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
- Difficulty in concentrating
- Decreased heart rate
- Increased appetite
- Weight gain
- Craving sweet foods
Symptoms of withdrawal can often lead to a relapse, and re-use of tobacco.
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.
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:
- Irritability, frustration, or anger
- Difficulty concentrating
- Increased appetite
- Depressed mood
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.
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.
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.
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.
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.
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