Tobacco Withdrawal

When an individual decides to reduce or quit their tobacco use, especially after consuming for an extended period, they might experience a range of symptoms, which can be classified into various categories. The symptoms can range from physical to psychological, almost all arising due to the body’s dependence on nicotine and its sudden deprivation of it.

Physical symptoms

Physical symptoms of tobacco and nicotine withdrawal include the following: 

• Nicotine cravings: Cravings often manifest as a strong urge to smoke or chew tobacco.
• Coughing: Coughing is how the body tries to clear out the mucus and irritants from the lungs and airways.
• Dizziness: Some people experience dizziness due to the changes in oxygen levels in the body after quitting.
• Increased appetite/weight gain: Because nicotine represses appetite, some individuals may experience weight gain and increased hunger after quitting.
• Insomnia: Individuals may have trouble sleeping, including trouble falling or staying asleep, due to intense cravings.
• Digestive problems: Some may experience constipation or other digestive changes.

Psychological symptoms

Psychological symptoms of tobacco withdrawal can include but are not necessarily limited to the following: 

• Irritability or frustration: Individuals may become more easily angered or upset while experiencing withdrawals.
• Depression: Sadness, thoughts of hopelessness, or numbness may occur. 
• Anxiety: Some people may feel nervous, restless, or tense after quitting.
• Mood swings: Rapid and unpredictable changes in mood may be common.
• Difficulty concentrating: Some individuals may have difficulty focusing on tasks or thinking clearly during withdrawal. 

Behavioral symptoms

Behavioral symptoms of nicotine or tobacco withdrawal include the following: 

• Restlessness: It is common to experience the desire to move or fidget.
• Increased use of other substances: Some might turn to alcohol or other drugs to cope with withdrawal.
• Seeking oral substitutes: A tendency to chew gum, eat more, or engage in other similar behaviors to tobacco use may be used to replace the oral habit of smoking.
• Avoidance of specific situations: Some might avoid situations that could prompt the urge to smoke, such as drinking or being around others who still smoke.

Sensory changes

Sensory changes during withdrawal could include the following: 

• Changes in taste: Food might taste different after quitting.
• Changes in smell: Individuals may experience enhanced or altered sense of smell after ceasing use. 

Recognizing these symptoms can be vital for individuals attempting to quit tobacco. Being prepared for the associated challenges may improve one’s ability to manage symptoms and improve the chances of quitting successfully.

Tobacco withdrawal stems primarily from the body’s reaction to the absence of nicotine, a highly addictive substance present in tobacco. The regular intake of tobacco products establishes a physiological dependence, and when the intake ceases or reduces, withdrawal symptoms may ensue. 

Below are the common causes associated with tobacco withdrawal:

• Nicotine dependence: Regular and prolonged use of tobacco products leads the body to rely on consistent nicotine levels. When these levels drop, withdrawal symptoms can emerge.
• Sudden cessation: Quitting tobacco products abruptly instead of gradually decreasing usage can lead to more intense withdrawal symptoms.

Risk factors

Risk factors for tobacco withdrawal include the following: 

• Duration of use: Individuals who have used tobacco for extended periods are likelier to experience pronounced withdrawal symptoms.
• Frequency of use: Heavy daily smokers or those who consume large amounts of tobacco in short periods face a higher risk of severe withdrawal.
• Method of quitting: Those who quit “cold turkey” without any aids or support might face stronger withdrawal symptoms.
• Genetics: Some studies suggest that genetics can affect how intensely one experiences withdrawal.
• Mental health conditions: People with anxiety, depression, or other mental health disorders might experience exacerbated withdrawal symptoms or find them more challenging to manage. 
• Previous quit attempts: Individuals who have tried to quit multiple times without success might struggle with subsequent attempts due to psychological barriers.

Awareness of these causes and risk factors may help individuals anticipate the challenges of quitting and seek appropriate support, strategies, or treatments.

Often, the primary goal of treatment for tobacco withdrawal is to alleviate the symptoms while supporting individuals in their journey to quit tobacco permanently. Common treatments aim to reduce cravings, manage withdrawal symptoms, and address the behavioral aspects of tobacco addiction. 

