Nicotine Withdrawal

What is nicotine withdrawal?

Nicotine withdrawal is the collection of physical, mental and emotional symptoms you feel as nicotine leaves your body. When you use tobacco products, your body and brain become used to nicotine. It’s a highly addictive drug. When you cut back or quit using nicotine-containing products, the lack of nicotine in your body can cause uncomfortable symptoms. Some include the urge to smoke again, feeling nauseous, having headaches or being grouchy.

Do all tobacco products contain nicotine?

Yes. Tobacco products including cigarettes, cigars, smokeless tobacco, hookah tobacco and most e-cigarettes contain nicotine.

When do nicotine withdrawal symptoms begin?

Nicotine withdrawal symptoms typically begin a few hours after your last dose of nicotine. They peak, or are most intense, on day two or three after going nicotine-free.

How long do nicotine withdrawal symptoms last?

Nicotine withdrawal symptoms can last a few days up to several weeks. Your symptoms will get a little better every day, especially after the third day following stopping.

What are the most common nicotine withdrawal symptoms?

Nicotine withdrawal symptoms vary from person to person. How severe your symptoms are depends on how frequently you use a nicotine product and the amount of nicotine in the product you use.

Common symptoms include:

• Urges or cravings for nicotine. This is the most common symptom.
• Headaches.
• Nausea.
• Dizziness.
• Feeling anxious, jumpy, irritable, grouchy or angry.
• Feeling frustrated, sad or depressed.
• Trouble sleeping.
• Trouble concentrating.
• Feeling tired, restless or bored.
• Increased appetite, gaining weight.
• Constipation and gas or diarrhea.
• Cough, dry mouth, sore throat and nasal drip.
• Chest tightness.

What causes nicotine withdrawal symptoms?

Nicotine binds to certain receptors in your brain. It causes your brain to release a chemical called dopamine. Dopamine is a “feel good” neurohormone. As long as you continue to use nicotine-containing products, dopamine continues to be released. When you don’t smoke or use nicotine-containing products, your brain’s receptors are no longer stimulated by nicotine. Less dopamine is released and your pleasure center — your mood and behavior — begin to be affected, causing some of your withdrawal symptoms.

Nicotine also changes the balance of other chemical messengers in your brain. Stopping the use of nicotine disrupts the chemical balance, causing some of the physical and other withdrawal symptoms.

What treatments can help me quit tobacco products and reduce nicotine withdrawal symptoms?

When you’re ready to quit smoking, your healthcare provider is ready to discuss medications that can help. Nicotine replacement therapy can help relieve withdrawal symptoms. Replacement therapy contains a small amount of nicotine but none of the cancer-causing chemicals and other chemicals found in tobacco products. This small amount of nicotine curbs your withdrawal symptoms. You’ll feel better and more comfortable, which will make quitting tobacco products easier.

Nicotine replacement therapy is available as:

• Skin patch (Habitrol®, Nicoderm CQ®, Nicotrol®).
• Chewing gum (Nicorelief®, Nicorette®).
• Lozenges (Commit®, Nicorelief®, Nicorette®).
• Nasal spray (Nicotrol®).
• Inhaler (Nicotrol®).

Nicotine replacement therapy is available over-the-counter (patch, gum and lozenge) and by prescription (nasal spray and oral inhaler).

Other medications used to treat withdrawal symptoms include the antidepressant bupropion (Zyban) and varenicline (Chantix). Varenicline is a smoking cessation aid that blocks the pleasant effects of nicotine on the brain.

Nicotine replacement therapy and other medications used to treat withdrawal symptoms only treat your physical dependence to nicotine. To help you cope with the emotional and mental aspects of dependence, you’ll need other help. Ask your healthcare provider about quit programs and other support groups in addition to 1.800.QUIT.NOW (1.800.784.8669). Pairing nicotine replacement therapy or medications with a program that helps change behavior can improve your chance of quitting compared with using only one quit method.

What are some other non-medical ways to manage nicotine withdrawal symptoms?

Other ways to help manage nicotine withdrawal symptoms include:

• Get physical! Find some form of physical activity to keep your body active. It’s a double win for you — quitting nicotine use and getting your body fit at the same time.
• Spend time with friends who don’t smoke. Tell people you are quitting so they can encourage you and provide support.
• Keep your hands busy. Find a favorite fidget toy or stress ball that will keep your hands active.
• Substitute a straw, toothpick or cinnamon stick to replace the physical sensation of having something touching your lips and mouth. Chewing gum can also keep your mouth busy.
• Talk back to your temptations. Write down logical responses to your “tug of war” thoughts that it’s OK to use a nicotine product. You’ll be ready when the thoughts come up the next time.
• Practice deep breathing when you feel the urge to use nicotine. It may help you relax and allow the urge to pass.
• Distract yourself in all ways possible. Sing or talk to a friend (so your mouth is moving). Play with your pet (to feel joy, laugh and keep your hands active). Put together a puzzle (to keep your mind and hands engaged).

Can withdrawal symptoms be prevented?

