The effect of stopping smoking on perceived stress levels Peter Hajek, Tamara Taylor & Hayden McRobbie Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK ABSTRACT Aims Many smokers believe that smoking helps them to cope with stress, and that stopping smoking would deprive them of an effective stress management tool. Changes in stress levels following long-term smoking cessation are not well mapped.This longitudinal project was designed to provide more robust data on post-cessation changes in perceived stress levels by following a cohort of smokers admitted to hospital after myocardial infarction (MI) or for coronary artery bypass (CAB) surgery, as such patients typically achieve higher continuous abstinence rates than other compa- rable samples. Design A total of 469 smokers hospitalized after MI or CAB surgery and wanting to stop smoking were seen in the hospital and completed 1-year follow-ups. Ratings of helpfulness of smoking in managing stress at baseline, smoking status (validated by salivary cotinine concentration) and ratings of perceived stress at baseline and at 1-year follow-up were collected. Findings Of the patients, 41% (n = 194) maintained abstinence for 1 year. Future abstainers and future smokers did not differ in baseline stress levels or in their perception of coping properties of smoking. However, abstainers recorded a significantly larger decrease in perceived stress than continuing smokers, and the result held when possible confounding factors were controlled for (P < 0.001). Conclusions In highly dependent smokers who report that smoking helps them cope with stress, smoking cessation is associated with lowering of stress. Whatever immediate effects smoking may have on perceived stress, overall it may generate or aggravate negative emotional states. The results provide reassurance to smokers worried that stopping smoking may deprive them of a valuable coping resource. Keywords Nicotine withdrawal, smoking cessation, stress. Correspondence to: Hayden McRobbie, Wolfson Institute of Preventive Medicine, Queen Mary’s School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK. E-mail: h.j.mcrobbie@qmul.ac.uk Submitted 4 August 2009; initial review completed 25 September 2009; final version accepted 22 January 2010 INTRODUCTION Dependent smokers cite stress relief as one of the major reasons for smoking [1]. At the same time, the incidence of high stress levels and low mood is higher in smokers than in non-smokers and ex-smokers [2–8]. The common explanation for this apparent paradox is that smoking can provide a valuable coping and affect regu- lation tool which makes it particularly attractive for individuals prone to stress [9]. The high stress levels among smokers are thus due to self-selection. An alter- native hypothesis suggests that far from helping with stress, smoking can in fact act as a stressor, e.g. via periods of withdrawal discomfort arising during each inter-cigarette interval, or due to some other neurotoxic effects of tobacco use [10]. According to this view, the perception of a calming effect of smoking is a misattrib- uted withdrawal relief [11–13]. Smoking may be pro- viding stress relief acutely, while generating stress across a longer time-period. Laboratory studies of acute effects of smoking after short abstinence cannot easily differentiate ‘genuine’ stress and anxiety relief from alleviation of withdrawal discomfort [14]. There exists some support for both genuine anxiolytic effects of smoking as well as for the withdrawal relief hypothesis. For example, some animal studies and human studies on non-smokers suggest that nicotine can alleviate stressful states acutely [15], but smokers most sensitive to sedative effects of smoking report above-average stress just before lighting up a RESEARCH REPORT doi:10.1111/j.1360-0443.2010.02979.x © 2010 The Authors. Journal compilation © 2010 Society for the Study of Addiction Addiction, 105, 1466–1471