Craving y abstinencia de la nicotina en fumadores españoles en un tratamiento para dejar de fumar
DOI:
https://doi.org/10.20882/adicciones.4Palabras clave:
Craving, abstinencia, recaída, España, dejar de fumar.Resumen
El craving y el síndrome de abstinencia de la nicotina (SAN) forman parte del trastorno por consumo del tabaco en el DSM-5. Ambos aparecen tras dejar de fumar o tras una reducción brusca del consumo de tabaco, y están relacionados con los resultados de dejar de fumar a corto y largo plazo. El objetivo del presente estudio fue analizar la relación del craving y del síndrome de abstinencia con dejar de fumar al final del tratamiento y con la recaída a los 3 meses de seguimiento en una muestra de fumadores españoles. La muestra estaba formada por 342 fumadores (37,7% hombres; 62,3% mujeres) que recibieron tratamiento cognitivo-conductual para dejar de fumar. La evaluación del craving y del síndrome de abstinencia se realizó a través de la escala Minnesota Nicotine Withdrawal Scale. Los abstinentes al final del tratamiento, comparados con los no abstinentes, mostraron un síndrome de abstinencia y un craving significativamente menor al finalizar el tratamiento. Además, los abstinentes tenían puntuaciones menores en dependencia de la nicotina antes del tratamiento. Entre los abstinentes, el craving descendió significativamente desde los valores presentados antes de dejar de fumar, mientras que en los participantes que no dejaron de fumar los valores de craving permanecieron en los mismos niveles. La dependencia de la nicotina elevada fue el predictor de fumar al final del tratamiento, mientras que el síndrome de abstinencia de la nicotina elevado fue predictor de la recaída a los 3 meses. Los resultados apoyan el papel robusto del craving y del SAN en dejar de fumar y en la recaída, aunque difieren en sus patrones de cambio a lo largo del tiempo.Citas
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American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th ed., revised text. Washington, D. C.: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th Edition: DSM-5. Washington D. C.: Author.
Baker, T. B., Breslau, N., Covey, L., & Shiffman, S. (2012). DSM criteria for tobacco use disorder and tobacco withdrawal: A critique and proposed revisions for DSM-5. Addiction, 107, 263-275. doi:10.1111/j.1360-0443.2011.03657.x
Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review, 111, 33-51. doi:10.1037/0033-295X.111.1.33
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Becoña, E. (2007). Programa para Dejar de Fumar [Smoking Cessation Program]. Vigo, Spain: Nova Galicia Edicións.
Becoña, E., & Vázquez, F. L. (1998). The Fagerström Test for Nicotine Dependence in a Spanish sample. Psychological Reports, 83, 1455-1458. doi:10.2466/pr0.1998.83.3f.1455
Benowitz, N. L. (2010). Nicotine addiction. The New England Journal of Medicine, 362, 2295-2303. doi:10.1056/NEJMra0809890
Centers for Disease Control and Prevention (2012). Current Cigarette Smoking Among Adults- United States, 2011. Morbidity and Mortality Weekly Report, 61, 889-894.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum.
de Leon, J., Becoña, E., Gurpegui, M., Gonzalez-Pinto, A., & Diaz, F. J. (2002). The association between high nicotine dependence and severe mental illness may be consistent across countries. Journal of Clinical Psychiatry, 63, 812-816.
Etter, J. F., & Hughes, J. R. (2006). A comparison of the psychometric properties of three cigarette withdrawal scales. Addiction, 101, 362-372. doi:10.1111/j.1360-0443.2005.01289.x
Ferguson, J. A., Patten, C. A., Schroeder, D. R., Offord, K. P., Eberman, K. M., & Hurt, R. D. (2003). Predictors of 6-month tobacco abstinence among 1224 cigarette smokers treated for nicotine dependence. Addictive Behaviors, 28, 1203-1218. doi:10.1016/S0306-4603(02)00260-5
Ferguson, S. G., Shiffman, S., & Gwaltney, C. J. (2006). Does reducing withdrawal severity mediate nicotine patch efficacy? A randomized clinical trial. Journal of Consulting and Clinical Psychology, 74, 1153-1161. doi:10.1037/0022-006X.74.6.1153
Gilbert, D. G., McClernon, F. J., Rabinovich, N. E., Plath, L. C., Jensen, R. A., & Melisk, C. J. (1998). Effects of smoking abstinence on mood and craving in men: Influences of negative-affect-related personality traits, habitual nicotine intake and repeated measurements. Personality and Individual Differences, 25, 399-423. doi:10.1016/S0191-8869(98)00003-8
Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerström, K. O. (1991). The Fagerström Test for Nicotine Dependence: A revision of the Fagerström Tolerance Questionnaire. British Journal of Addictions, 86, 1119-1127. doi:10.1111/j.1360-0443.1991.tb01879.x.
