title: Tolerance and Effectiveness of Forced and Prolonged Smoking Cessation Among French Submariners.
abstract: This study investigates nicotine withdrawal symptoms and resumption rates of tobacco abuse among French submariners during and after a 7-week mission without using tobacco.
  
  
  
  A prospective study was conducted in 2010 during two missions aboard nuclear-powered ballistic missile submarines. Over a 6-month follow-up, the study subjects completed five standardized questionnaires (Fagerström test, Hospital Anxiety Depression, and the Minnesota Nicotine Withdrawal Scale).
  
  
  
  Out of 222 prospective study subjects, 168 were included, 52 of whom were smokers. For 84.9% of the smokers, the Fagerström test score was lower than 2 (no dependency). Additionally, 92% of the smokers did not experience withdrawal symptoms following an abrupt and mandatory cessation of cigarette smoking. Two-thirds of the smokers resumed their addiction within 2 months, 78% of whom did so the first day they had the opportunity.
  
  
  
  In the physically and mentally constraining environment of submarines, the behavioral component of cigarette dependency largely dominates over the psychological and physical components of nicotine dependence. This phenomenon occurs because the behavioral component of addiction is the source of smoking resumption and, therefore, must be better addressed to achieve sustained withdrawal.
authors.affiliation: Gap Armed Forces Medical Center, Guillaume Headquarters, BP 05014, Gap Cedex, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Derkenne
authors.affiliation: Pneumonology Department, Desgenettes Military Teaching Hospital, 108 Boulevard Pinel, 69003 Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bylicki
authors.affiliation: Suippes Armed Forces Medical Center, Maunoury Headquarters, 51600 Suippes, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Darléguy
authors.affiliation: Charles de Gaulle Aircraft Carrier, Naval Action Force, 83000 Toulon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Garnier
authors.affiliation: Monitoring Medical Center, Health Branch, Ministry of Health, BP 611, Papeete, Tahiti, French Polynesia.
authors.forename: Patrice
authors.initials: P
authors.lastname: Baert
authors.affiliation: Department of Anesthesiology, Critical Care and Emergencies, Percy Military Teaching Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Lamblin
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005602:France; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D011446:Prospective Studies; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology; D013375:Substance Withdrawal Syndrome / Q000150:complications / Q000523:psychology; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000188:drug therapy / Q000523:psychology