Medication

Medications may sometimes be used to support people quitting nicotine products, including the following: 

• Nicotine replacement therapy (NRT): NRT may include patches, gums, lozenges, nasal sprays, and inhalers that deliver nicotine without tobacco’s harmful effects. They aim to reduce cravings and ease withdrawal symptoms.
• Antidepressants: Some SSRI medications may reduce cravings and withdrawal symptoms. 
• Certain prescription medications: A class of medications called nicotinic agonists work by affecting the nicotine receptors in the brain, reducing cravings and withdrawal symptoms.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Other treatment options

Other treatment options for nicotine or tobacco withdrawal can include the following: 

• Acupuncture: Some people have found relief from cravings and withdrawal symptoms through acupuncture, though its use in tobacco cessation is still under study. 
• Hypnosis: While evidence is mixed, some individuals claim to have benefited from hypnosis sessions aimed at reducing their desire to smoke.

Self-care

Self-care can be part of distracting yourself from cravings and improving daily mental health. The following strategies may be valuable to start: 

• Regular exercise: Engaging in physical activity may alleviate withdrawal symptoms and reduce cravings. 
• Healthy diet: Eating balanced meals may help individuals maintain energy levels and reduce the increased appetite some experience during withdrawal. 
• Staying hydrated: Drinking enough water may flush out nicotine and other toxins from the body. 
• Avoiding smoking risks: Staying away from situations or environments that prompt the urge to smoke can be beneficial during the early stages of quitting.
• Support groups: Engaging with others on the same journey may provide mutual encouragement and practical tips, whether online via social media or in person.
• Relaxation techniques: Incorporating deep breathing exercises, progressive muscle relaxation, and meditation into your routine may assist in managing the stress and anxiety that often accompany withdrawal. 

A multi-faceted approach combining personal strategies and professional guidance may significantly enhance the likelihood of overcoming tobacco withdrawal and successfully quitting.

Therapy can be an essential tool for those struggling with tobacco withdrawal. A professional therapist⁴ can offer guidance, coping strategies, and emotional support throughout the quitting journey. Online therapy allows for tailored support that can be instrumental in the quitting process. Further resources include:

• Smokefree.gov: This government resource offers tools, tips, and support to help individuals quit smoking. The site provides a step-by-step guide, mobile apps, and a helpline for tailored assistance.
• American Lung Association: This organization is dedicated to lung health. They offer resources for smokers looking to quit, including advice, personal support, and information about the latest research.
• Nicotine Anonymous: Nicotine Anonymous follows a 12-step program similar to Alcoholics Anonymous. It provides a community for those wanting to quit nicotine, offering shared experiences and mutual encouragement.

Navigating tobacco withdrawal can be challenging, but success is often attainable with resources and support. Using therapy and the resources above may significantly improve an individual’s journey toward a nicotine-free life.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Tobacco withdrawal can be challenging, and research through agencies like The US Department of Health and Human Services is ongoing to determine methods of increasing success rates when individuals quit smoking.

Rather than only indicating a hidden disorder, tobacco withdrawal symptoms may interact with each other in a dynamic network. A study of participants undergoing nicotine patch therapy and behavioral counseling revealed strong associations between withdrawal symptoms, particularly sleep problems with restlessness and affective symptoms. Restlessness and affective symptoms were central to these interactions. Findings suggest that understanding individual withdrawal symptoms and their interconnection is vital, challenging the traditional perspective of them being indicators of an underlying disorder.

The nicotine metabolite ratio (NMR) is a tool that measures how quickly someone metabolizes nicotine. It can help individuals choose the best smoking cessation treatment, increasing the chances of quitting successfully. Despite significant advances in tobacco control, smoking remains a top preventable cause of death. This research strongly indicates that personalized quit-smoking strategies using NMR can be significantly effective. This approach, tailored to individual genetic and environmental factors, may reduce smoking-related health issues and disparities.

Below are several statistics on tobacco and tobacco withdrawal:

• According to the World Health Organization, tobacco kills more than eight million people yearly, including 1.3 million non-smokers exposed to second-hand smoke.
• The US Department of Health and Human Services cites smoking as the primary cause of both preventable diseases and premature death.
• A statistic published in the Journal of the American Medical Association says 7.5% of smokers who try to quit annually achieve success.
• A study published in The Journal of Positive Psychology showed that with therapy, nearly a third of participants successfully quit smoking for at least six months, and most found the sessions beneficial and attended regularly.