The nicotine withdrawal syndrome is listed in the DSM-IV as a psychiatric disorder (American Psychiatric Association, 1994). While the course of most symptoms of nicotine withdrawal is presumed to be short and transient (American Psychiatric Association, 1994; Hughes, 2007b; Shiffman et al., 2006), even within this time frame for many individuals nicotine abstinence evokes a level of dysphoria commonly associated with clinical impairment (Hughes, 2006). A cycle of chronic nicotine dependence can be established soon after starting to smoke (DiFranza et al., 2007), which can entail numerous attempts to quit smoking (Prochaska et al., 1992), and bouts of nicotine withdrawal associated with chronic relapse to cigarette smoking (Hughes, 2007a; Piasecki et al., 1998; Shiffman et al., 1997). There is evidence of nicotine withdrawal symptoms in both adult (Hughes, 1992) and adolescent samples of self-quitters (Prokhorov et al., 2001), and in controlled experimental studies of nicotine abstinence in adults (Gilbert et al., 1998; Gilbert et al., 2002) and adolescents (Killen et al., 2001). In clinic samples of adults seeking to quit smoking, nicotine withdrawal symptoms have been associated with relapse to smoking (Hughes, 2007a; Piasecki et al., 1998; Shiffman et al., 1997; Shiffman et al., 1976).
