Nicotine Withdrawal- Symptoms, Side Effects and Timeline

withdrawal

Introduction

Nicotine withdrawal is something that all smokers will experience. Whether it’s when they crave their next cigarette, or a week into quitting cold turkey, nicotine addiction and withdrawal are the reason smokers continue to light up, and the reason why we find it so hard to quit. When it comes to nicotine withdrawal, it takes mental strength to overcome each stage. Although it is the healthiest decision a smoker can ever make, a lot of subtle and unpleasant things will happen to your body as you become nicotine (and smoke) free. Understanding what happens during nicotine withdrawal, and how long it lasts, is a key part of the arsenal you need to quit smoking.

What is Nicotine Withdrawal?

Nicotine is highly addictive. When you take in nicotine in any way, your body will quickly develop an addiction to it, and you will begin to only feel comfortable when you have nicotine in your system. Nicotine withdrawal is what your body experiences as the nicotine levels in your body decrease.

addiction

Symptoms

There are seven main symptoms that everyone will experience throughout nicotine withdrawal: irritability/frustration, anxiety, depressed mood, difficulty concentrating, increased appetite, insomnia, and restlessness [1]. The effects of nicotine withdrawal vary depending on personality type and genetics, how much you smoke, and whether you cut down slowly or quit cold turkey. Most of the symptoms of nicotine withdrawal will peak and begin to improve after 3-5 days, and may take 2-3 weeks to reach manageable levels. Symptoms of nicotine withdrawal can be grouped into three categories: physical, emotional and behavioural [2]. If you smoked less than five cigarettes a day, you are much less likely to experience the physical symptoms of withdrawal [3].

cigarettes

Physical Withdrawal Symptoms – Shakes, constipation, fatigue and increased appetite.

Emotional Withdrawal Symptoms – There are many emotional symptoms of nicotine withdrawal, including anxiety, apathy, depression, increased sensitivity to pain, and irritability.

Behavioural Withdrawal Symptoms – Difficulty concentrating, cravings, and impaired memory.

Cravings

Cravings are a huge part of nicotine withdrawal, and are considered the hardest symptom to as your body adjusts to life without nicotine. Cravings come in two distinct forms, based on the two distinct ways your body becomes addicted to nicotine – physically and psychologically [4]. Physical nicotine addiction is caused by your body’s physical demand for nicotine for normal brain function, and is responsible for almost all of the withdrawal symptoms mentioned above. Cravings based on the physical addiction to nicotine are strong, and will subside after several days nicotine-free. Psychological addiction is based on the rituals, habits, feelings and friendships you previously associated with smoking. Psychological addiction-based cravings are not based on a physical dependence on nicotine, but can be much harder than physical cravings to break long term.

cravings

There are some therapies available that will reduce physical addiction to nicotine in people who find it difficult if not impossible to stop smoking, but it is down to the individual to break their psychological attachments to smoking [4].

Nicotine Withdrawal Timeline

Studies show that genetics can be responsible for 50-75% of the strength of someone’s nicotine addiction, and around 50% of the variance between people in their quitting success. For people that carry genes associated with addiction and dependence, it is easier to get addicted, and much harder to quit smoking [5,6]]. Here’s a timeline of what you can expect to happen throughout nicotine withdrawal:

20 minutes – 4 hours

The effects of the nicotine from your last cigarette start to wear off; you begin to crave another one. However, positive health effects of quitting are already kicking in after 20 minutes; your blood pressure and heart rate will normalise, and tiny cellular hairs (known as cilia) in your lungs will start to move and grow again, helping to clear bacteria and mucus out of your lungs [7].

health

8 – 10 hours

At this point, your cravings will be getting more intense and you will be wondering how to fill the time, as your body’s nicotine levels get even lower. This can often lead to restlessness as your brain looks for a way to satisfy it’s craving for nicotine. It’s right about now you might be reaching for your e-cigarette or nicotine patches, and any preparations you made before you quit will be helpful. At around this point, your body’s carbon monoxide levels will have returned to almost completely normal levels – meaning your blood can carry a normal amount of oxygen again, and your entire body can now benefit [8].

timeline

24 hours

At this point, your brain and body will be trying everything they can to encourage you to smoke – you may become irritable, and your appetite will increase as your body looks for ways to stimulate the reward pathways normally triggered by nicotine [9]. Cravings will come in waves and feel relentless at times, it’s best to take them one at a time and find the best way for you to get through them. At this point, nicotine is still in your bloodstream, but at barely traceable levels.

cravings

3-5 days

Nicotine has finally left your bloodstream and almost all parts of your body. Cravings will have reached an all-time high around this time. But, after your cravings peak, you should finally notice you’re getting slightly longer breaks between them. Your lungs will be relaxing and their capacity will have increased drastically. You may have had headaches after 48 hours of quitting, these should be beginning to subside. You may develop a chesty cough that can last up to two weeks – your lungs could not clean themselves well as a smoker – as your lung function improves dramatically, it’s high time for them to have a spring clean.

