Tobacco Withdrawal

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  • on September 20, 2021
Tobacco Withdrawal

Table of Contents

Overview

The cessation of tobacco use following a period of prolonged use commonly leads to the manifestation of aversive symptoms brought about by abstinence, also known as withdrawal. Abstinence syndromes are often seen as substance use disorders. The mainstay of withdrawal symptoms includes craving; in the case of tobacco withdrawal, this is exemplified by a nicotine craving.

Additional symptoms are mood-related, cognitive, and also physiological. The clinical significance of tobacco withdrawal is attributable to the fact that it can cause significant distress, and increase the likelihood of relapse. Recent literature in neuroscience has hypothesized the development of major behavioral and neurochemical alterations following the withdrawal of chronic cigarette/e-cigarette exposure. 

Withdrawal symptoms are experienced by about half of the quitting population, with prior degree of dependence and history playing important parts in determining the severity of the withdrawal symptoms. Age, sex, and comorbid disorders have also been outlined as potential correlates of withdrawal. 

Nicotine-replacement therapies are often the most sought-after treatment for withdrawal. 

Signs and Symptoms 

Cessation of tobacco use after prolonged usage leads to the manifestation of withdrawal symptoms. The common pattern of possible withdrawal symptoms observed across substance use disorders include: 

  • Craving nicotine 
  • Irritability, anxiety, impatience, restlessness
  • Flu-like symptoms 
  • Dreaming/Nightmares
  • Difficulty in concentrating 
  • Decreased heart rate
  • Increased appetite
  • Weight gain 
  • Dysphoria 
  • Insomnia 
  • Craving sweet foods

Symptoms of withdrawal can often lead to a relapse, and re-use of tobacco. 

Risk Factors

Tobacco withdrawal is said to affect 50% of the individuals who make an attempt to quit tobacco use, often self-quitters. Dependence level has been implicated as one of the factors that is directly proportionate to the severity of withdrawal symptoms. Age and negative affect have also been identified as correlates of severe withdrawal.

Adolescents seem to feel exacerbated effects of withdrawal. A study identified variable symptoms in subjects who were women, with a peak and decline in symptoms early on during abstinence, in heavy smokers, and those who had a history of depression.

The presence of comorbid disorders such as major depression, anxiety disorders, attention-deficit/hyperactivity disorder, and other underlying substance disorder can also impact withdrawal severity. The potential onset of withdrawal symptoms upon cessation of use is also determined by genetic components, with heritability contributing to 50-75% of the risk of dependence.

Diagnosis

Withdrawal symptoms can usually be experienced within 24 hours of the last incidence of tobacco use, and is said to last for between 14-21 days. The severity of the symptoms are highest 2-3 days after cessation of use. It is uncommon for symptoms to be present for a month or more. 

The DSM-5 outlines the following diagnostic criteria:

  • Daily use of tobacco for at least several weeks 
  • Abrupt cessation of tobacco use, or reduction in the amount of tobacco used, followed within 24 hours by four or more of the following signs or symptoms: 
  1. Irritability, frustration, or anger
  2. Anxiety
  3. Difficulty concentrating
  4. Increased appetite
  5. Restlessness
  6. Depressed mood
  7. Insomnia 

The ICD-10 also mentions weakness, dysphoric moods, increased cough, and mouth ulceration as possible signs pointing to a nicotine withdrawal state. 

The signs and symptoms are the cause of clinically significant distress or functional impairment. They are also not attributable to other medical conditions, or other mental disorders, including other substance use. 

The distress felt due to withdrawal often acts as a hurdle preventing individuals from stopping or controlling their tobacco use. 

Treatment

Individuals experiencing withdrawal symptoms may use nicotine-replacement therapies such as nicotine patches, nicotine lozenges or gum, nasal sprays and inhalers. In order to avoid resorting to tobacco use. Breathing exercises and over-the-counter pain medication can help with symptoms such as headaches. Additional pharmacotherapy includes bupropion and varenicline. 

Individuals benefit from psychosocial measures such as support groups, web-based intervention programs, phone counselling, and more.

Specialist

Individuals experiencing withdrawal symptoms are likely to approach their primary healthcare providers in order to receive some temporary relief from the symptoms. Depending on the severity of withdrawal, general practitioners can take necessary measures and advice with regards to symptom management.ย 

Comorbidity

The symptoms of tobacco withdrawal overlap with those of other substance withdrawal syndromes like alcohol withdrawal; sedative, hypnotic, or anxiolytic withdrawal; stimulant withdrawal; caffeine withdrawal; opioid withdrawal, caffeine intoxication; anxiety, depressive, bipolar, and sleep disorders and medication-induced akathisia.

In conclusion

The habit is challenging to break. Detoxing from nicotine is a very serious process. This explains why smokers make so many unsuccessful attempts to stop before they succeed.

Your heart and blood arteries, as well as your hormones, metabolism, and brain, are all impacted by nicotine. You experience withdrawal when you stop having it. If you can’t get your nicotine fixed, you’ll actually desire it and get cranky.

It is advisable to consult a professional counselor if you are not able to quit Tobacco on your own.

