Nicotine addiction and withdrawal

• 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 considered 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.

  More than 38 million people in the United States have successfully quit smoking. Yet there are still around 50 million Americans who smoke. Most say they would like to quit.

  Although the number of cigarette smokers in the United States has dropped in recent years, the number of smokeless tobacco users has steadily risen. 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:

  • Acts as an appetite suppressant (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.
  • Elevates the blood level of glucose (blood sugar) and increases insulin production.
  • Increases bowel activity, saliva, and bronchial secretions.
  • Increases heart rate by around 10 to 20 beats per minute.
  • Increases blood pressure reading by 5 to 10 mmHg (because it constricts 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.

  Symtoms 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 and 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 aggravate the symptoms of other psychiatric problems, according to the American Psychiatric Association.

• 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

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

  Such medicines include:

  • Bupropion (Wellbutrin, Zyban)
  • Varenicline (Chantix)
  • Other medications, including clonidine, antidepressants such as nortriptyline or fluoxetine (Prozac), and buspirone (Buspar) have shown some benefits, but are not FDA-approved for smoking cessation

  Like any addiction, quitting tobacco is difficult, especially if you are acting alone. If you join smoking cessation programs, you have a much better chance of success. See: Stop smoking support programs

  • These programs are offered by hospitals, health departments, community centers, and work sites.
  • The best quit-smoking programs combine multiple strategies to help keep you from starting smoking again. Counseling by telephone can be as helpful and as effective as face-to-face counseling.

  A screening test for depression may also be helpful to ensure proper treatment and increase the odds of maintaining smoking abstinence.

  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 occurred or what 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:

  • Heart disease
  • Pregnancy problems
  • Several types of cancer
  • Stroke

  See: Making the decision to quit tobacco

  Weight gain due to increased eating also may occur. This is much less unhealthy than continuing to smoke. People who have concerns about their weight should address them while quitting, so these concerns do not undermine their attempts to stay away from cigarettes.

  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

  Benowitz NL. Tobacco. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 30.

  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: 12/25/2009

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.