What are some of the withdrawal symptoms associated with quitting smoking?

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Quitting smoking may cause short-term problems, especially for those who have smoked heavily for many years. These temporary changes can result in withdrawal symptoms.

Common withdrawal symptoms associated with quitting include the following:

• Nicotine cravings (nicotine is the substance in tobacco that causes addiction).
• Anger, frustration, and irritability.
• Anxiety.
• Depression.
• Weight gain.

Studies have shown that about half of smokers report experiencing at least four withdrawal symptoms (such as anger, anxiety, or depression) when they quit (1). People have reported other symptoms, including dizziness, increased dreaming, and headaches (2).

The good news is that there is much you can do to reduce cravings and manage common withdrawal symptoms. Even without medication, withdrawal symptoms and other problems subside over time. It may also help to know that withdrawal symptoms are usually worst during the first week after quitting. From that point on, the intensity usually drops over the first month. However, everyone is different, and some people have withdrawal symptoms for several months after quitting (3, 4).

What are some of the triggers for smoking?

In addition to nicotine cravings, reminders in your daily life of times when you used to smoke may trigger you to smoke. Triggers are the moods, feelings, places, or things you do in your daily life that turn on your desire to smoke.

Triggers may include any of the following:

• Being around smokers.
• Starting the day.
• Feeling stressed.
• Being in a car.
• Drinking coffee or tea.
• Enjoying a meal.
• Drinking an alcoholic beverage.
• Feeling bored.

Knowing your triggers helps you stay in control because you can choose to avoid them or keep your mind distracted and busy when you cannot avoid them.

What can I do about nicotine cravings?

As a smoker, you get used to having a certain level of nicotine in your body. You control that level by how much you smoke, how deeply you inhale the smoke, and the kind of tobacco you use. When you quit, cravings develop when your body wants nicotine. It takes time to break free from nicotine addiction. Also, when you see people smoking or are around other triggers, you may get nicotine cravings. Cravings are real. They are not just in your imagination. At the same time, your mood may change, and your heart rate and blood pressure may go up.

The urge to smoke will come and go. Cravings usually last only a very brief period of time. Cravings usually begin within an hour or two after you have your last cigarette, peak for several days, and may last several weeks. As the days pass, the cravings will get farther apart. Occasional mild cravings may last for 6 months.

Here are some tips for managing cravings:

• Remind yourself that they will pass.
• Avoid situations and activities that you used to associate with smoking.
• As a substitute for smoking, try chewing on carrots, pickles, apples, celery, sugarless gum, or hard candy. Keeping your mouth busy may stop the psychological need to smoke.
• Try this exercise: Take a deep breath through your nose and blow out slowly through your mouth. Repeat 10 times.
• Ask your doctor about nicotine replacement products or other medications.

Go online to Smokefree.gov, a website created by the National Cancer Institute’s (NCI) Tobacco Control Research Branch, and use the Step-by-Step Quit Guide to learn about other tips for managing cravings.

What can I do about anger, frustration, and irritability?

After you quit smoking, you may feel edgy and short-tempered, and you may want to give up on tasks more quickly than usual. You may be less tolerant of others and get into more arguments.

Studies have found that the most common negative feelings associated with quitting are feelings of anger, frustration, and irritability. These negative feelings peak within 1 week of quitting and may last 2 to 4 weeks (2).

Here are some tips for managing these negative feelings:

• Remind yourself that these feelings are temporary.
• Engage in a physical activity, such as taking a walk.
• Reduce caffeine by limiting or avoiding coffee, soda, and tea.
• Try meditation or other relaxation techniques, such as getting a massage, soaking in a hot bath, or breathing deeply through your nose and out through your mouth for 10 breaths.
• Ask your doctor about nicotine replacement products or other medications.

What can I do about anxiety?

Within 24 hours of quitting smoking, you may feel tense and agitated. You may feel a tightness in your muscles—especially around the neck and shoulders. Studies have found that anxiety is one of the most common negative feelings associated with quitting. If anxiety occurs, it builds over the first 3 days after quitting and may last 2 weeks (2).

Here are some tips for managing anxiety:

• Remind yourself that anxiety will pass with time.
• Set aside some quiet time every morning and evening—a time when you can be alone in a quiet environment.
• Engage in physical activity, such as taking a walk.
• Reduce caffeine by limiting or avoiding coffee, soda, and tea.
• Try meditation or other relaxation techniques, such as getting a massage, soaking in a hot bath, or breathing deeply through your nose and out through your mouth for 10 breaths.
• Ask your doctor about nicotine replacement products or other medications.

