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Reduction in Cortisol After Smoking Cessation Among Users of Nicotine Patches

From the Division of Community Health Sciences (Psychology) (M.U.), St. George’s, University of London, London, United Kingdom; the Department of Epidemiology and Public Health (R.W., A.S., A.M.), University College London, United Kingdom; and the Departments of Psychology (P.E., A.C.) and Human and Health Sciences (F.H.), University of Westminster, London, United Kingdom.

Address correspondence and reprint requests to Michael Ussher, PhD, Division of Community Health Sciences (Psychology), St. George’s, University of London, Cranmer Terrace, London SW17 ORE, U.K. E-mail: mussher{at}sgul.ac.uk

Objective: Cortisol has been shown to decline after stopping smoking and this decline has been associated with smoking relapse and with reports of increased withdrawal severity and distress. We examined whether a decrease in cortisol is evident in smokers trying to quit using nicotine patches and whether cortisol is related to withdrawal symptoms, smoking urges, subjective stress, nicotine dependence, and smoking relapse.

Methods: Among 112 smokers trying to quit using 15-mg patches, salivary cortisol and reports of stress, withdrawal, and urges were measured before quitting smoking and up to 6 weeks of abstinence among abstinent smokers using 15-mg nicotine patches. Thirty participants both remained abstinent and provided cortisol samples at all measurement times.

Results: Relative to preabstinence, there was a significant decline in cortisol after abstinence of 1 day, and after 1, 2, and 6 weeks (p < .05). The decline in cortisol on the first day of abstinence was positively associated with reported cigarette consumption (p < .01) and tended (nonsignificant) to be associated with smoking relapse at 6 weeks (p = .07). A lower absolute level of cortisol, but not the change in cortisol, on the first day of abstinence was significantly associated with increased reports of urges, withdrawal symptoms, and stress (p < .05), independently of reported cigarette consumption.

Conclusions: Smokers using 15-mg nicotine patches are likely to experience a decline in cortisol on stopping smoking. This decline is likely to be greater among heavier smokers and may predict relapse to smoking. Those with lower cortisol after cessation may experience increased withdrawal symptoms, urges to smoke, and subjective stress.

Key Words: cortisol • smoking cessation • nicotine patches • urges to smoke • stress • withdrawal symptoms

Abbreviations: HPA = hypothalamic–pituitary–adrenocortical; NRT = nicotine replacement therapy; FTND = Fagerström Test for Nicotine Dependence; CO = carbon monoxide; PPM = parts per million; RPM = revolutions per minute; °C = degrees centigrade; S-IgA = salivary immunoglobulin-A; nmol/L = nanomole/liter; ACTH = adrenocorticotrophic hormone; SD = standard deviation.

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