Withdrawal from nicotine; Smoking - nicotine addiction and withdrawal; Smokeless tobacco - nicotine addiction; Cigar smoking; Pipe smoking; Smokeless snuff; Tobacco use; Chewing tobacco
Tobacco and nicotine have a potential for addiction that is similar to alcohol, cocaine, and morphine.
Nicotine withdrawal creates anxiety, irritability, headache, hunger, and a craving for cigarettes or other sources of nicotine. These symptoms occur when a nicotine-dependent person suddenly stops smoking or using tobacco, or cuts back on the number of cigarettes or amount of tobacco products used.
See also: Smoking - tips on how to quit
Tobacco is a plant grown for its leaves, which are smoked, chewed, or sniffed for a variety of effects.
More than 38 million people in the United States have successfully quit smoking. Yet there are still around 50 million Americans who smoke. Most say they would like to quit.
Although the number of cigarette smokers in the United States has dropped in recent years, the number of smokeless tobacco users has steadily risen. Smokeless tobacco products are either placed in the mouth, cheek, or lip and sucked or chewed on, or placed in the nasal passage. Nicotine absorption from smokeless tobacco is similar to smoking tobacco, and addiction is still very strong.
Both smoking and smokeless tobacco use carry many health risks. See: Making the decision to quit tobacco.
Almost all people who try to quit have some form of nicotine withdrawal. Generally, people who smoked the longest or smoked a greater number of cigarettes each day are more likely to have withdrawal symptoms. Withdrawal symptoms are both physical and psychological.
People who are regular smokers tend to have particularly strong cravings. Their withdrawal symptoms get worse at certain times, places, or situations associated with smoking.
Nicotine use can have many different effects on body functions, both positive and negative. Nicotine acts as both a stimulant and depressant on your body. The use of nicotine:
Symptoms of nicotine withdrawal generally start within 2 - 3 hours after the last tobacco use, and will peak about 2 - 3 days later. Symptoms may be severe, depending on how long you smoked and how many cigarettes you smoked each day. Common symptoms include:
A milder form of nicotine withdrawal that involves some or all of these symptoms can occur when a smoker switches from regular to low-nicotine cigarettes or significantly cuts down on the number of cigarettes smoked.
Symptoms of nicotine withdrawal can mimic, disguise, or worsen the symptoms of other psychiatric problems.
There are several strategies for treating nicotine withdrawal.
Nicotine supplements can help. All of them work well, if used properly. See: Nicotine replacement therapy
Nicotine supplements come in several forms:
Nonhabit forming prescription medications may help you quit smoking and keep you from starting again. See: Smoking cessation medications
Such medicines include:
Like any addiction, quitting tobacco is difficult, especially if you are acting alone. If you join a smoking cessation program, you have a much better chance of success. See: Stop smoking support programs
Untreated depression can prevent you from quitting tobacco. A screening test for depression may help ensure proper treatment and increase the odds that you will stay off tobacco products.
People who are trying to quit smoking often become discouraged when they don't succeed at first. Research shows that the more times you try, the more likely you are to succeed -- so don't give up! If you aren't successful the first time you try to quit, look at what worked or didn't work, think of new ways to quit smoking, and try again. Many attempts are often necessary to finally "beat the habit." See: Smoking - tips on how to quit
Nicotine withdrawal is short-lived and symptoms pass in time, usually in less than a week. Withdrawal is the most uncomfortable part of quitting, but the real challenge is beating long-term cravings and staying away from tobacco.
Long-term use of nicotine products, whether smoking or using smokeless tobacco products, carries many risks, including:
Weight gain due to increased eating also may occur. This is much less unhealthy than continuing to smoke. People who have concerns about their weight should address them while quitting, so these concerns do not affect their attempts to stay away from cigarettes.
Nicotine withdrawal may also bring on a relapse of major depression, bipolar disorder, or other substance abuse problems.
See your health care provider if you wish to stop smoking, or have already done so and are experiencing withdrawal symptoms. Your provider can help provide treatments, some of which are only available by prescription.
Benowitz NL. Tobacco. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 30.
Burke MV, Ebbert JO, Hays JT. Treatment of tobacco dependence. Mayo Clin Proc. 2008;83:479-483.
Hays JT, Ebbert JO, Sood A. Treating tobacco dependence in light of the 2008 US Department of Health and Human Services clinical practice guideline. Mayo Clin Proc. 2009;84:730-735.
© 2011 University of Maryland Medical Center (UMMC). All rights reserved.
UMMC is a member of the University of Maryland Medical System,
22 S. Greene Street, Baltimore, MD 21201. TDD: 1-800-735-2258 or 1.866.408.6885