What Is Nicotine Withdrawal Syndrome?
Tuesday, March 06, 2007
Jonathan Foulds, MA, MAppSci, PhD
There are a number of symptoms which are commonly reported by people giving up smoking with such consistency that they are referred to as the “Nicotine Withdrawal Syndrome”. We know that they are caused by the absence of the drug, nicotine, because they are relieved by giving the person nicotine in another form (e.g. via nicotine replacement therapy). When a person stops taking nicotine, the amount of the drug in the body drops by half roughly every two hours. This means that it takes about 24 hours for all the nicotine to be gone from the body, and for withdrawal symptoms to reach their peak.
“It was like a bereavement, I’d lost my constant companion for the past 20 years. After about 6 weeks I realised I’d beaten my worst enemy rather than lost a best friend”
The main withdrawal symptoms are irritability, restlessness, depression, anxiety, difficulty concentrating, poor sleep, hunger and craving for tobacco. Professor John Hughes of the University of Vermont has studied this phenomenon extensively. One of his studies examined over 600 people giving up smoking without any help. He found that about half of them reported a significant increase in at least four of these symptoms within two days of quitting, but after 30 days most were finding it much easier and less than one in five were still suffering from an increase in four symptoms.
Clearly every smoker does not experience an increase in all these symptoms when they quit. It is also clear that most withdrawal symptoms return to normal within a month. A couple of months after quitting, most ex-smokers actually feel that their mood is better than while they were smoking (i.e. fewer unpleasant symptoms).
If you are feeling really irritable during the first couple of weeks after quitting and are starting to wonder if it is worth all the hassle (or your family and work colleagues are!), it is important to remember that you are not going to feel like that forever, and that within a few weeks your mood and concentration should be back to normal.
After a few more weeks your mood will probably be better than when you were smoking. It isn't clear why mood should improve to be better than while smoking. Perhaps it is so stressful to be a nicotine addict nowadays that it feels relatively stress-free in the long run to not have to be chasing that next nicotine "fix".
21 Comments:
At Mon Apr 23, 08:45:00 PM 2007,
Anonymous said…
sir,
Iam really happy to see your article.I would like everyone to refer your article so that every individual who smokes will have an idea of how we can quit smoking.i would alo request you to make this article publish in as many ways so that every one will know about it.
Thanking you
At Wed May 02, 10:51:00 PM 2007,
susan said…
I've been thinking that some techniques used in drug and acohol rehab programs would be beneficial to those who are still having trouble quiting. I wonder which ones. Since smoking is so harmful I think going to a rehab center would be worthwhile for some. Or at least quiting while in a new, different environment, and a non-smoking one of course. The longest time I quit was when I was on vacation with non-smokers, it was taboo and my withdrawl sympoms were less, thought about smoking less. Interesting...
At Sat May 19, 06:31:00 PM 2007,
Jonathan Foulds, MA, MAppSci, PhD said…
You are correct that many of the techniques used to recover from other drug addictions can be applied to nicotine. In our clinical service we find that people who have succeeded in beating another addiction (e.g. alcohol using AA) often do well at quitting smoking because they have a very good understanding of the key principles of recovery from addiction (including the importance of complete abstinence).
The idea of going to "rehab" to quit smoking is not widely accepted, but there are a few residential treatment centers for tobacco addiction around the country (e.g. Mayo Clinic in Rochester MN has one). You are also correct that residential addictions treatment programs should be addressing tobacco in all their patients rather than ignoring it or even facilitating continued smoking. You can read about our experiences working on this aspect in New Jersey at the following link:
http://pubs.niaaa.nih.gov/publications/arh293/toc29-3.htm
At Wed Aug 29, 07:16:00 PM 2007,
jacob said…
But aren't any medications or at least online medications to help you quit smocking? I understand they work by giving you some of the nicotine.
At Thu Aug 30, 11:58:00 AM 2007,
Jonathan Foulds, MA, MAppSci, PhD said…
Dear Jacob,
Yes you are correct than a number of medications are available that help smokers to quit, partly by reducing their nicotine withdrawal symptoms.
Check out my other posts describing those medicines, including this one on nicotine containing medicines:
http://www.healthline.com/blogs/smoking_cessation/2007/06/which-nicotine-replacement-therapy.html
At Tue Nov 06, 04:58:00 PM 2007,
Anonymous said…
I quit smoking 3 times...each time I was pregnant and had no withdrawl symptoms at all, none. Now I am quitting for good after fifteen years of smoking and my withdrawl symptoms are bad, real bad. Why didn't I experience withdrawl symptoms the first three times, was it psycosymatic?
