Listening to nicotine: Negative affect and the smoking withdrawal conundrum

In recent years, theoretical models of drug motivation and drug dependence have downplayed the role of withdrawal symptoms in the maintenance of addiction. During this same period, strong links between drug use and measures of negative affect have been uncovered in empirical research. In this article, we examine these trends in the context of research on smoking. Evidence is presented from two recent studies on smoking relapse that highlight the intimate connection between withdrawal symptomatology and negative affect. Specifically, these studies reveal that (a) single-occasion measures of withdrawal symptoms or other markers of physical dependence do not contribute incremental validity in predicting relapse relative to measures of negative affect, the trajectory of withdrawal symptoms is highly idiosyncratic, (c) exacerbations cannot be tightly coupled with pharmacological events, (d) the temporal dynamics of withdrawal reflect fluctuations in negative affect, and (e) differences in the trajectory of withdrawal symptoms index relapse vulnerability. We conclude that a broadened view of withdrawal recognizing its probable affective bases will enhance its explanatory power and suggest new treatment strategies.