Tolerance and Effectiveness of Forced and Prolonged Smoking Cessation Among French Submariners.

Objectives: This study investigates nicotine withdrawal symptoms and resumption rates of tobacco abuse among French submariners during and after a 7-week mission without using tobacco.

Methods: A prospective study was conducted in 2010 during two missions aboard nuclear-powered ballistic missile submarines. Over a 6-month follow-up, the study subjects completed five standardized questionnaires (Fagerström test, Hospital Anxiety Depression, and the Minnesota Nicotine Withdrawal Scale).

Results: Out of 222 prospective study subjects, 168 were included, 52 of whom were smokers. For 84.9% of the smokers, the Fagerström test score was lower than 2 (no dependency). Additionally, 92% of the smokers did not experience withdrawal symptoms following an abrupt and mandatory cessation of cigarette smoking. Two-thirds of the smokers resumed their addiction within 2 months, 78% of whom did so the first day they had the opportunity.

Conclusions: In the physically and mentally constraining environment of submarines, the behavioral component of cigarette dependency largely dominates over the psychological and physical components of nicotine dependence. This phenomenon occurs because the behavioral component of addiction is the source of smoking resumption and, therefore, must be better addressed to achieve sustained withdrawal.