At Thu Nov 08, 12:59:00 PM 2007,
Jonathan Foulds, MA, MAppSci, PhD said…
Dear anonymous of Nov 6,
Although there is some consistency within individuals, withdrawal severity can vary from time to time, especially over 15 years. Its possible you had already reduced prior to quitting during your pregnancies thus potentially lessening the impact. The lesson for others is that if you manage ti quit without too much difficulty don't interpret that as meaning that you can smoke and quit whenever you feel like it. If you manage to quit, value it and don't throw it away.
At Sat Dec 08, 08:35:00 PM 2007,
Anonymous said…
I am a 56 year old male, heart attack age 53, angioplasty age 54, left lung removed @ age 21. I smoke 1-2 packs of Marlboros a day. How long does it take nicotine to completely clear my system if I quit and use no nicotine replacement products?
Thank you,
Jim Bieleniewicz
At Mon Dec 10, 06:10:00 PM 2007,
Jonathan Foulds, MA, MAppSci, PhD said…
Dear Anonymous (56 year old),
Nicotine has a half life in the human body of around 2 hours. So if you finnished your last cigarette at midnight, lats say as a very heavy smoker with a blood nicotine level of 80 ng/ml (higher than most smokers), 2 hours later it would be 40 ng/ml, then 20, 10, 5, 2, 1, 0. So its all gone in 14 hours (or I say 24 just to be sure as we all metabolize nicotine at a slightly different rate).
But its important to be clear what that means. Some people thimk they've beaten the addiction once all the nicotine has gone. Wrong! In fact its precisely the opposite. Its once all the nicotine has gone that the nicotine receptors in your brain start shouting "feed me, feed me" and its at that point that cravings, bad moods etc start to peak. The mood disturbance can last for 2-4 weeks. Note however, some lucky people (the minority of heavy smokers) find that they arn't troubled too much by cravings and withdrawal symptoms. So if you want to give it a go without any medication support, best of luck.
At Wed Dec 19, 07:41:00 AM 2007,
teri said…
I have tried to quit smoking twice before. Once with the patch and I was so mean I couldn't stand to be in the room with myself. The second time was with wellbutrin and the withdrawl was bad but better than before however after 6 months I started back smoking. I have just started the Chantix (day 6) and have read the articles about side affects. I do get nausia when I take it and have vivid dreams at night. Those are the only side affects so far. I am afraid of what I have read. Can I expect more side effects the longer I am on it? I thought that the Chantix would reduce the severity of the cravings and help with the mood swings from withdrawl. Am I wrong about this? I am not on any other medications and have not had any mental health issues so do I need to worry about that now that I am taking Chantix?
At Thu Dec 20, 03:59:00 PM 2007,
Jonathan Foulds, MA, MAppSci, PhD said…
Terri,
We normally find thatnicotine withdrawal symptoms become less severe over time, such that the 4th week is usually noticeably easier than the first (e.g. less mood distrubance, irritability etc). You are correct that by far the most common effect of Chantix is to reduce the severity of withdrawal symptoms and cravings.
For most people the side effects of Chantix are less after a couple of weeks of use (ie once the body has become used to the high dose). So there is no reason to expect that side-effects will worsen - quite the opposite. I'm advising people starting Chantix to keep in touch with their doctor. i.e. actually see the doctor rather than just calling in for the Rx and arrange another appointment to discuss progress about a week after the target quit date. That way he/she can monitor symptoms and answer your questions. The serious adverse events that have been reported appear to be very rare, and may not be related to Chantix at all. So follow the advice of your doctor and the labelling on the pack. But continue to keep in contact with your family practice. Key thing in all of this is to quit smoking successfully. So make sure you have no tobacco around on your quit day, consider where you can get extra support and keep your mind busy during the first few weeks. Best of luck, and let us know how it goes.
At Tue Jan 01, 03:47:00 PM 2008,
Anonymous said…
I took chantix for 2 weeks and decided July 31, 2007 would be my quit date and I mad that date work!!! I have not smoked since that date. Have gained 21 lbs and that is really bothering me, have decided now to work on the weight. I have das that I still want to smoke really bad but I am not going to ever go back. Have been a smoker for 30 years 1 to 2 packs a day. I don't want to stink and don't want my hands and clothes to stink. Wish me luck!!!
