Prospective examination of effects of smoking abstinence on cortisol and withdrawal symptoms as predictors of early smoking relapse

Mustafa N al'Absi, Dorothy K Hatsukami, Gary L Davis, Lorentz E. Wittmers

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170 Scopus citations


This study addressed the hypothesis that exaggerated mood and cortisol changes during the first 24h of smoking abstinence are associated with early relapse. Salivary cortisol levels and mood reports were measured during 24-h ad libitum smoking and the first 24-h abstinence period of a quit attempt. Seventy-two habitual smokers (34 women and 38 men) who were interested in smoking cessation participated. Cotinine concentrations in saliva and expired carbon monoxide were measured before and after abstinence and 1 week after the quit date to verify smoking status. Abstinence produced significant withdrawal symptoms in all participants and reduced cotinine and carbon monoxide levels. While participants showed the expected diurnal changes in cortisol levels, those who relapsed within the first week post quitting exhibited a greater drop in morning cortisol concentrations during abstinence relative to their ad libitum smoking levels. Participants who relapsed reported greater withdrawal symptoms, craving for cigarettes, and distress, and they also reported greater reduction in positive affect during the first 24-h period of abstinence than those who maintained abstinence. These results support the hypothesis that early relapse is associated with exaggerated mood and adrenocortical perturbations observed during the first day of abstinence.

Original languageEnglish (US)
Pages (from-to)267-278
Number of pages12
JournalDrug and alcohol dependence
Issue number3
StatePublished - Mar 8 2004

Bibliographical note

Funding Information:
We thank Deanna Ellestad, Angie Harju, Laurie Franks, Huong Timp, Jonathan Erickson, and Andrew Cumings for assistance with data collection and management. We thank Clemens Kirschbaum of the University of Düsseldorf, Germany, for assistance with the cortisol and cotinine assays. This research was supported in part by grants to Dr. al’Absi from the National Cancer Institute (CA 88272). Dr. al’Absi was also supported by grants from the National Institute on Drug Abuse (DA013435). Dr. Hatsukami was supported by the TTURC Grant DA013333.


  • Cortisol
  • Gender
  • Mood
  • Nicotine
  • Relapse
  • Treatment
  • Withdrawal symptoms


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