lungs

1 week

After one week without nicotine, most of the physical symptoms of nicotine withdrawal should have subsided. You can expect to still experience cravings and triggers in certain situations, but with distraction these should become easier to handle as your physical dependence on nicotine subsides. You can expect to experience some anxiety as your brain begins to rewire your reward system to function normally without nicotine [10]. People who make it past the one week mark are 9 times more likely to quit.

physical cravins

1 month

Any anxiety will have subsided, psychological cravings should be at an all time low and physical cravings non-existent. From hereon, a strong and clear mental game is the most important key to maintaining a nicotine-free life. Psychological cravings and the ‘romance’ of smoking may continue to be very real in your mind; rewarding yourself for reaching specific goals, and gentle and constant reminders of why you have quit, are the best remedy.

anxiety

Treatment

Treatment for nicotine withdrawal often revolves around introducing nicotine back into your body in a controlled way that does not involve smoking tobacco, giving you time to break your psychological dependence without having to address the physical addiction at the same time. There are many options available and it may take time to work out what is best for you. Nicotine gum, patches, and e-cigarettes are some of the most popular ways to help control your cravings. Controlling your nicotine intake in this way will also help break the psychological connection between nicotine intake and smoking, making withdrawal symptoms and cravings a little easier to manage. If you cut down the amount of cigarettes you smoke over time, or use alternative nicotine delivery options like e-cigarettes, you can reduce the symptoms of nicotine withdrawal.

treatment

Medications that are in clinical trials [11] or have been newly approved for use in people having difficulty quitting [12], involve breaking down nicotine in your body early, or blocking receptors in your brain that respond to it, stopping someone from gaining satisfaction from cigarettes. These therapies can have quite severe side effects, so are not to be considered lightly. Champix is one such medication, and is considered of the most effective ways to quit smoking. The most common side effect is nausea, affecting 30% of users. Mood changes and mood swings are also widely reported amongst users, although they are considered a highly uncommon side effect. [13].

Conclusion

The worst effects of nicotine withdrawal will peak at 3-5 days after you’ve quit, and will take up to 2 weeks to subside to manageable levels. Nicotine addiction has one of the hardest withdrawals to overcome due to its combination of physical and psychological impacts [14]. Almost every person looking to quit smoking will have to quit several times and relapse, before they are successful [15], but research shows that this is all part of the quitting process. Studies show that the longer you quit for each attempt, the more likely you will quit forever [1].

Sources

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6. Latent class typology of nicotine withdrawal: genetic contributions and association with failed smoking cessation and psychiatric disorders. Xian H, Scherrer JF, Madden PA, Lyons MJ, Tsuang M, True WR, Eisen SA
Psychol Med. 2005 Mar; 35(3):409-19. https://www.ncbi.nlm.nih.gov/pubmed/15841876/

7. Fundam Clin Pharmacol. 1999;13(4):501-7. Effects of cigarette smoking on short-term variability of blood pressure in smoking and non smoking healthy volunteers. Ragueneau I1, Michaud P, Démolis JL, Moryusef A, Jaillon P, Funck-Brentano C. https://www.ncbi.nlm.nih.gov/pubmed/10456293

8. Chest. 2000 Mar;117(3):758-63. Breath carbon monoxide as an indication of smoking habit. Middleton ET1, Morice AH. https://www.ncbi.nlm.nih.gov/pubmed/10713003

9. American Psychiatric Association . Diagnostic and statistical manual of mental disorders: DSM 5. American Psychiatric Association; Washington: 2013
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10. Behav Res Ther. 2005 Dec;43(12):1683-700. Acute nicotine withdrawal symptoms and anxious responding to bodily sensations: a test of incremental predictive validity among young adult regular smokers. Zvolensky MJ1, Feldner MT, Leen-Feldner EW, Gibson LE, Abrams K, Gregor K. https://www.ncbi.nlm.nih.gov/pubmed/16239158

11. An enzymatic approach reverses nicotine dependence, decreases compulsive-like intake, and prevents relapse. Marsida Kallupi, Song Xue, […], and Olivier George Sci Adv. 2018 Oct; 4(10): eaat4751
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192681/

12. FDA Approvals: Chantix (varenicline)
News Author: Yael Waknine CME Author: Yael Waknine. Accessed 23/10/18
https://www.medscape.org/viewarticle/532569

13. Pfizer Medical Information – warnings and precautions for Champix. Accessed 23/10/18
https://www.pfizermedicalinformation.ca/en-ca/champix/warnings-and-precautions

14. DiFranza, J., & Ursprung, W. W. (2010). A systematic review of the international classification of diseases criteria for the diagnosis of tobacco dependence. Addictive Behaviors, 35, 805–810.
https://www.ncbi.nlm.nih.gov/pubmed/20493638

15. Bold KW, Rasheed AS, McCarthy DE, Jackson TC, Fiore MC, Baker TB. Rates and predictors of renewed quitting after relapse during a one-year follow-up among primary care patients. Ann Behav Med. 2015;49(1):128-40.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223110/

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