Cigarette smoking and mental illness: a study of nicotine withdrawal

Am J Public Health. 2014 Feb;104(2):e127-33. doi: 10.2105/AJPH.2013.301502. Epub 2013 Dec 12.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Humans
  • Male
  • Mental Disorders / epidemiology*
  • Nicotine / adverse effects*
  • Patient Acuity
  • Prevalence
  • Smoking / epidemiology*
  • Smoking Cessation / statistics & numerical data
  • Socioeconomic Factors
  • Substance Withdrawal Syndrome / epidemiology*


  • Nicotine