Nicotine withdrawal is a group of symptoms that occur in the first few
weeks upon the abrupt discontinuation or decrease in intake of nicotine. Symptoms
include cravings for nicotine, anger/irritability, anxiety, depression,
impatience, trouble sleeping, restlessness, hunger or weight gain, and
difficulty concentrating. A quit smoking program may improve one’s chance for
success in quitting nicotine. Nicotine withdrawal is recognized in both the
American Psychiatric Association Diagnostic and Statistical Manual and
the WHO International Classification of Diseases.
Symptoms The most documented symptoms are
cravings for nicotine, anger/irritability, anxiety, depression,
impatience, trouble sleeping, restlessness, hunger or weight gain, and
difficulty concentrating. Symptoms are usually strongest for the first few days
and then dissipate over 2-4 weeks. Withdrawal symptoms make it harder to
quit nicotine products and most methods for quitting smoking involve reducing
nicotine withdrawal. The most common symptoms are irritability, anxiety and
difficulty concentrating. Depression and insomnia are the least common. Other
withdrawal symptoms may include constipation, cough, dizziness,
drowsiness, impulsivity, fatigue, flu symptoms, mood swings, mouth ulcers, and
increased dreaming. Cessation of nicotine usually increases eating and
weight, decreases memory, decreases the ability to pay attention and concentrate
on tasks, and decreases heart rate. Cessation of tobacco can also require
changes in levels of various medications.
Definition Nicotine withdrawal is the effect that
nicotine-dependent individuals experience after they discontinue or
decrease nicotine use. Nicotine is an addictive substance found most commonly
in tobacco and tobacco products including cigarettes, cigars, chewing
tobacco, pipe tobacco, snus, snuff, and most e-cigarettes. Withdrawal is the
body’s reaction to not having the nicotine it had become accustomed to.
Withdrawal is most common and intense in cigarette smokers, intermediate in
smokeless users, and rare in users of nicotine medications. The symptoms of
nicotine withdrawal usually appear 2-3 hours after last intake of nicotine,
peak in 2-3 days, and last for 2-3 weeks, although they can last longer in
some users. In a minority of smokers, cravings may last for years. Nicotine
withdrawal causes few physical signs and is not life-threatening but can be as
severe as withdrawal from alcohol and illegal drugs. There is some evidence
that stopping nicotine may make a prior psychiatric problem worse but this is
uncertain. After the initial withdrawal period, anxiety, depression, and quality
of life generally improve such that former smokers are better off than
continuing smokers. If smokers regularly do not smoke in certain situations,
entering these situations can precipitate withdrawal symptoms through
a process called conditioned withdrawal. Causes
Various etiological models have been proposed to explain the causes of
nicotine withdrawal. Nicotine binds to nicotinic receptors in the brain that,
in turn, cause an increase in dopamine. Dopamine is the major chemical that
stimulates reward centers in the brain. The brain recruits an opposing force to
dampen the effects of nicotine and this causes tolerance. The onset of this
opposing force and the fact that the brain becomes used to and dependent on
nicotine to function normally is known as physical dependence. When nicotine
intake is decreased, the brain's opposing force is now unopposed and this
causes withdrawal symptoms. It also appears that opiate, serotonergic,
glutamic, cannabinoid, and corticotrophin receptors may play a role
in nicotine withdrawal. Treatment
Gradually reducing nicotine intake causes less withdrawal than abruptly
stopping. Another way to reduce nicotine withdrawal symptoms is to provide the
body with an alternative source of nicotine for a temporary period and then
taper this new nicotine intake. Other medications used for quitting smoking
include bupropion, varenicline, nortriptyline, and clonidine.
Non-medications treatments such as increased exercise also can reduce
nicotine withdrawal. Many behavior changes such as avoiding situations
where one usually smoked, planning ahead to deal with temptations, and seeking
the support of friends and family are effective in helping people quit
smoking, but whether this is due to reduced withdrawal is unclear.
Epidemiology Most daily cigarette smokers have at
least one of the above withdrawal symptoms when they try to stop and half
have four or more. Withdrawal can occur in non-daily users, however heavier
users and those with a past or current psychiatric disorder tend to have more
severe withdrawal. Genetics also influence the severity of withdrawal.
Newborns of smokers do not suffer nicotine withdrawal.
See also Withdrawal
Smoking cessation References