Nicotine Withdrawal

What is nicotine withdrawal?

Nicotine withdrawal is a real and recognized psychiatric disorder, listed in both the DSM-5 (American Psychiatric Association Diagnostic and Statistical Manual) and the WHO International Classification of Diseases, respectively.

It is generally considered to be a temporary disorder, lasting from several days to several weeks, although for some former nicotine users, withdrawal symptoms can linger for months or years. How severe the symptoms are and how long they last are dependent on a number of factors which are discussed below.

Nicotine withdrawal is surmountable. Some can endure it without formal treatment, whereas others require treatment or combinations of treatments to succeed. Anyone planning to withdraw from nicotine should have a conversation about it with their doctor. Based on a patient’s medical and psychiatric history, a doctor should be able to assess the potential severity of withdrawal and make helpful recommendations.

Nicotine is a drug that’s found naturally in tobacco leaves. It was discovered, and widely used, in South America as far back as 5000 BC. From this early on, nicotine’s stimulating effects on the brain and body were evident, and sought after. The debilitating and deadly side effects of smoking, chewing and inhaling tobacco, sadly, weren’t recognized until much later. In the past century many nicotine product manufacturers have added unnatural amounts of nicotine to their products, making them as addictive as opioids, cocaine and alcohol.

Nicotine withdrawal symptoms

Nicotine withdrawal affects all who quit nicotine, though some more harshly than others. It’s thought to begin within a half hour of smoking a cigarette, and will become increasingly more felt over the next 48-72 hours before it starts to wane. Its symptoms, which range in intensity from uncomfortable to almost intolerable, include many.

Symptoms of nicotine withdrawal include:

  • Intense nicotine cravings that come in waves, lasting several minutes each. These can be quite frequent.
  • Feelings of irritability, impatience, annoyance, moodiness, frustration and tension, resulting from ‘out of whack’ serotonin and dopamine levels.
  • Feelings of anxiety and/or depression, also caused by the brain’s chemicals being ‘off’.
  • Difficulty sleeping, as nicotine affects neurotransmitters that regulate sleep function.
  • Dizziness. The use of nicotine raises blood pressure and heart rate. Stopping nicotine can cause feelings of dizziness.
  • Nausea, stomach pains and constipation. Nicotine stimulates the digestive system. Stopping nicotine will be noticeable to it.
  • Weight gain and feelings of excessive hunger, as nicotine is also an appetite suppressant. Additionally, the act of smoking or chewing tobacco can burn an added 200 calories per day. These can add up.
  • Restlessness and sluggishness are common, probably due to a lack of sleep.
  • Tingling in the extremities that may feel like a panic attack.
  • Mouth ulcers, sweating, headaches and flu-like symptoms are common after stopping nicotine.
  • A cough. Nicotine also stimulates phlegm-production. Quitting nicotine can produce a cough.
  • Vivid dreams and/or nightmares during sleep.
  • Difficulty thinking and concentrating during the day.
  • Difficulty organizing things and/or retaining short term memory; feeling spaced out or ‘out of it’.
  • Looking for ‘replacement activities’ such as constant snacking or a lot of day time naps.

These symptoms will dissipate over time after quitting nicotine. Some will be overcome quickly. With any of the above symptoms, if the intensity or length seem unusually severe or longer lasting than they should, contact your health provider or seek medical attention immediately.

Although it’s rare, some withdrawal issues can be a cause for medical concern or can be confused with a different underlying health issue. This is why it’s highly recommended to quit nicotine under a doctor’s guidance and care.

Nicotine withdrawal causes

There is quite a bit of science involved in understanding the specifics of how nicotine works. The bottom line, for those looking to quit its usage, is that prior to using nicotine, a brain doesn’t require it to function. Here is a brief layman’s description of why.

When a person begins using nicotine, its effects on certain brain chemicals are potent and immediate. Most noticeable is that dopamine and serotonin production are suddenly overtaken by an outside stimulant. At the same time, their natural function is suppressed and nicotine becomes required to produce their effects. Dependency on this ‘rush’ of ‘feel good’ chemicals begins almost instantaneously, and becomes reinforced with time and repetition.

Nicotine withdrawal happens when a person suddenly stops an existing nicotine supply to their brain. Upon doing this, a sudden lack of a stimulating ‘rush’ is felt and craved. This is accompanied by the fact that natural dopamine and serotonin regulation have been thrown, by nicotine, out of whack. The ‘downer’ side of this is felt quite intensely and can affect the way we feel along with many of the body’s daily functions until it’s recovered and returned to its natural chemical state. The upside of quitting nicotine is that it really only takes up to 5 days before it’s out of the system.

Nicotine withdrawal treatment

Many people can withstand nicotine withdrawal without medicinal or other formal treatments. That being said, all people who are giving up nicotine should, at least, let their doctor know. For those who’ve tried quitting several times without success, or for those who have other conditions that may complicate the quitting process – or even those who are determined but simply want that extra boost of assistance – there are withdrawal treatments available.

