Nicotine Withdrawal

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Three Stages of Nicotine Addiction

Withdrawal from nicotine appears in three different stages and most smokers are familiar with the first two.

Stage 1: Between smokes

The first is a mild urge to smoke another cigarette and comes as the last dose of nicotine begins to wear off. About every ten to twenty minutes a regular smoker will light up another cigarette. This cycle of rising and falling nicotine levels is repeated throughout the day.

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Stage 2: I need a smoke

The second stage of withdrawal happens when a regular smoker doesn’t smoke for two to three hours. This can happen when a social activity prevents smoking and it also happens every night when the smoker sleeps. Over the course of sleeping eight hours, nicotine levels in the body fall appreciably. In a sense, smokers go through this stage every morning until they have their first cigarette.

Stage 3: Serious Nicotine Cravings

The third stage of withdrawal is much harder than the relatively minor urges from the first two stages. This involves serious cravings for nicotine (in any form) and peaks at 2 to 3 days of abstinence. The common symptoms are:

  • A craving that is intense and sustained. Thoughts about smoking seem to rise up, unbidden. This can even interfere with the ability to concentrate or focus on anything else. Smokers will sometimes even act out complex behaviors related to smoking – for example, they may inadvertently stop at the store where they used to purchase cigarettes, or perform other routines that were linked to smoking without realizing they are doing it.
  • Anxiety coupled with irritability is common. A smoker may feel frustrated that the urges are still with them and become impatient with quitting. Rationalizations about smoking and bargaining (“Maybe just one…”) emerge.
  • Difficulty sleeping along with disturbing dreams.
  • Depression arises, probably for many reasons: the understanding that quitting isn’t going to be easy; worry that the withdrawal symptoms won’t go away; a sense of powerlessness over their addiction; the generally lousy physical feelings.
  • Appetite usually improves without the nicotine acting to suppress it. Weight gain can be the result -- sometimes food compensates for not having a cigarette in the mouth.
  • Headaches are common – partially from a lack of nicotine and partly from the stress involved in quitting.

Symptoms may be less severe for those who do not smoke regularly or haven’t smoked for very long. Some symptoms may appear even in smokers who switch from regular to light cigarettes or switch the way they get nicotine (chew, cigarettes, snuff).

Other considerations

Those addicted to nicotine who wish to quit should be advised of a few important points. Withdrawal is usually much harsher than expected. It lasts longer and is harder to endure than most people anticipate. Perhaps this is why multiple tries might be needed – a sort of ‘training up’ toward the ultimate goal. Those attempting to quit should be warned about the difficulty.

In some circumstances smokers should seek medical advice before quitting. Those with serious or chronic medical problems should have help, and anyone with a psychiatric illness needs to inform their caregiver. Quitting smoking can exacerbate the symptoms of some psychiatric conditions.

Anyone taking regular medications (especially drugs with tight tolerances) may need adjustments or follow up testing. Nicotine can affect how some drugs are metabolized. The prescribing doctor and dispensing pharmacist should be informed.

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