Characterizing nicotine withdrawal in smokers experiencing homelessness

Objective: The rate of cigarette smoking among persons experiencing homelessness is five times the national prevalence, and these smokers experience difficulty quitting. Nicotine withdrawal may be a barrier to initiating and sustaining successful smoking cessation, but its time course is poorly characterized in this population. We hypothesize that withdrawal symptoms will be elevated and related to treatment outcomes. Methods: This secondary data analysis characterized nicotine withdrawal symptoms, as measured by the Minnesota Nicotine Withdrawal Severity Index, during a quit attempt in treatment-seeking smokers experiencing homelessness who enrolled in a randomized smoking cessation trial. Participants (N = 70) reported MNWS symptoms three times prior to the scheduled quit date and twice weekly for 4 weeks post-quit date. We also examined the relation of pre-quit symptoms to treatment outcomes (quit day smoking status, patch adherence, duration of abstinence, and percent negative CO samples submitted). Results: Endorsement of withdrawal symptoms was highest prior to the quit date and decreased over time with increases at weeks 3 to 4; a sizable percentage (20% to 35%) of participants endorsed symptoms throughout the 4 week post-quit period. Severity for most symptoms was at its lowest 2-3 weeks post-quit date, then increased in weeks 3 and 4. Anticipatory withdrawal was inversely related to nicotine patch adherence (p = .01), but not the abstinence-based treatment outcomes (ps > 0.05). Conclusions: Continued withdrawal symptom endorsement throughout treatment and increases in severity noted 3 to 4 weeks post-quit date suggest possible targets for intervention as part of smoking cessation counseling for smokers experiencing homelessness. Anticipatory withdrawal symptoms (prior to the quit date) were common and predictive of poor adherence to cessation aids.