What can I do about depression?

It is normal to feel sad for a period of time after you first quit smoking. If mild depression occurs, it will usually begin within the first day, continue for the first couple of weeks, and go away within a month.

Having a history of depression is associated with more severe withdrawal symptoms—including more severe depression. Some studies have found that many people with a history of major depression will have a new major depressive episode after quitting. However, in those with no history of depression, major depression after quitting is rare.

Many people have a strong urge to smoke when they feel depressed. Here are some tips for managing depression:

• Call a friend and plan to have lunch or go to a movie, concert, or other pleasurable event.
• Identify your specific feelings at the time that you seem depressed. Are you actually feeling tired, lonely, bored, or hungry? Focus on and address these specific needs.
• Increase physical activity. This will help to improve your mood and lift your depression.
• Breathe deeply.
• Make a list of things that are upsetting to you and write down solutions for them.
• If depression continues for more than 1 month, see your doctor. Ask your doctor about prescription medications that may help you with depression. Studies show that bupropion and nortriptyline can help people with a past history of depression who try to quit smoking. Nicotine replacement products also help (5).
• Learn about the signs of depression, and where to go for help, at the National Institute of Mental Health website.

What can I do about weight gain?

Gaining weight is common after quitting. Studies have shown that, on average, people who have never smoked weigh a few pounds more than smokers, and, when smokers quit, they attain the weight they would have had if they had never smoked (6).

Although most smokers gain fewer than 10 pounds after they quit smoking, the weight gain can be troublesome for some people (7, 8). However, the health benefits of quitting far outweigh the health risks of a small amount of extra weight.

Here are some tips for managing weight gain:

• Ask your doctor about the medication bupropion. Studies show that it helps counter weight gain (5).
• Studies also show that nicotine replacement products, especially nicotine gum and lozenges, can help counter weight gain (5). Because some people who quit smoking increase their food intake (6), regular physical activity and healthy food choices can help you maintain a healthy weight.
• If weight gain is a problem, you may want to consult a nutritionist or diet counselor.

How can I resist the urge to smoke when I’m around smokers?

You may want to analyze situations in which watching others smoke triggers an urge in you to smoke. Figure out what it is about those situations that makes you want to smoke. Is it because you associate feeling happy with being around other smokers? Or, is there something special about the situations, such as being around the people you usually smoked with? Is it tempting to join others for routine smoke breaks?

Here are some tips:

• Limit your contact with smokers, especially in the early weeks of quitting.
• Do not buy, carry, light, or hold cigarettes for others.
• If you are in a group and others light up, excuse yourself, and don’t return until they have finished.
• Do not let people smoke in your home. Post a small “No Smoking” sign by your front door.
• Ask others to help you stay quit. Give them specific examples of things that are helpful (such as not smoking around you) and things that are not helpful (like asking you to buy cigarettes for them).
• Focus on what you’ve gained by quitting. For example, think of how healthy you will be when all smoking effects are gone from your body and you can call yourself smoke-free. Also, add up how much money you have saved already by not purchasing cigarettes and imagine (in detail) how you will spend your savings in 6 months.

How can I start the day without smoking?

Many smokers light up a cigarette right after they wake up. After 6 to 8 hours of sleep, a smoker’s nicotine level drops and the smoker needs a boost of nicotine to start the day. After you quit, you must be ready to overcome the physical need and routine of waking up and smoking a cigarette. Instead of reaching for your cigarettes in the morning, here are some tips:

• The morning can set the tone for the rest of the day. Plan a different wake-up routine, and divert your attention from smoking.
• Be sure no cigarettes are available.
• Before you go to sleep, make a list of things you need to avoid in the morning that will make you want to smoke. Place this list where you used to place your cigarettes.
• Begin each day with a planned activity that will keep you busy for an hour or more. It will keep your mind and body busy so you don’t think about smoking.
• Begin each day with deep breathing and by drinking one or more glasses of water.

How can I resist the urge to smoke when I’m feeling stressed?

Most smokers report that one reason they smoke is to handle stress. This happens because smoking cigarettes actually relieves some of your stress by releasing powerful chemicals in your brain. Temporary changes in brain chemistry cause you to experience decreased anxiety, enhanced pleasure, and alert relaxation. Once you stop smoking, you may become more aware of stress.

Everyday worries, responsibilities, and hassles can all contribute to stress. As you go longer without smoking, you will get better at handling stress, especially if you learn stress reduction and relaxation techniques.

