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Nicotine addiction and withdrawal

Definition

Tobacco and nicotine can be addictive like alcohol, cocaine, and morphine.

Nicotine withdrawal occurs when you suddenly stop smoking or using tobacco after using it for a long time. It can also occur if you cut back on the number of cigarettes or amount of tobacco products you use.  Nicotine withdrawal creates anxiety, irritability, headache, hunger, and a craving for cigarettes or other sources of nicotine. These symptoms peak 12 to 24 hours after quitting and then slowly go away.

See also: Smoking - tips on how to quit

Alternative Names

Withdrawal from nicotine; Smoking - nicotine addiction and withdrawal; Smokeless tobacco - nicotine addiction; Cigar smoking; Pipe smoking; Smokeless snuff; Tobacco use; Chewing tobacco

Causes, incidence, and risk factors

Tobacco is a plant grown for its leaves, which are smoked, chewed, or sniffed for a variety of effects.

  • It is an addictive substance because it contains the chemical nicotine.
  • Tobacco also contains more than 19 known cancer-causing chemicals (most are collectively known as "tar") and more than 4,000 other chemicals.

Millions of people in the United States have successfully quit smoking. Although the number of cigarette smokers in the United States has dropped in recent years, the number of smokeless tobacco users has steadily increased. 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.

Symptoms

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:

  • Decreases the appetite (for this reason, the fear of weight gain affects some people's willingness to stop smoking).
  • Boosts mood and may even relieve minor depression. Many people will feel a sense of well-being.
  • Raises the blood level of blood sugar (glucose) and increases insulin production.
  • Increases bowel activity, saliva, and phlegm.
  • Increases heart rate by around 10 to 20 beats per minute.
  • Increases blood pressure by 5 to 10 mmHg (because it tightens the blood vessels).
  • May cause sweating, nausea, and diarrhea.
  • Stimulates memory and alertness. People who use tobacco often depend on it to help them accomplish certain tasks and perform well.

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:

  • An intense craving for nicotine
  • Anxiety, tension, restlessness, frustration, or impatience
  • Difficulty concentrating
  • Drowsiness or trouble sleeping, as well as bad dreams and nightmares
  • Headaches
  • Increased appetite and weight gain
  • Irritability or depression

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.

Treatment

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:

  • Gum
  • Inhalers
  • Nasal spray
  • Skin patch

Nonhabit forming prescription medications may help you quit smoking and keep you from starting again.  See: Smoking cessation medications

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

Expectations (prognosis)

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.

Complications

Long-term use of nicotine products, whether smoking or using smokeless tobacco products, carries many risks, including:

  • Cancer
  • Heart disease
  • Pregnancy problems
  • Stroke

See: Making the decision to quit tobacco

Some people gain weight after smoking because they eat instead of smoke.  This is much less unhealthy than continuing to smoke. People who have concerns about their weight should talk to a health care provider about them before and during quitting.

Nicotine withdrawal may also bring on a relapse of major depression, bipolar disorder, or other substance abuse problems.

Calling your health care provider

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.

References

George TP. Nicotine and tobacco.In: Goldman L, Schafer AI, eds.Cecil Medicine. 24th ed.Philadelphia,PA: Saunders Elsevier; 2011:chap 31.

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.


Review Date: 11/23/2011
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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