Effects of the nicotine patch on performance during the first week of smoking cessation

Complaints of feeling unfocused and being unable to concentrate are common during smoking cessation, and such feelings may contribute to a subtle erosion of the motivation to quit. A heterogeneous sample of 21 established smokers (10 women, 11 men) completed this double-blind, placebo-controlled study to test the hypothesis that nicotine replacement during cessation therapy (using a 21-mg nicotine patch) would improve performance on tasks sensitive to nicotine deprivation. Participants were trained to stable performance on simple reaction time, mathematical processing, Sternberg memory, rapid visual-information processing, grammatical reasoning, and the Stroop Color-Word (Stroop) tasks. They received smoking cessation counseling and were randomly assigned to nicotine patch and placebo patch groups. Performance was assessed prior to cessation, and early (days 2 and 3) and late (days 5 through 7) in the first cessation week. The hypothesis was not supported. Increased accuracy was associated with the patch only for grammatical reasoning. No reaction time differences were found in the simple reaction time, grammatical reasoning, and mathematical processing tasks. Reaction time was faster in the placebo group on the more difficult portions of those tasks requiring sustained attention (rapid visual-information processing, Stroop Color-Word, and Sternberg memory tasks). These results differ substantially from those obtained when young adults are allowed to smoke or chew nicotine gum after relatively brief periods of deprivation. Evidence that smoking may interfere with cognition is accumulating; these results support this view. The subjective performance decrements noted by many smokers during cessation may be related to overall negative affect, rather than to direct effects on cognition and attention.