Unfortunately, everyone who has been a regular user of tobacco products experiences some degree of withdrawal when they quit. Your healthcare provider can recommend over-the-counter or prescription products to ease your withdrawal symptoms. These products, however, mostly target cravings or urges. There are some behavioral strategies you can try to curb other withdrawal symptoms. These include:

• Drink fluid or eat fiber-rich foods to ease constipation.
• Drink fluids to relieve cough.
• Perform deep breathing exercises to ease chest tightness.
• Drink water, chew sugar-free gum or suck on sugar-free candy to ease dry mouth and sore throat.
• Organize your work in advance, take a few breaks to help with concentration issues.
• Get plenty of sleep, take short naps as needed to counter fatigue.
• Change positions slowly to help adjust to dizziness.
• Drink lots of water and eat a low-calorie, healthy snack to fight hunger.
• Don’t drink caffeinated beverages and products (e.g., chocolates) several hours before bedtime, listen to calming music and turn off electronic devices to help you sleep.
• Practice relaxation techniques, take a warm bath or go for a walk to reduce irritability.
• Review other non-medication tips listed in the previous question.

What’s the long-term outcome?

Experiencing nicotine withdrawal is the toughest part of quitting smoking. It may take several tries to quit. You’re not alone. This is very common. But it IS possible to quit. About 62% of adult smokers (55 million adults) who ever smoked have quit (2018 data). Ask your healthcare provider for help. They can provide the smoking cessation aids and counseling you need to quit.

A note from Cleveland Clinic
The nicotine in tobacco products is addictive, which can make trying to quit a hard thing to do. Not only do you have a physical nicotine dependence but you also may have an emotional dependence too. It may be your way to cope with stress or may be simply an embedded ritual, like smoking while drinking a cup of coffee.

Dealing with nicotine withdrawal symptoms is not necessarily easy either. But know that you CAN do this. You can quit. You move closer to quitting with each attempt. Nicotine withdrawal is a short-term experience. The long-term health benefits you’ll gain from quitting will be with you for the rest of your life. Know that your healthcare team is ready to help you.

Is the nicotine in tobacco the only reason why people become addicted to tobacco products?

Nicotine is an addictive chemical. It can be as addictive as other drugs including alcohol and cocaine. Although nicotine is the main addictive substance in tobacco products, it’s not the only one. Acetaldehyde is another chemical that reinforces nicotine dependence. Having chemicals in your body that affect your brain chemistry and cause addiction is only one part of the addiction puzzle. Other factors play a role in why some people become addicted to tobacco. These include:

• Genetics: Your genetic makeup may contribute to your susceptibility to tobacco addiction. It may influence how your brain responds to nicotine.
• Family of smokers: Children of parents who were smokers or who hang out with friends who are smokers are more likely to become smokers or users of nicotine products.
• Abuse of other substances: People who use other illegal drugs and abuse alcohol are more likely to become nicotine users.
• Mental health issues: Research has shown that people who have depression, schizophrenia or other mental health conditions are more likely to become smokers.
• Age: The younger you are when you begin using nicotine, the more likely you are to become addicted to it.
• Nicotine type and amount: The speed and amount of nicotine delivered play a role in addiction. The greater the speed and higher the amount, the greater likelihood of a stronger addiction. For example, cigarettes and cigars deliver nicotine more quickly than chew.
• Habits and rituals: All the habits and rituals associated with nicotine use reinforce addiction. These habits and rituals include such things as smoking after a meal, smoking while drinking coffee, smoking when taking a break, smoking while drinking alcohol, smoking while driving or smoking while socializing.

Is nicotine use really that harmful? What health harms are caused by nicotine use?

Tobacco use is the leading cause of premature death. Tobacco is thought to contain at least 70 cancer-causing chemicals. One out of every three cancer deaths is caused by smoking. Smoking is harmful to almost every organ in your body. Smoking causes lung disease, cardiovascular diseases (heart attacks and strokes), diabetes, rheumatoid arthritis, immune system weakness, erectile dysfunction, age-related macular degeneration and cataracts, impairs fertility and many other health harms. Smoking during pregnancy deprives the baby of oxygen, slows fetal growth, causes withdrawal symptoms in fetuses and learning/behavioral problems in children.

What health benefits happen after quitting tobacco and other nicotine-containing products?

Health benefits and repairs begin to happen almost immediately after quitting.

Health benefits after quitting include:

Minutes after quitting:

• Your heart rate drops.

After 24 hours:

• Blood nicotine level drops to zero.

After several days:

• Blood carbon monoxide level equals someone who doesn’t smoke.

After one to 12 months:

• Coughing and shortness of breath decrease.

After one to two years:

• Heart attack risk drops sharply.

After three to six years:

• Coronary heart disease risk is cut in half.

After five to 10 years:

• Risk of cancers of the mouth, throat and voice box (larynx) decrease by 50%.
• Stroke risk decreases.

After 10 years:

• Risks of cancers of the esophagus, kidney and bladder decrease.

After 10 to 15 years:

• Lung cancer risk drops by 50%.

After 15 years:

• Coronary heart disease drops close to someone who doesn’t smoke.

After 20 years:

• Risks of cancers of the mouth, throat, voice box (larynx) and pancreas drops close to someone who doesn’t smoke.
• Cervical cancer decreased by 50%.