Not all of these treatments work for everyone. Some work better for some than for others. Fortunately there are lots of options, and combinations of options, to choose from.

Over-the-counter nicotine replacement products

These products aim to help you reduce nicotine intake over a more tolerable, ‘weaning’ time period. The benefit is that they get the cigarettes or chewing tobacco out of your mouth, helping you to overcome ‘the habit’ while physical withdrawal symptoms are reduced or kept at bay.

There are many types and brands of nicotine replacement products. They come in varying levels of quality and with varying histories of success. Do your research before deciding on what to try. Over-the-counter nicotine withdrawal products include lozenges, gum and nicotine patches.

Prescription nicotine withdrawal aids

Similar to the OTC products listed above, there are nicotine sprays and inhalers that can be tried. These are available by prescription only.

Medications

Quit-smoking medications do not all work the same way. Some are intended to reduce cravings while others help treat withdrawal symptoms such as depression or insomnia. There are medications that can make a person get sick from nicotine, making it a deterrent. No medication is a simple answer to quitting nicotine, and some can have harsh or even dangerous side effects.

That being said, if you’re thinking about medication, do your research and speak with a trusted doctor.

Talk therapy, behavioral therapy, hypnosis

Each of these therapies has a place in dealing with the process of quitting nicotine. It is well worth asking a doctor about any or all of these options, as they may be equally helpful in tackling withdrawal along with addressing psychological and behavioral symptoms and complications.

Support

There are online and in-person support and smoking cessation groups in or near almost any locality. If you have trouble finding a group that meets your needs, your doctor may be able to advise you. Your local hospital, health department, community center – even the HR person where you work – can be great resources for this information.

Also, the support and understanding of co-workers, friends and family is important. There are also hotlines you can try – for example 1-800-QUITNOW.

Sheer determination and desire

Many people have to try more than once to quit. The more you try to quit, the more likely you will be to succeed. This is backed up by years of research.

Nicotine withdrawal prevention

The best way to prevent nicotine withdrawal, along with an increased likeliness of developing tobacco-related health problems, is to never smoke, chew or inhale tobacco, or become reliant on using nicotine in any form. Next, we’ll go through the complications and challenges of nicotine withdrawal.

Complications

There are several factors that can complicate nicotine withdrawal. These can include pre-existing mood or anxiety disorders, pre-existing depression or other mental illnesses and addiction(s) to other substances. Nicotine withdrawal can also become complicated when nicotine usage has been excessive and long-lasting. In all of these cases, medical help is strongly advised.

Nicotine can mask some depression and mental issues. Quitting nicotine can quickly make these things apparent, and may require psychotherapy or medicinal treatment. These issues are quite common and can be short-term or long-lasting. They do need to be addressed, though. If you’re taking medications for psychological or other health issues, dosages may need to be adjusted when quitting nicotine.

Though this is still being studied and mapped, it seems that there are also genetic reasons why nicotine is more addictive to some people than it is to others.

Challenges

There is more to quitting tobacco than just dealing with chemical nicotine withdrawal. Most tobacco products, particularly cigarettes, are also habit-forming. Lifestyles are built, or tailored, around them. With this in mind, below are some tips that may help you to deal with some of the behavioral challenges of quitting smoking.

Know what your most habitual ‘smoking triggers’ are – friends or co-workers who smoke, certain social activities, heading out to the porch after a big meal, lounging by the pool, driving a car, talking on the phone. Though these can’t all be avoided, or certainly not for long, most of them can be avoided for a time while going through withdrawal.

Some can be avoided altogether. For the ones that can’t, be aware of them. Write them down. Plan some strategies for dealing with them. Swim instead of lounging at the pool. Walk instead of sitting on the porch after dinner. Let your smoking friends know that you still like them, but won’t be able to hang out with them for a while. Drink water. Suck on mints. Use a speakerphone or headset an walk around while you’re talking. You can be getting household chores done while you chat.

Weight gain is a common complaint of those who are quitting tobacco. Generally, it will cap off at about 20 extra pounds. This might be considered a reasonable trade off. Better yet, increasing physical activity when quitting smoking is helpful on several levels. For starters, you might enjoy the feeling that it’s easier to play sports or take longer walks as an ex-tobacco user. Also, moving around more will prevent some of the excess snacking and, of course, will burn calories as well. Joining a gym or a local sports league can also help you to be in different social situations – ones that you don’t associate with being a ‘smoker’.

Eating well can also help in curbing weight gain. When you feel the need to snack, try cucumber slices in a delicious dressing or dip, try fruit or other veggies. In addition to helping with weight, the added fiber will help your digestive system to readjust more quickly and comfortably.

When strong cravings hit, do some deep breathing, take a cool shower, take a jog or a walk or just get up from your desk to stretch or jump up and down. Get creative. These cravings pass and then resurge. At some point, they’ll resurge with less frequency.

Most importantly, don’t give up and don’t beat yourself up if it doesn’t work right away, or even after several attempts. Those who keep trying to quit nicotine will usually meet with success.