Nicotine withdrawal

Generality

Nicotine withdrawal, or nicotine withdrawal syndrome, is a set of symptoms that those who have recently decided to quit smoking are subject to.

Nicotine abstinence appears as soon as a couple of hours after the last cigarette; after 3 days from the healthy decision, it enters the acute phase and, after 14-21 days, begins to resolve.

Its main symptoms are: uncontrollable desire to smoke, irritability, anger, depression, nausea, headaches and stomach cramps.

To be able to overcome nicotine withdrawal, there are numerous support programs, which teach the most effective tricks on how to stop smoking, and also of pharmacological preparations, which however are indicated in extreme cases (ie when the overcoming of the syndrome of abstinence is very difficult).

What is nicotine withdrawal?

Nicotine withdrawal, or nicotine withdrawal syndrome, is a set of symptoms that appears in ex-smokers, shortly after inhaling tobacco for the last time.

Although it may seem strange to some, nicotine withdrawal is a real phenomenon, as nicotine is an addictive substance , just like heroin, cocaine, marijuana, alcohol and so on.

What is nicotine?

Named in honor of Jean Nicot, nicotine is an alkaloid - hence a substance of vegetable origin - and represents the most well-known toxic component of tobacco.

In addition to creating dependence in the long run, nicotine also has immediate effects on the human body, such as raising blood pressure and increasing heart rate.

Is nicotine withdrawal a disease?

Nicotine withdrawal is a disease.

The reliable confirmation of what just stated comes from the inclusion of the aforementioned syndrome both in the last edition of the so-called Diagnostic and Statistical Manual of Mental Disorders (*), and in the International Classification of Diseases drawn up by the WHO (World Health Organization)

* NB: the Diagnostic and Statistical Manual of Mental Disorders (DSM) is a collection of all the peculiar characteristics of known mental and mental illnesses, including the respective criteria required for diagnosis.

Causes

The human body, brain in particular, is particularly sensitive to nicotine and, if the latter is constant, tends to make its presence something habitual and unavoidable.

According to the researchers, it would be this particular habit in the presence of nicotine, by the brain, that causes withdrawal symptoms when an individual stops smoking; in fact, it seems that, with the abolition of smoking, brain cells feel the absence of nicotine and react as if they lacked something essential and indispensable.

As we will see later, nicotine withdrawal syndrome has a certain duration: this duration is the time frame that the brain needs, first of all, and the human body, secondly, to get used to the absence of nicotine.

Curiosity: what is the neurotransmitter protagonist of nicotine withdrawal?

According to the most reliable theories, in the human being, the neurotransmitter implicated in the nicotine withdrawal mechanism - as well as in that of nicotine dependence (NB: there is a logical relationship between the two mechanisms) - it would be dopamine .

Dopamine covers various functions, including that of mediating pleasure and reward . Nicotine would seem to stimulate the aforementioned function and this would explain why, once the intake is interrupted, the affected individual is ill and needs a cigarette or another source of the aforementioned alkaloid.

Who hits?

Nicotine withdrawal is a pathological phenomenon that can affect anyone who uses tobacco on an ongoing basis; therefore, habitual smokers of cigarettes, cigars or pipes are at risk.

Several studies have found that the intensity of the symptomatology is all the more serious, the higher the amount of tobacco that the now ex-smoker consumed daily, before abstaining from smoking. In other words, the most ardent ex-smokers are subjected to nicotine withdrawal with far more serious symptoms, compared to the less hardcore former smokers.

It should be pointed out that part of the aforementioned research has shown that nicotine withdrawal syndrome can also be seen in sporadic ex-smokers, ie those who, before finally quitting smoking, occasionally consumed some cigarettes.

Symptoms and complications

Possible symptoms of nicotine withdrawal include:

• Unstoppable desire to smoke;
• Nausea and intestinal cramps;
• Headache;
• Irritability;
• Anger;
• Anxiety;
• Depression;
• Constipation;
• Disturbed night sleep and sleepiness during the day;
• Difficulty concentrating;
• Increased appetite with consequent increase in body weight;
• Frustration;
• Tingling in the hands and feet.

Curiosity: how can we explain the increase in appetite and what consequences can it have?

The constant intake of nicotine increases the average release by the nervous system of serotonin and dopamine, two neurotransmitters that reduce the sense of hunger.

Therefore, if nicotine is suddenly lacking, the greater release of serotonin and dopamine, as well as the aforementioned reduction in the sense of hunger, is also lost; from this it follows that the interested subject is more hungry than usual.

In those who quit smoking, the greatest appetite is particularly intense during the first two weeks, a period in which the consequent increase in body weight (in those who obviously cannot control caloric intake) can also be 4.5 kilograms .

Onset and evolution of symptoms

The first symptoms of nicotine withdrawal appear as soon as 2-3 hours after the last cigarette, cigar or a mouthful of pipe.

After 3 days - that is the amount of time the body needs to completely eliminate all traces of nicotine - the most acute phase of withdrawal syndrome begins. It is from this moment, in fact, that the former smoker suffers more intensely than the uncontrollable desire to smoke, irritability, concentration difficulties, etc.

For the resolution of symptoms or, at least, to appreciate an improvement (ie a decrease in intensity), 2-3 weeks must elapse after the last nicotine intake.

How to notice that nicotine withdrawal is improving?

The former smoker can sense when the acute phase of nicotine withdrawal is coming to an end with some unmistakable signals, including mainly:

• Absent or reduced need to smoke (compared to an earlier time when this need was strongly present);
• Greater tranquility (compared to an earlier phase in which there was irritability and anger);
• Minor sense of anxiety (compared to a first in which anxiety, sleep disturbances etc. were present).