Thanks, Judy in Tennessee
At Thu Jan 03, 07:43:00 PM 2008,
Jonathan Foulds, MA, MAppSci, PhD said…
Anonymous (of Jan 1 08),
Congratulations on achieving over 5 months of tobacco abstinence so far. Thats a great achievement and you are right to decide to never go back to it, nomatter what.
It does also sound about the right time to start to tackle the weight gain. You can probably get some good advice on this from my colleagues on Healthline who are experts on diets and weight loss.
Best of luck.
At Wed Jan 23, 01:53:00 PM 2008,
Anonymous said…
I started taking Chantrix after 10 years of smoking... I unfortunately am one of the few that experienced serious depression and also out of control anxiety attacks. I have never experienced either before. SCARY!!!
I am still working through these problems, but am convinced I can overcome. Could any of these effects be from withdrawal of nicotine?
At Thu Jan 24, 09:17:00 PM 2008,
Jonathan Foulds, MA, MAppSci, PhD said…
Dear anonymous (of Jan 23),
Its possible that those effects could have been related to nicotine withdrawal, it could have been caused by Chantix, or it could have been something else, or a combination of factors. Its hard to say with any confidence. The main thing is get help with the depression and to succeed in quitting smoking.
All the best.
At Fri Feb 22, 07:51:00 AM 2008,
Anonymous said…
I have been smoke free for a month. I have done this with the help of a hyptonist,(I understand and know he just supplied me with the tools to quit). I still am going through the withdrawals altho they are getting better as in the desire to smoke but I seem to ache all over my body at night when I go to bed. It keeps me awake for awhile but then I do go to sleep and usually all night. This does worry me and I am hoping it is my body detoxing. I smoked for 35 years. I have gained 10-15 pounds but I am not really worried about that but was wondering if that could have something to do with the ache and pains of my body changing in so many ways ?
At Wed Feb 27, 07:31:00 PM 2008,
Anonymous said…
Thank you so much for your article. I have only been smoke free for 11 days and thought I was going crazy until I read this. I have gained 5 pounds in 11 days, hungrier than I have ever been, and I am so tired and irritable. Has anyone ever reported an oversensitive mouth? My tongue burns with salty things and acidic things, such as tomatoes...they hurt my mouth?? Also, about 4 days after quitting I got really sick with a head/chest cold, coughing, and rather miserable for about 48 hours only...is this typical?
I'm glad to see that I should look forward to all of these things going away soon before I just cave in and buy a pack.
At Tue Mar 04, 09:58:00 PM 2008,
Jonathan Foulds, MA, MAppSci, PhD said…
Anon. of Feb 27,
I more typically hear of an increase in taste and smell sensations, but not sensitivity of the mouth. Some people develop mouth sores for a while when they quit smoking. Although people are just as susceptible to colds while quitting as they were when smoking, in the longer run its clear that lung function improves and the rate of respiratory infections should decrease after quitting
At Tue Mar 04, 10:17:00 PM 2008,
Jonathan Foulds, MA, MAppSci, PhD said…
Dear Anon of Feb 22,
While weight gain on stopping smoking is common, lasting body-aches and pains is less so. If these continue then its worth discussing with your doctor as these may be caused by something unrelated to quitting smoking.
At Thu Apr 17, 04:02:00 PM 2008,
Anonymous said…
What i am experiencing is too important not to share. I have smoked daily for 40 years, thought i would never be able to quit, but knew i had to. Well i set a date. April 11, 2008. I realize it has only been 7 days, but i really didn't think i could make it 7 hours. But, what i want to say is I found a miracle way to quit. I used the laser system and i have NOT had any cravings or withdrawal systems. I never dreamed it could be this easy. I will go back when necessary to get "zapped" again. no pain,actually very relaxing. This is working for me and who knows it could work for you.
At Tue Jul 08, 11:28:00 AM 2008,
Anonymous said…
I started taking Chantix 6/14/2008. I smoked for the first week, and I quit on the 8th day. I have slipped up a couple of times, and took a couple of drags on a cigarette. I smoked for 32 years, and tried to quit several times using the patch, but started back smoking again. I am haveing terrible withdrawals. I would think that they should be getting better by this point. I am very anxious, and shakey. I feel like i could jump out of my skin most of the time. I don't know how much more of this I can take. When is it going to get better?
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