Here are some tips:

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• Know the causes of stress in your life (your job, traffic, your children, money) and identify the stress signals (headaches, nervousness, or trouble sleeping). Once you pinpoint high-risk trigger situations, you can start to develop new ways to handle them.
• Create peaceful times in your everyday schedule. For example, set aside an hour where you can get away from other people and your usual environment.
• Try relaxation techniques, such as progressive relaxation or yoga, and stick with the one that works best for you.
• Rehearse and visualize your relaxation plan. Put your plan into action. Change your plan as needed.
• You may find it helpful to read a book about how to handle stress.

How can I resist the urge to smoke when I'm driving or riding in a car?

You may have become used to smoking while driving—to relax in a traffic jam or to stay alert on a long drive. Like many smokers, you may like to light up when driving to and from work to relieve stress, stay alert, relax, or just pass the time. There is some evidence that smoking actually does make you feel more awake and alert.

Tips for short trips:

• Remove the ashtray, lighter, and cigarettes from your car.
• Keep nonfattening snacks in your car (such as licorice, sugarless gum, and hard candy).
• Turn on your favorite music and sing along.
• Take an alternate route to work or try carpooling.
• Clean your car and make sure to use deodorizers to reduce the tobacco smell.
• Tell yourself:
  • “This urge will go away in a few minutes.”
  • “So, I’m not enjoying this car ride. Big deal! It won’t last forever!”
  • “My car smells clean and fresh!”
  • “I’m a better driver now that I’m not smoking while driving.”

When you are driving or riding with other people:

• Ask passengers not to smoke in your car.
• If you’re not driving, find something to do with your hands.

Your desire to smoke may be stronger and more frequent on longer trips. Tips for long trips:

• Take a stretch break.
• Take fresh fruit along.
• Plan rest stops.
• Plan stops for water or fruit juice.

How can I resist the urge to smoke when I’m having coffee or tea?

You may be used to smoking when drinking coffee or tea (for example, during or after meals or during work breaks), and you may associate good feelings with drinking a hot beverage. When you give up smoking, expect to feel a strong urge to reach for a cigarette while drinking coffee or tea. Although you do not have to give up coffee or tea to quit smoking, you should expect that coffee or tea will not taste the same without a cigarette.

Here are some tips:

• If you used to smoke while drinking coffee or tea, tell people you have quit, so they won’t offer you a cigarette.
• Between sips of coffee or tea, take deep breaths to inhale the aroma. Breathe in deeply and slowly while you count to five, and then breathe out slowly, counting to five again.
• Try switching to decaffeinated coffee or tea for a while, particularly if quitting has made you irritable or nervous.
• Keep your hands busy by nibbling on healthy foods, doodling, or making a list of tasks for the day.
• If the urge to smoke is very strong, drink your coffee or tea more quickly than usual and then change activities or rooms.
• When you quit smoking, drinking coffee or tea without smoking may make you feel sad. Focus on what you’ve gained by quitting.

How can I enjoy a meal without smoking?

Food often tastes better after you quit smoking, and you may have a bigger appetite. Expect to want to smoke after meals. Your desire to smoke after meals may depend on whether you are alone, with other smokers, or with nonsmokers.

Your urge to smoke may be stronger with certain foods, such as spicy or sweet foods. Also, the urge to smoke may be stronger at different meal times.

Here are some tips:

• Know what kinds of foods increase your urge to smoke and stay away from them.
• If you are alone, call a friend or take a walk as soon as you’ve finished eating.
• Brush your teeth or use mouthwash right after meals.
• If you have coffee or a fruit drink, concentrate on the taste.
• Wash the dishes by hand after eating—you can’t smoke with wet hands!
• Eat at smoke-free restaurants.

How can I resist the urge to smoke when I’m drinking an alcoholic beverage?

You may be used to smoking when drinking beer, wine, liquor, or mixed drinks, and you may associate good feelings with drinking alcoholic beverages. When you quit smoking, you may feel a strong urge to smoke when you drink alcohol. Know this up front if you are going to drink. If you do drink, keep in mind that your control over your behavior may be impaired under the influence of alcohol. When you try to quit smoking, drinking alcohol may make it even tougher to cope.

Here are some tips for the first few weeks after quitting:

• Many people find it helpful to reduce or avoid drinking alcohol.
• Switch to nonalcoholic drinks.
• If you do drink, don’t choose the alcoholic beverages you usually have when smoking.
• Don’t drink at home or by yourself.
• Stay away from the places you usually drink alcohol, or drink only with nonsmoking friends.

