Tobacco use can lead to an addiction to nicotine – similar to cocaine, heroin or alcohol. When an individual stops using tobacco, withdrawal symptoms begin within a couple of hours.
When a person smokes a cigarette, the body and brain have to make changes to be able to tolerate the substance. Once this happens, the body begins to act like having this substance is normal. When a person quits smoking, the body feels abnormal because it has gotten used to the chemical. This stage of adjustment, learning to live without nicotine, can be challenging due to withdrawal symptoms. On average, these symptoms last about 2 – 4 weeks, but the first week can be the toughest.
Common withdrawal symptoms:
It is not unusual for patients to relapse after quitting tobacco, especially after their first attempt. Chances of relapse are high for new mothers, and women in general are more likely to relapse. Also, many patients relapse due to discontinuing treatment medications too soon (i.e., medications that are approved by the FDA to help smokers quit).
It is important for clinicians to impress upon patients that they should not be discouraged when a relapse occurs. Each time they try to quit, their chances of eventually quitting improve. This is a step in the process of quitting.
Trigger and Solution: Tips for Patients to Prevent Relapse
Trigger: After quitting, thinking that I can have just one. This usually leads to another one after that, and then another.
A Solution: Remind yourself that cravings to smoke are like an itch: the more you scratch it the itchier it gets. It might help to take this a step at a time. You don't have to worry about quitting for a lifetime: the only cigarette you need to worry about picking back up is the first one.
Trigger: Stress (or celebrations). For years you have used tobacco as a way of dealing with stressful (including happy) situations
A Solution: Begin thinking about ways to cope with stress - and ways to reward yourself - without tobacco use. Fun activities, talking with a trusted friend, saving up money for special rewards, exercise - these are some of the ways to cope that others have discovered. Having trouble thinking of ideas on your own? Speak with your health care provider or call The Maine Tobacco HelpLine at 1-800-207-1230.
Trigger: Consuming alcohol. Many people have found that drinking even small amounts of alcohol can trigger a return to smoking.
A Solution: Unless alcohol is also a problem for you, most people don't need to give it up for good but many find that they need to stay away from drinking for the first couple of weeks.
Trigger: Too much caffeine. When people quit smoking, caffeine can begin to affect the person more strongly than when still smoking. This can add to feelings of anxiety, restlessness and difficulty sleeping.
A Solution: Cut back on the amount of coffee, tea or soft drinks containing caffeine that you consume. With coffee, an easy way to do this is to mix in some decaf with every cup that you drink.
Trigger: Smelling others' tobacco smoke. For some people the smell of tobacco – or even just being around others when they are smoking - can be too tempting.
A Solution: Try to avoid smoking situations for the first few weeks. It may be hard to avoid it entirely but the more you can minimize your contact the easier it will be. In situations where it is completely unavoidable, try to think in advance about who else might be present that doesn't smoke. Try hanging out with him or her.
Trigger: Not enough medication or coming off of it too soon. For people using the nicotine gum, lozenge, inhaler or nasal spray it is not uncommon for people to not use enough of the medicine. With almost all tobacco treatment medication, people often come off it too soon.
A Solution: Don't wait for a craving to hit. It may be too late. With the gum, lozenge, inhaler and nasal spray try taking it as directed periodically throughout the day. This will keep a steady supply of medicine in your body to help with any cravings. For all tobacco treatment medicines, take the medication for at least 8 weeks.
Managing Cravings. Preparing patients for coping with cravings associated with tobacco use can help them achieve success.
Redirection. Redirecting patients' urges can help them through their most vulnerable times. Patients can be armed with ways to redirect urges with actions such as:
Have patients create their own list, or use Terry Martin's 101 Things to Do Instead of Smoking.
Creating positive actions. Quitting tobacco dependence is a process. Turning negative actions and thoughts into positive solutions can help patients build a quit program that works over the long term. It can also provide them with knowledge about what leads to relapse so they can avoid those in the future.
The following is adapted from Terry Martin's "Things to Avoid When You Quit Smoking" to share with patients.
Find more resources for quitting, helping others quit and quitting success stories at Quit Tobacco.