Hughes, J. R. (1992). Tobacco withdrawal in self-quitters. Journal of Consulting and Clinical Psychology, 60, 689-697. doi:10.1037/0022-006X.60.5.689
Hughes, J. R. (2007). Effects of abstinence from tobacco: Valid symptoms and time course. Nicotine & Tobacco Research, 9, 315-327. doi:10.1080/14622200701188919
Hughes, J. R., Baker, T., Breslau, N., Covey, L., & Shiffman, S. (2011). Applicability of DSM criteria to nicotine dependence. Addiction, 106, 894-895. doi:10.1111/j.1360-0443.2010.03281.x
Hughes, J. R., & Hatsukami, D. (1998). Errors in using tobacco withdrawal scale. Tobacco Control, 7, 92-93. doi:10.1136/tc.7.1.92a
Hughes, J. R., Higgins, S. T., & Bickel, W. K. (1994). Nicotine withdrawal versus other drug withdrawal syndromes: Similarities and dissimilarities. Addiction, 89, 1461-1470. doi.10.1111/j.1360-0443.1994.tb03744.x
Hughes, J. R., Higgins, S. T., & Hatsukami, D. K. (1990). Effects of abstinence from tobacco: A critical review. In L. T. Kozlowski, H Annis, H. D. Cappell, F. Glase, M. Goodstasdt, Y. Israel (Eds). Research in advances in alcohol and drug problems (Vol.10). New York: Plenum.
Ministerio de Sanidad, Servicios Sociales e Igualdad. (2013). Encuesta Nacional de Salud: ENSE 2011-2012. http://www.msc.es/estadEstudios/estadisticas/encuestaNacional/encuesta2011.htm
Piasecki, T. M., Jorenby, D. E., Smith, S. S., Fiore, M. C., & Baker, T. B. (2003a). Smoking withdrawal dynamics: I. Abstinence distress in lapsers and abstainers. Journal of Abnormal Psychology, 112, 3-13. doi:10.1037/0021-843X.112.1.3
Piasecki, T. M., Jorenby, D. E., Smith, S. S., Fiore, M. C., & Baker, T. B. (2003b). Smoking withdrawal dynamics: II. Improved tests of withdrawal-relapse relations. Journal of Abnormal Psychology, 112, 14-27. doi:10.1037/0021-843X.112.1.14
Robinson, J. D., Lam, C. Y., Carter, B. L., Minnix, J. A., Cui, Y., Versace, F., ... Cinciripini, P. M. (2011). A multimodal approach to assessing the impact of nicotine dependence, nicotine abstinence, and craving on negative affect in smokers. Experimental and Clinical Psychopharmacology, 19, 40-52. doi:10.1037/a0022114
Schlam, T. R., Piper, M. E., Cook, J. W., Fiore, M. C., & Baker, T. B. (2012). Life 1 year after a quit attempt: Real-time reports of quitters and continuing smokers. Annals of Behavioral Medicine, 44, 309-319. doi:10.1007/s12160-012-9399-9
Shiffman, S., Engberg, J. B., Paty, J. A., Perz, W. G., Gnys, M., Kassel, J. D., & Hickcox, M. (1997). A day at a time: Predicting smoking lapse from daily urge. Journal of Abnormal Psychology, 106, 104-116. doi:10.1037/0021-843X.106.1.104
Shiffman, S., West, R. J., & Gilbert, D. G.; SRNT Work Group on the Assessment of Craving and Withdrawal in Clinical Trials (2004). Recommendation for the assessment of tobacco craving and withdrawal in smoking cessation trials. Nicotine & Tobacco Research, 6, 599-614. doi:10.1080/14622200410001734067
Tiffany, S. T., Warthen, M. W., & Goedeker, K. C. (2009). The functional significance of craving in nicotine dependence. In R. A. Bevins, A. R. Caggiula (Eds.), The motivational impact of nicotine and its role in tobacco use (pp.171-197). Nebraska: Springer.
Toll, B. A., O’Malley, S. S., McKee, S. A., Salovey, P., & Krishnan-Sarin, S. (2007). Confirmatory factor analysis of the Minnesota Nicotine Withdrawal Scale. Psychology of Addictive Behaviors, 21, 216-225.