How can I resist the urge to smoke when I’m feeling bored?

When you quit smoking, you may miss the increased excitement and good feeling that nicotine gave you. This may be particularly true when you are feeling bored.

Here are some tips:

• Plan more activities than you have time for.
• Make a list of things to do when confronted with free time.
• Move! Do not stay in the same place too long.
• If you feel very bored when waiting for something or someone (a bus, your friend, your kids), distract yourself with a book, magazine, or crossword puzzle.
• Look at and listen to what is going on around you.
• Carry something to keep your hands busy.
• Listen to a favorite song.
• Go outdoors, if you can, but not to places you associate with smoking.

Do nicotine replacement products relieve nicotine cravings and withdrawal symptoms?

Yes. Nicotine replacement products deliver measured doses of nicotine into the body, which helps to relieve the cravings and withdrawal symptoms often felt by people trying to quit smoking. Nicotine replacement products are effective treatments that can increase the likelihood that someone will quit successfully (5, 9).

Five forms of nicotine replacement products have been approved by the U.S. Food and Drug Administration (FDA):

• The nicotine patch is available over the counter (without a prescription). A new patch is worn on the skin each day, supplying a small but steady amount of nicotine to the body. The nicotine patch is sold in varying strengths, usually as an 8- to 10-week quit-smoking treatment. Typically, the nicotine doses are gradually lowered as treatment progresses. The nicotine patch may not be a good choice for people with skin problems or allergies to adhesive tape. Also, some people experience the side effect of having vivid dreams when they wear the patch at night. These people may decide to wear the patch only during the daytime.
• Nicotine gum is available over the counter in two strengths (2 and 4 milligrams). When a person chews nicotine gum and then places the chewed product between the cheek and gum tissue, nicotine is released into the bloodstream through the lining of the mouth. To keep a steady amount of nicotine in the body, a new piece of gum can be chewed every 1 or 2 hours. The 4-milligram dose appears to be more effective among highly dependent smokers (those who smoked 20 or more cigarettes per day) (10, 11). Nicotine gum might not be appropriate for people with temporomandibular joint disease or for those with dentures or other dental work, such as bridges. The gum releases nicotine more effectively when coffee, juice, or other acidic beverages are not consumed at the same time.
• The nicotine lozenge is also available over the counter in 2 and 4 milligram strengths. The lozenge is used similarly to nicotine gum; it is placed between the cheek and the gums and allowed to dissolve. Nicotine is released into the bloodstream through the lining of the mouth. The lozenge works best when used every 1 or 2 hours and when coffee, juice, or other acidic beverages are not consumed at the same time.
• Nicotine nasal spray is available by prescription only. The spray comes in a pump bottle containing nicotine that tobacco users can inhale when they have an urge to smoke. Nicotine is absorbed more quickly via the spray than with other nicotine replacement products. Nicotine nasal spray is not recommended for people with nasal or sinus conditions, allergies, or asthma or for young tobacco users. Side effects from the spray include sneezing, coughing, and watering eyes, but these problems usually go away with continued use of the spray.
• A nicotine inhaler, also available by prescription only, delivers a vaporized form of nicotine to the mouth through a mouthpiece attached to a plastic cartridge. Even though it is called an inhaler, the device does not deliver nicotine to the lungs the way a cigarette does. Most of the nicotine travels only to the mouth and throat, where it is absorbed through the mucous membranes. Common side effects include throat and mouth irritation and coughing. Anyone with a breathing problem such as asthma should use the nicotine inhaler with caution.

Experts recommend combining nicotine replacement therapy with advice or counseling from a doctor, dentist, pharmacist, or other health care provider. Also, experts suggest that smokers quit using tobacco products before they start using nicotine replacement products (12). Too much nicotine can cause nausea, vomiting, dizziness, diarrhea, weakness, or rapid heartbeat.

Are nicotine replacement products safe?

It is far less harmful for a person to get nicotine from a nicotine replacement product than from cigarettes because tobacco smoke contains many toxic and cancer-causing substances. Long-term use of nicotine replacement products has not been associated with any serious harmful effects (11).

Are there products to help people quit smoking that do not contain nicotine?

