Expanding the scope of the withdrawal syndrome: Anhedonia as a core nicotine withdrawal symptom.

Abstract

Some evidence suggests that anhedonia is a component of nicotine withdrawal, but additional research is needed to support this conclusion and establish its clinical relevance. Secondary analyses were conducted for a comparative effectiveness smoking cessation clinical trial of combination nicotine replacement therapy, nicotine patches, and varenicline (N = 1,084). Self-reported consummatory anhedonia was assessed at multiple time points pretarget quit day (TQD) and post-TQD, and biochemically confirmed 7-day point-prevalence smoking abstinence was assessed at 4, 12, and 26 weeks post-TQD. Data collection occurred from May 2012 to November 2015. Analyses were conducted using hierarchical linear modeling, logistic regression, and general linear models. Anhedonia demonstrated a prototypical inverted-U pattern from pre- to post-TQD consistent with withdrawal, which was not moderated by medication condition (ps > .83). Greater postquit anhedonia was associated with lower odds of biochemically confirmed abstinence at 4 weeks (odds ratio [OR] = 0.96, 95% confidence interval [CI] = [0.94, 0.98], p < .001), 12 weeks (OR = 0.96, 95% CI = [0.94, 0.99], p = .001), and 26 weeks (OR = 0.95, 95% CI = [0.93, 0.98], p < .001) post-TQD. These effects remained even after controlling for other withdrawal symptoms and individual characteristics. Gold standard smoking pharmacotherapies had comparable statistical effects on anhedonia's trajectory and association with abstinence during treatment. The results replicate and extend previous research supporting anhedonia as a motivationally significant symptom of nicotine withdrawal. The results suggest anhedonia not only conforms to features of a tobacco withdrawal symptom but is associated with difficulty stopping smoking. (PsycInfo Database Record (c) 2025 APA, all rights reserved).