Velicer, W. F., Prochaska, J. O., Rossi, J. S., & Snow, M. G. (1992). Assessing outcome in smoking cessation studies. Psychological Bulletin, 111, 23-41. doi:10.1037//0033-2909.111.1.23
West, R., & Hajek, P. (2004). Evaluation of the Mood and Physical Symptoms Scale (MPSS) to assess cigarette withdrawal. Psychopharmacology, 177, 195-199. doi:10.1007/s00213-004-1923-6
West, R., Hajek, P., Stead, L., & Stapleton, J. (2005). Outcome criteria in smoking cessation trials: Proposal for a common standard. Addiction, 100, 299-303. doi:10.1016/j.addbeh.2011.11.012.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, (4th ed.). Washington, D. C.: American Psychiatric Association.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th ed., revised text. Washington, D. C.: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th Edition: DSM-5. Washington D. C.: Author.
Baker, T. B., Breslau, N., Covey, L., & Shiffman, S. (2012). DSM criteria for tobacco use disorder and tobacco withdrawal: A critique and proposed revisions for DSM-5. Addiction, 107, 263-275. doi:10.1111/j.1360-0443.2011.03657.x
Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review, 111, 33-51. doi:10.1037/0033-295X.111.1.33
Becoña, E. (1994). Evaluación de la conducta de fumar [Assessment of smoking behaviour]. In J. L. Graña (Ed.), Conductas Adictivas: Teoría, evaluación y tratamiento (pp. 403-454). Madrid: Debate.
Becoña, E. (2007). Programa para Dejar de Fumar [Smoking Cessation Program]. Vigo, Spain: Nova Galicia Edicións.
Becoña, E., & Vázquez, F. L. (1998). The Fagerström Test for Nicotine Dependence in a Spanish sample. Psychological Reports, 83, 1455-1458. doi:10.2466/pr0.1998.83.3f.1455
Benowitz, N. L. (2010). Nicotine addiction. The New England Journal of Medicine, 362, 2295-2303. doi:10.1056/NEJMra0809890
Centers for Disease Control and Prevention (2012). Current Cigarette Smoking Among Adults- United States, 2011. Morbidity and Mortality Weekly Report, 61, 889-894.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum.
de Leon, J., Becoña, E., Gurpegui, M., Gonzalez-Pinto, A., & Diaz, F. J. (2002). The association between high nicotine dependence and severe mental illness may be consistent across countries. Journal of Clinical Psychiatry, 63, 812-816.
Etter, J. F., & Hughes, J. R. (2006). A comparison of the psychometric properties of three cigarette withdrawal scales. Addiction, 101, 362-372. doi:10.1111/j.1360-0443.2005.01289.x
Ferguson, J. A., Patten, C. A., Schroeder, D. R., Offord, K. P., Eberman, K. M., & Hurt, R. D. (2003). Predictors of 6-month tobacco abstinence among 1224 cigarette smokers treated for nicotine dependence. Addictive Behaviors, 28, 1203-1218. doi:10.1016/S0306-4603(02)00260-5
Ferguson, S. G., Shiffman, S., & Gwaltney, C. J. (2006). Does reducing withdrawal severity mediate nicotine patch efficacy? A randomized clinical trial. Journal of Consulting and Clinical Psychology, 74, 1153-1161. doi:10.1037/0022-006X.74.6.1153
Gilbert, D. G., McClernon, F. J., Rabinovich, N. E., Plath, L. C., Jensen, R. A., & Melisk, C. J. (1998). Effects of smoking abstinence on mood and craving in men: Influences of negative-affect-related personality traits, habitual nicotine intake and repeated measurements. Personality and Individual Differences, 25, 399-423. doi:10.1016/S0191-8869(98)00003-8
Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerström, K. O. (1991). The Fagerström Test for Nicotine Dependence: A revision of the Fagerström Tolerance Questionnaire. British Journal of Addictions, 86, 1119-1127. doi:10.1111/j.1360-0443.1991.tb01879.x.