Yes, a doctor may prescribe one of several medicines that do not contain nicotine:

• Bupropion, a prescription antidepressant, was approved by the FDA in 1997 to treat nicotine addiction (under the trade name Zyban^®). This drug can help to reduce nicotine withdrawal symptoms and the urge to smoke and can be used safely with nicotine replacement products (9, 12). Several side effects are associated with this product. Discuss with your doctor if this medicine is right for you.
• Varenicline, a prescription medicine marketed as Chantix^®, was approved by the FDA in 2006 to help cigarette smokers stop smoking. This drug may help those who wish to quit by easing their nicotine cravings and by blocking the pleasurable effects of nicotine if they do resume smoking. Several side effects are associated with this product. Discuss with your doctor if this medicine is right for you.

Are there alternative methods to help people quit smoking?

Some people claim that alternative approaches such as hypnosis, acupuncture, acupressure, laser therapy (laser stimulation of acupuncture points on the body), or electrostimulation may help reduce the symptoms associated with nicotine withdrawal. However, in clinical studies these alternative therapies have not been found to help people quit smoking (13). There is no evidence that alternative approaches help smokers who are trying to quit.

How can I get help quitting tobacco?

NCI and other agencies and organizations can help smokers quit:

• Go online to Smokefree.gov, a website created by NCI’s Tobacco Control Research Branch, and use the Step-by-Step Quit Guide.
• Call NCI’s Smoking Quitline at 1–877–44U–QUIT (1–877–448–7848) for individualized counseling, printed information, and referrals to other sources.
• Refer to the NCI fact sheet Where To Get Help When You Decide To Quit Smoking.

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If you crave smoking mostly when you are drinking alcohol, it can be difficult to break that habit. People may tell you that it should be easy to quit because you only smoke when you drink. But alcohol can break your resolve and make it easy to give in to the urge to smoke.

Nicotine Addiction and Psychological Dependence

Nicotine addiction has two components—physical addiction and psychological dependence.

• Physical addiction, while intense, can be broken in a matter of days by clearing nicotine out of the body.
• Psychological dependence involves the association smokers build up between smoking and daily life over the years, from having a smoke with your morning coffee to lighting up when stressed.

For most people, it is the mental side of smoking that ties you most heavily to nicotine addiction. The fact that you link smoking only with drinking does give you an advantage. You can concentrate your efforts to quit on this one area alone rather than having to face triggers every time you turn around.

Alcohol Diminishes Inhibitions and Resolve

One of the big problems with alcohol is that it reduces your inhibitions. For someone who is trying to quit smoking, reduced inhibitions increase the risk of a smoking relapse. It just doesn't seem so important to stay true to your smoking cessation program once you've had a couple of drinks.

Additionally, you will probably be with friends who are smoking, or you'll see other smokers at the bar, making it all the more difficult for you. What do you do when they offer you a cigarette or they step outside for a smoke?

Quitting can be done successfully. With a plan and some practice, you can recondition yourself away from feeling like you need to smoke while enjoying a drink or two when out with friends.

Go Alcohol-Free at First

While your goal may be able to enjoy a drink without smoking, starting with going alcohol-free has advantages. You'll be able to deal with the triggers in that setting without the disadvantage of alcohol loosening up your resolve.

Try going alcohol-free for the night. Sip on cranberry juice and seltzer water or something similar. No one has to know if you'd rather keep it a secret. Privately tell the bartender or your server that when you order a mixed drink, you want it served minus the alcohol.

Socialize with friends as you normally would and work through the triggers that the situation brings up for you. You will probably need to do this more than once before it starts to feel comfortable. It may not be much fun, but it is the first step in breaking the associations you have with smoking in this environment.

Plan Ahead

Have an escape plan in mind for those moments when you feel like you're about to smoke a cigarette. Get up and head to the bathroom or step outside for some fresh air (avoiding the outdoor smoking area). If that doesn't do the trick, you may want to consider calling it a night and go home earlier than usual.

Go to a Smoke-Free Bar

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Most public meeting places are going smoke-free, although this will depend on the laws in your area. If your favorite watering hole hasn't yet done so, suggest to your friends that you try out a new place for a change.

Practice Makes Perfect

You are teaching yourself new, healthy habits each time you successfully navigate the situations that trigger the urge to smoke. Practice will cement them in place.

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Be patient and give yourself time to replace old associations with new ones that don't include smoking. The day will come when you'll be able to socialize with others who are smoking while having a drink or two without it bothering you.

You are smart to do the work now to quit because smoking even a few cigarettes is dangerous to your health. And, more likely than not, you would soon find yourself lighting up in situations other than the bar. Nicotine addiction has a way of moving in and taking up more and more of your time and resources. Better to kick it to the curb now.