Exploring the nature and relationship of tobacco cigarette craving and withdrawal.

Abstract

The status of craving as a tobacco withdrawal symptom is unclear. Some withdrawal scales include it, whereas others do not. This issue is theoretically and clinically important and affects the predictive validity and interpretation of withdrawal measures. This study investigated abstinence symptoms among individuals (N = 232) undergoing unmedicated withdrawal from tobacco cigarettes during the first week following a target quit day (TQD). Participants were motivated to quit and were given counseling before and after their TQD. Analyses focused on the dynamic patterns of craving and other withdrawal symptoms before and after the TQD: how such patterns were related to smoking, symptom coherence both cross-sectionally and over time as reflected by principal components analyses, and how symptoms related to two latent symptomatic dimensions reflecting susceptibility and severity as estimated with multidimensional hurdle graded response model analyses. Results showed that relative to other symptoms, craving showed the greatest increase after the quit attempt and was more strongly related to withdrawal-relevant criteria such as smoking heaviness and tobacco dependence. However, craving had the lowest associations with the principal component estimated from all withdrawal symptoms, suggesting relatively weak coherence with the rest of the syndrome. Moreover, in contrast to other symptom types, craving strongly reflected smoking heaviness in the postquit period, in that cigarette use accounted for its TQD-contingent increase. Hurdle models showed that craving was a relatively insensitive marker of withdrawal occurrence, but it reflected the intensity of withdrawal if it occurred. Thus, craving is distinct from other withdrawal symptoms but has clinical utility for predicting important outcomes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).