摘要：Objectives. We compared prevalence, severity, and specific symptom profiles for nicotine withdrawal across categories of mental illness. We also examined the influence of nicotine withdrawal on efforts to quit smoking among those with mental illness. Methods. We analyzed data from 2 sources: wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, limiting the sample to current smokers (2001–2002; n = 9913); and a 2-wave cohort telephone survey of a national sample of adult smokers (2004–2006; n = 751). Results. Mental illness was associated with a substantially greater likelihood of nicotine withdrawal syndrome; approximately 44% of nicotine withdrawal syndrome diagnoses were attributable to mental illness. Symptom profiles were highly comparable between mental illness categories, although anxiety-related symptoms were better markers of withdrawal for those with an internalizing disorder. Smokers with mental illness were motivated to quit but were less likely to be successful in their quit attempts, and both dependence and withdrawal independently accounted for this lower likelihood of success. Conclusions. Nicotine withdrawal may be a particularly important target for intervention among those with mental illness who smoke cigarettes. Individuals with mental illness are more likely to smoke cigarettes, are more dependent on nicotine, and have greater difficulty quitting smoking 1,2 than are those without mental illness. The prevalence of mental illness in the United States is approximately 28%; yet, smokers with mental illness consume 40%–50% of cigarettes. 1,2 A self-medication hypothesis has largely driven the conceptualization of this issue 3–8 : smoking is initiated and maintained to reduce psychiatric symptoms, and these symptoms are exacerbated during abstinence. This notion, that smoking can be important for symptom self-management, has likely contributed to smoking disparities between those with and those without mental illness. 3 There are effective means of treating smoking for those with mental illness 9 ; however, nontreatment remains the norm. 10 A growing body of researchers, clinicians, and policymakers has called for a paradigm shift in how we approach this issue. 3,11–13 Smoking is becoming increasingly viewed as a preventable and treatable cause of diminished life quality among those with mental illness, 3,12 rather than a necessary form of self-medication. A 2008 National Institute of Mental Health report noted that the focus on a self-medication hypothesis has come at the expense of research on other important facets of smoking, particularly nicotine withdrawal. 3 Studies have found that cigarette smokers with mental illness may experience more severe nicotine withdrawal symptoms 14,15 ; however, these studies were conducted among small samples with a limited range of diagnoses. Weinberger et al. conducted an investigation using data from a US nationally representative sample of cigarette smokers and found that those with mental illness were more likely to report nicotine withdrawal symptoms and life problems associated with their withdrawal. 16 Weinberger et al. focused on a few particular diagnoses; thus, they did not investigate the overall extent to which nicotine withdrawal is an issue among those with mental illness or comparisons of nicotine withdrawal between mental illness diagnoses. Previous research on this topic has also been limited in that specific nicotine withdrawal symptom profiles have not been compared across mental illness diagnoses. This type of analysis will potentially highlight specific nicotine withdrawal symptom targets for intervention. Finally, it remains unclear whether nicotine withdrawal in itself is associated with lower likelihood of quit success among those with mental illness or whether nicotine withdrawal is simply an extension of greater nicotine dependence among those with mental illness. We conducted 2 studies of nicotine withdrawal, mental illness, and tobacco cessation. In the first, we compared the likelihood of being diagnosed with a nicotine withdrawal syndrome and the severity of nicotine withdrawal symptoms between smokers with and those without mental illness and across mental illness diagnoses. We then estimated the proportions of nicotine withdrawal syndrome in the population of smokers attributable to each mental illness category. We compared nicotine withdrawal symptom profiles between mental illness categories to better understand consistencies and differences in specific nicotine withdrawal symptoms. In the second study, we examined whether smokers with mental illness were more or less motivated to quit smoking and more or less likely to make quit attempts. Among smokers who made a quit attempt, we examined whether those with mental illness were more or less likely to successfully stop using tobacco and how nicotine withdrawal and dependence influenced cessation efforts.
