they had experienced; 24 of 25 subjects reported that craving was the second symptom experienced; and 20 of the 21 subjects that had experienced needing reported that this was the third symptom they had experienced. All subjects reported that during abstinence symptoms appeared in the order of wanting, craving and needing. Subjects reported that stress-induced urges to smoke are not relieved by smoking, do not follow a characteristic sequence, and do not have a latency.
  
  
  CONCLUSIONS
  Abstinence from tobacco provokes characteristic symptoms of wanting, craving and needing that are widely endorsed by smokers as symptoms they have experienced. These symptoms develop in a set sequence of wanting, craving and needing in all, or nearly all, smokers over their clinical course. These symptoms recur in the same sequence during acute episodes of abstinence. Smokers can distinguish between four symptoms: wanting, craving, needing and stress-induced urges to smoke, but these distinctions are not captured by generic 'craving' measures.
authors: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA 01655, USA. difranzj@ummhc.org
authors: Joseph R
authors: JR
authors: DiFranza
authors: W W Sanouri
authors: WW
authors: Ursprung
authors: Leah
authors: L
authors: Biller
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*; D013315:Stress, Psychological / Q000503:physiopathology; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult