Early life adversity influences stress response association with smoking relapse

Psychopharmacology (Berl). 2017 Nov;234(22):3375-3384. doi: 10.1007/s00213-017-4724-4. Epub 2017 Sep 5.


Rationale: We examined the hypothesis that stress-related blunting of cortisol in smokers is particularly pronounced in those with a history of severe life adversity.

Objectives: The two aims of this study were first to examine hormonal, craving, and withdrawal symptoms during ad libitum smoking and after the first 24 h of abstinence in smokers who experienced high or low levels of adversity. Second, we sought to examine the relationship between adversity and hypothalamic-pituitary-adrenal (HPA) hormones to predict relapse during the first month of a smoking cessation attempt.

Methods: Hormonal and self-report measures were collected from 103 smokers (49 women) during ad libitum smoking and after the first 24 h of abstinence. HPA hormones were measured during baseline rest and in response to acute stress in both conditions. All smokers were interested in smoking cessation, and we prospectively used stress response measures to predict relapse during the first 4 weeks of the smoking cessation attempt.

Results: The results showed that high adversity was associated with higher distress and smoking withdrawal symptoms. High level of early life adversity was associated with elevated HPA activity, which was found in both salivary and plasma cortisol. Enhanced adrenocorticotropic hormone (ACTH) stress response was evident in high-adversity but not in low-adversity relapsers.

Conclusions: This study demonstrated that early life adversity is associated with stress-related HPA responses. The study also demonstrated that, among smokers who experienced a high level of life adversity, heightened ACTH and cortisol responses were linked with increased risk for smoking relapse.

Keywords: HPA; Life adversity; Stress.

MeSH terms

  • Adrenocorticotropic Hormone / blood
  • Adult
  • Chronic Disease
  • Craving / physiology
  • Female
  • Humans
  • Hydrocortisone / blood*
  • Hypothalamo-Hypophyseal System / physiopathology
  • Life Change Events*
  • Pituitary-Adrenal System / physiopathology
  • Prospective Studies
  • Recurrence
  • Smoking / blood
  • Smoking / psychology*
  • Smoking Cessation / psychology*
  • Statistics as Topic
  • Stress, Psychological / complications*
  • Substance Withdrawal Syndrome / blood


  • Adrenocorticotropic Hormone
  • Hydrocortisone