The stronger the reduction in nicotine craving after smoking the first cigarette in the morning, the more difficult it will be to quit smoking, according to a Yale School of Medicine study in Drug and Alcohol Dependence. In a study of 207 smokers, the researchers found significant reductions in craving, withdrawal and mood after smoking the first cigarette of the day. The greater the craving reduction, the more likely the smoker would relapse, said Benjamin Toll, assistant professor in the Department of Psychiatry and lead author of the study. "This preliminary study provides evidence that there are significant changes in craving, withdrawal, and affect related to smoking the first cigarette of the day, with the largest of these changes observed for craving," Toll said. "Moreover, changes in tobacco craving in response to the first cigarette of the day may be a novel predictor of smoking relapse that should be tested in future studies." Toll said it is known that smokers who light up immediately after waking are more dependent on nicotine and may have more trouble quitting smoking than those who do not. Existing evidence also suggests that individuals who experience less light-headedness in response to the initial cigarette of the morning are generally heavier smokers with a longer smoking history. What has not been studied extensively, he said, and what was examined in this study are changes in craving and mood in response to the first cigarette of the day and examining the relationship of these changes to treatment outcome. The standard measures of dependence include the Fagerström Test for Nicotine Dependence, which asks smokers how soon after they wake up do they smoke; do they find it difficult to refrain from smoking in places where it is forbidden; which cigarette do they most hate to give up; how many cigarettes do they smoke daily; is smoking more frequent earlier in the day after waking; and do they smoke when bedridden with an illness. Other measures include time to first cigarette, carbon monoxide in exhaled air, level of cotinine, a byproduct of nicotine, in the blood, daily cigarette consumption, and number of years smoking. Co-authors include Ty Schepis, Stephanie O'Malley, Sherry McKee, and Suchitra Krishnan-Sarin of Yale. The research was supported by the National Institutes of Health. Drug and Alcohol Dependence: (May 2007)

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