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Am Fam Physician. 1998;57(10):2529-2530

Controversy exists regarding anxiety levels in patients who stop smoking. Some studies have demonstrated that patients experience an increased level of anxiety when attempting to stop smoking, while others suggest a decrease in the level of anxiety. Most of these trials have not featured complete abstinence from smoking during the studies. It is possible that the increase in anxiety levels is more closely related to the failure of complete cessation than to withdrawal from smoking. West and Hajek studied the impact of complete cessation of smoking on levels of anxiety.

Study subjects were recruited from family physician offices and from the general public. To be eligible for inclusion in the study, patients had to have smoked at least 15 cigarettes per day for at least five years. Strict criteria for lapse-free abstinence was established, with patient reporting and saliva sampling to ensure compliance. Anxiety levels were evaluated by the State-Trait Anxiety Inventory—State Form X at one and two weeks before the stop date, then again at 24 hours and one, two, three and four weeks after the stop date.

Seventy of 101 patients who entered the study completely abstained during the four-week study, as established by report and saliva sampling. Members of this group had no increase in anxiety levels following smoking cessation and had a decrease in anxiety levels after the first week.

The authors conclude that smoking may cause chronic anxiety and that smoking cessation may reduce anxiety levels in these persons. This finding may be used when counseling patients who voice concern about the impact of tobacco abstinence on their anxiety levels.

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