What factors can accentuate the symptom picture?

According to behavioral investigations on ex-smokers in full nicotine withdrawal phase, the symptoms of the latter can be accentuated in some specific situations, including:

• Being in the company of people who smoke;
• To drive. This is linked to the fact that, very often, smokers have the habit of smoking in the car, especially if they spend several hours a day there, for work or other activities;
• The moments of stress;
• After drinking coffee or tea. Several scientific studies have shown that the intake of caffeine or theine stimulates the need for smoking in smokers;
• After taking alcohol. As for alcohol, the same holds true for coffee and tea: it seems that its intake is a stimulus to the need to smoke;
• The moments of fatigue;
• During long conversations on the phone. This is a similar situation, in a sense, driving a car; it is, in fact, a moment that, for smokers, is well suited to cigarette consumption.

Exceptions

According to the testimonies of some ex-smokers, in rare and particular situations, nicotine abstinence - in particular the uncontrollable desire to smoke - can last much longer than canonical times (3 weeks), remaining for months if not even for years.

Is it life-threatening?

However unpleasant and annoying its symptoms are, nicotine withdrawal is not a life-threatening condition. Indeed, the reason for which it is present, namely the abolition of smoking, has only beneficial effects on human beings.

This lack of danger is what differentiates nicotine withdrawal from alcohol withdrawal or abstinence from illegal drugs; although all three are the result of a mechanism of dependence, in fact, the second forms of abstinence can have serious consequences on the health of the victim.

Therapy

To overcome nicotine abstinence, doctors and experts recommend relying, first of all, on one of the many programs that teach how to stop smoking, using tricks, etc.

Therefore, only in the case in which the undertaken program turns out ineffective and the symptoms of the abstinence syndrome unworkable, do they consider practicable the road that leads to the assumption of specific pharmacological products.

Nicotine withdrawal drugs

Among the medicines indicated to overcome nicotine withdrawal, there are two nicotine-free drug preparations, called varenicline and bupropion, and the so-called nicotine substitutes, which instead contain nicotine.

• Varenicline ( Chantix ). This drug reduces the desire to smoke, mimicking the effects that nicotine has on the body.

  Assumed only on prescription, varenicline can have several side effects, some more common than others. The most common side effects include nausea and gastrointestinal problems; among the rarest side effects, mood swings, disturbed sleep and nightmares deserve a mention;

• Bupropion ( Zyban ). Like varenicline, this medicine calms the desire to smoke, thanks to the fact that it produces the same effects on the body as nicotine.

  Specific for the treatment of depression and to be taken only on medical prescription, bupropion can have several side effects; among the latter, the most common are dry mouth, disturbed sleep, anxiety and irritability, while the less common are headaches, confusion, seizures and difficulty concentrating.

  Finally, bupropion also presents several contraindications; in fact, it is not suitable for those suffering from anorexia nervosa, bulimia nervosa, brain tumors and epilepsy.

• Nicotine substitutes . They are pharmacological preparations designed to reduce the desire to smoke gradually, not abruptly; the quantity of nicotine they provide, in fact, reduces the impact that the symptoms of abstinence produce against the most in need ex-smokers.

  Usable even without a prescription, nicotine substitutes exist in the form of patches, chewing gum, inhalers, sprays and lotions.

  In the case of pregnancy, women who intend to use it should first seek advice from their treating physician, to understand how to behave.

Some simple tricks to control the symptoms ...

Experts advise a former smoker who wants to suffer less because of nicotine withdrawal, by:

• Avoid frequenting places where it is easy to meet smokers;
• Avoid keeping company that smokes. In the acute phase of abstinence, this arrangement is very important;
• Avoid consumption of alcohol and temporarily reduce the consumption of coffee and tea;
• Practice more physical activity. Physical exercise has the power to mitigate the stress of everyday life, which very often represents one of the reasons why people smoke;
• Engage in pastimes, like reading a book, new hobbies, etc., so as to occupy the free moments of the day and feel less the lack of nicotine;
• Get chewing gum and use it whenever your desire for smoking increases considerably;
• Ask for advice from those who, among friends, acquaintances and relatives, have successfully passed nicotine withdrawal. The comparison, in these situations, can provide new ideas on how to best deal with the symptoms;
• Be patient, because the desire to smoke is not constant, but alternates acute phases, in which it seems uncontrollable, with decidedly more tenuous phases, in which it is barely perceptible.

Why is it worth suffering from nicotine withdrawal?

The answer to this question is very simple: the symptoms of nicotine withdrawal are nothing compared to the serious diseases that smoking can cause (lung cancer, throat cancer, pulmonary fibrosis, etc.).

Prognosis

Quitting smoking, overcoming nicotine withdrawal, is definitely difficult.

It is no coincidence, moreover, that many ex-smokers have stopped smoking only after several attempts.

Curiosity

According to an interesting study, it seems that many of the people wishing to quit smoking succeed in this "undertaking" on the third attempt.

If on the one hand this represents confirmation of the difficulties that lie behind the overcoming of nicotine withdrawal, on the other it is a sort of incentive not to "let go" and to try again, in case of failure, until it comes out " "winners.

When is it possible to speak of complete healing?

In order to be able to talk about complete recovery from nicotine withdrawal, doctors and industry experts believe that it is necessary to wait for the moment after the acute phase to be overcome.

In other words, a former smoker can be considered cured of nicotine withdrawal syndrome only once the symptom improvement phase has been overcome.