Get in touch with our experts for a session today.

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Table of Contents

Frequently Asked Questions

Tobacco withdrawal refers to the onset of aversive symptoms shortly after discontinuing the use of tobacco.ย 

Withdrawal, in addition to leading to significant distress, can also increase the risk of relapse within individuals.

The abrupt cessation of tobacco use after a period of prolonged use can result in the manifestation of several aversive symptoms. This is known as withdrawal.

Withdrawal is extremely common, and affects at least half of those who make an attempt to quit smoking.

Most people who successfully quit smoking have tried and failed multiple times prior to eventually succeeding. You can try joining support groups, government-aided cessation programs, web-based programs, quitlines or engaging in telephone counselling.ย 

Withdrawal symptoms usually last between 2-3 weeks from the last incidence of tobacco use. It is uncommon for withdrawal symptoms to last for a month or more.

Smoking sometimes suppresses appetite. Nicotine can also speed up metabolism. Due to these factors, there is often weight gain after quitting smoking.

Smokerโ€™s leg is peripheral artery disease that can develop due to smoking. Due to the narrowing of the blood vessels, blood flow to the leg is decreased. This causes pain in the legs while walking.

Experiencing withdrawal symptoms can be dependent on many factors, such as how much you smoked, genetic factors, and more. Some people may experience withdrawal more severely than others.ย 

The degree of dependence often determines the severity of withdrawal symptoms. The greater the dependence, the higher the likelihood of severe withdrawal.

Withdrawal has common symptoms that can be recognized after quitting tobacco use. Hence, people can usually recognize when they are experiencing it.

You are likely to feel the effect of withdrawal whenever you completely stop using tobacco. While those who abruptly quit smoking tend to more severely feel the effect of withdrawal, so it may help to reduce tobacco usage up until your set quit date.

  1. Triggers can be largely individualistic, and are usually the things one may commonly associate with the act of smoking. For e.g. many individuals may associate cigarettes and alcohol together, and so it is advisable to avoid drinking while attempting to quit smoking. It is very important to stay away from triggers to the best of oneโ€™s abilities.ย 

Medications such as bupropion and varenicline are often prescribed to help quit smoking. Non-prescription nicotine-replacement therapies include nicotine lozenges, patches, and gum.

Most of the dangers associated with smoking are due to the several toxic chemicals from cigarette smoke, and not from nicotine. Owing to this, nicotine replacement therapies are much safer than smoking.

You usually do not need a prescription for lozenges, patches or gum, but it is generally a good idea to consult with your primary healthcare provider before using them. Nasal sprays and inhalers may require a prescription.

Your primary healthcare provider will be able to prescribe medication such as bupropion or varenicline if they deem it necessary.ย 

  1. Smith, A. E., Cavallo, D. A., McFetridge, A., Liss, T., & Krishnan-Sarin, S. (2008). Preliminary examination of tobacco withdrawal in adolescent smokers during smoking cessation treatment. Nicotine & Tobacco Research, 10(7), 1253-1259.
  2. Piasecki, T. M., Jorenby, D. E., Smith, S. S., Fiore, M. C., & Baker, T. B. (2003). Smoking withdrawal dynamics: III. Correlates of withdrawal heterogeneity. Experimental and Clinical Psychopharmacology, 11(4), 276.
  3. Soyster, P., Anzai, N. E., Fromont, S. C., & Prochaska, J. J. (2016). Correlates of nicotine withdrawal severity in smokers during a smoke-free psychiatric hospitalization. Preventive medicine, 92, 176-182.
  4. Ponzoni, L., Braida, D., Carboni, L., Moretti, M., Viani, P., Clementi, F., … & Sala, M. (2020). Persistent cognitive and affective alterations at late withdrawal stages after long-term intermittent exposure to tobacco smoke or electronic cigarette vapour: Behavioural changes and their neurochemical correlates. Pharmacological Research, 158, 104941.
  5. Shiffman, S. M. (1979). The tobacco withdrawal syndrome. Cigarette smoking as a dependence process, 23, 158-184.
  6. Hughes, J. R., Gust, S. W., Skoog, K., Keenan, R. M., & Fenwick, J. W. (1991). Symptoms of tobacco withdrawal: a replication and extension. Archives of general psychiatry, 48(1), 52-59.
  7. Hughes, J. R. (2006). Clinical significance of tobacco withdrawal. Nicotine & Tobacco Research, 8(2), 153-156.
  8. McLaughlin, I., Dani, J. A., & De Biasi, M. (2015). Nicotine withdrawal. Current topics in behavioral neurosciences, 24, 99โ€“123. https://doi.org/10.1007/978-3-319-13482-6_4
  9. Centers for Disease Control and Prevention. (2020, October 28). Quit smoking medicines are much safer than smoking | Quit Smoking | Tips from Former Smokers | CDC. cdc.gov. https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/quit-smoking-medications/3-reasons-to-use-medicines-when-you-quit/quit-medicines-are-safer-than-smoking/index.html
  10. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5ยฎ). American Psychiatric Pub.
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