Developmental course(s) of lifetime cigarette use and panic attack comorbidity: an equifinal phenomenon?

Amit et al. (2007) looked at two big national surveys. They wanted to see how smoking and panic attacks grow together over a lifetime.

They did not test any treatment. They only mapped the patterns.

People follow two clear roads. In one road, heavy smoking comes first, then panic attacks show up years later. In the other road, panic attacks start early and smoking follows as a kind of self-medication.

Both roads end at the same place: panic plus nicotine dependence. The authors call this "equifinality" — different starts, same finish.

Tsai et al. (2015) extend the story. Their long study in Taiwan shows that kids who enter puberty early are more likely to be on the "smoking first" road. Early puberty adds speed to that path.

Labrecque et al. (2007) give hope. They show that strong CBT can knock down panic even when it travels with other anxiety. If panic is trimmed, the urge to smoke may drop too.

Furer et al. (2024) look at very light smokers and find that delay discounting does not push craving the usual way. This seems to clash with Amit’s heavy-smoker paths, but the two studies sample different ends of the smoking spectrum — no real contradiction.

You can’t change the past, but you can pick which road a client stays on. Ask new clients when their first panic attack happened and when they started smoking. If panic came first, teach coping skills before you target quitting. If smoking came first, watch for early signs of panic and be ready to refer for CBT. Either way, treat both problems together, not one at a time.