Hughes, J. R. (1992). Tobacco withdrawal in self-quitters. Journal of Consulting and Clinical Psychology, 60, 689-697. doi:10.1037/0022-006X.60.5.689
Hughes, J. R. (2007). Effects of abstinence from tobacco: Valid symptoms and time course. Nicotine & Tobacco Research, 9, 315-327. doi:10.1080/14622200701188919
Hughes, J. R., Baker, T., Breslau, N., Covey, L., & Shiffman, S. (2011). Applicability of DSM criteria to nicotine dependence. Addiction, 106, 894-895. doi:10.1111/j.1360-0443.2010.03281.x
Hughes, J. R., & Hatsukami, D. (1998). Errors in using tobacco withdrawal scale. Tobacco Control, 7, 92-93. doi:10.1136/tc.7.1.92a
Hughes, J. R., Higgins, S. T., & Bickel, W. K. (1994). Nicotine withdrawal versus other drug withdrawal syndromes: Similarities and dissimilarities. Addiction, 89, 1461-1470. doi.10.1111/j.1360-0443.1994.tb03744.x
Hughes, J. R., Higgins, S. T., & Hatsukami, D. K. (1990). Effects of abstinence from tobacco: A critical review. In L. T. Kozlowski, H Annis, H. D. Cappell, F. Glase, M. Goodstasdt, Y. Israel (Eds). Research in advances in alcohol and drug problems (Vol.10). New York: Plenum.
Ministerio de Sanidad, Servicios Sociales e Igualdad. (2013). Encuesta Nacional de Salud: ENSE 2011-2012. http://www.msc.es/estadEstudios/estadisticas/encuestaNacional/encuesta2011.htm
Piasecki, T. M., Jorenby, D. E., Smith, S. S., Fiore, M. C., & Baker, T. B. (2003a). Smoking withdrawal dynamics: I. Abstinence distress in lapsers and abstainers. Journal of Abnormal Psychology, 112, 3-13. doi:10.1037/0021-843X.112.1.3
Piasecki, T. M., Jorenby, D. E., Smith, S. S., Fiore, M. C., & Baker, T. B. (2003b). Smoking withdrawal dynamics: II. Improved tests of withdrawal-relapse relations. Journal of Abnormal Psychology, 112, 14-27. doi:10.1037/0021-843X.112.1.14
Robinson, J. D., Lam, C. Y., Carter, B. L., Minnix, J. A., Cui, Y., Versace, F., ... Cinciripini, P. M. (2011). A multimodal approach to assessing the impact of nicotine dependence, nicotine abstinence, and craving on negative affect in smokers. Experimental and Clinical Psychopharmacology, 19, 40-52. doi:10.1037/a0022114
Schlam, T. R., Piper, M. E., Cook, J. W., Fiore, M. C., & Baker, T. B. (2012). Life 1 year after a quit attempt: Real-time reports of quitters and continuing smokers. Annals of Behavioral Medicine, 44, 309-319. doi:10.1007/s12160-012-9399-9
Shiffman, S., Engberg, J. B., Paty, J. A., Perz, W. G., Gnys, M., Kassel, J. D., & Hickcox, M. (1997). A day at a time: Predicting smoking lapse from daily urge. Journal of Abnormal Psychology, 106, 104-116. doi:10.1037/0021-843X.106.1.104
Shiffman, S., West, R. J., & Gilbert, D. G.; SRNT Work Group on the Assessment of Craving and Withdrawal in Clinical Trials (2004). Recommendation for the assessment of tobacco craving and withdrawal in smoking cessation trials. Nicotine & Tobacco Research, 6, 599-614. doi:10.1080/14622200410001734067
Tiffany, S. T., Warthen, M. W., & Goedeker, K. C. (2009). The functional significance of craving in nicotine dependence. In R. A. Bevins, A. R. Caggiula (Eds.), The motivational impact of nicotine and its role in tobacco use (pp.171-197). Nebraska: Springer.
Toll, B. A., O’Malley, S. S., McKee, S. A., Salovey, P., & Krishnan-Sarin, S. (2007). Confirmatory factor analysis of the Minnesota Nicotine Withdrawal Scale. Psychology of Addictive Behaviors, 21, 216-225.
Velicer, W. F., Prochaska, J. O., Rossi, J. S., & Snow, M. G. (1992). Assessing outcome in smoking cessation studies. Psychological Bulletin, 111, 23-41. doi:10.1037//0033-2909.111.1.23
West, R., & Hajek, P. (2004). Evaluation of the Mood and Physical Symptoms Scale (MPSS) to assess cigarette withdrawal. Psychopharmacology, 177, 195-199. doi:10.1007/s00213-004-1923-6
West, R., Hajek, P., Stead, L., & Stapleton, J. (2005). Outcome criteria in smoking cessation trials: Proposal for a common standard. Addiction, 100, 299-303. doi:10.1016/j.addbeh.2011.11.012.
