Meta-Analysis Of Studies Investigation Of The Effect Of Smoking Cessation On Impatience

Background: Smoking cessation increases several symptoms, some of which appear to be due to nicotine withdrawal. One possible feature of withdrawal is impulsivity. Impulsivity is not currently included as a symptom of nicotine withdrawal neither in the Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) nor in withdrawal scales. However, a related term, “impatience” is listed in some nicotine withdrawal scales. (Hughes J. R., Measurements of the Effects of Abstinence from Tobacco: A Qualitative Review, 2007). Although impatience is not a synonym of impulsivity, both share the synonym “impetuous”. Therefore, impatience can be considered a measure of impulsivity. Although some reviews of the effect of smoking cessation on impatience have occurred, we know of no quantitative review of prospective studies of whether smoking cessation increases impatience. Purpose: To evaluate the effect of smoking cessation on impatience as measured by the Minnesota Nicotine Withdrawal Scale-Revised (MNWS). Methods: A literature search of MEDLINE (PubMED), EMBASE, and PsychInfo was conducted. Articles containing relevant keywords were reviewed by two evaluators independently. To be considered for inclusion in the meta-analysis, studies had to be prospective studies, had to have pre-cessation impatience measurements, to include at least overnight abstinence, had to have smoking abstinence biochemically verified, and had to include effect size as an outcome measure. Results: All pooled analyses were based on random-effects models. Seven trials met the selection criteria. The total number of subjects was 426. There was a significant level of heterogeneity among studies (χ = 55.71 (6), p<0.0001) and (I = 89%). The summary mean effect for impatience after tobacco cessation was an increase of .44 on a 0-3 scale (95% confidence interval [CI], 0.21-0.67) and a p-value<0.0001. Conclusion: The meta-analysis shows that impulsivity increases post smoking cessation. These findings imply that smoking cessation may have an effect on decision making. Additionally higher rates of impulsivity have been associated with smoking relapse. (Doran, Spring, McChargue, Peradia, & Richmond, 2004). In order to better assist in the development of individual treatments, a better understanding is needed of how increased impulsivity influences cognitive behavior and relapse rates. These findings support the inclusion of impulsivity as a criterion for nicotine withdrawal.