Introduction

In 2000, approximately half of all men (49.1%) and one in six women (16.3%) were found to be actively consuming tobacco. According to the latest reports from the World Health Organisation (WHO), tobacco usage is expected to decrease to 32.9% by 2025 and 30.6% by 2030 in males and to 6.7% by 2025 and 5.7% by 2030 in females. Although in a declining trend, there is still significant mortality and morbidity associated with nicotine consumption.¹ Currently, only 23 countries provide services to help you quit nicotine, supported by full or partial cost-coverage, which includes approximately 32% of the world’s total population.² Smokers who wish to stop commonly face a dilemma between whether to quit abruptly or gradually.

Understanding nicotine withdrawal

Why is quitting important?

Quitting is one of the best decisions that can potentially save your life. The substance in tobacco that makes it addictive, and therefore harder to quit, is called nicotine. Nicotine is present in cigarettes and electronic devices, such as vapes. The dependence on nicotine is postulated to be associated with its action on certain receptors in your brain, known as nicotinic acetylcholine receptors.³ 

On consumption of any product containing nicotine, these receptors get activated, which causes the release of neurotransmitters including dopamine, norepinephrine, endorphins and acetylcholine.⁴ These neurotransmitters are responsible for the perceived “positive” effects of nicotine, like arousal, relief of tension, and a pleasurable feeling. Over time, your brain can become used to the high level of “happy hormones”, thereby depending on external sources, such as nicotine, to remain in that feel-good state. 

What are the symptoms of nicotine withdrawal?

When you stop smoking, especially abruptly, you may experience withdrawal symptoms as your brain adjusts. Common symptoms include:⁵ 

• Craving
• Irritability or anxiety
• Restlessness
• Difficulty concentrating
• Impatience
• Sleep disturbances
• Physical discomfort
• Increased appetite

These symptoms usually attain their highest levels on the third day and reduce gradually over the following 3–4 weeks.⁶ Understanding what occurs and why it occurs can help you in your quitting journey.

What is cold turkey?

‘Cold turkey’ refers to quitting smoking abruptly, without using nicotine replacement or tapering.

Advantages

• Quick detox: Your body starts eliminating nicotine instantly, speeding up the withdrawal process
• Mental clarity: Some people find it empowering to make a firm decision and follow through
• Shorter quitting timeline: Stopping immediately could mean you spend less time thinking about quitting and more time adjusting to a smoke-free life

Disadvantages

• Intense withdrawal: The sudden absence of nicotine could lead to severe cravings, mood swings, and high levels of anxiety in the first few days
• Relapse risk: If you're unprepared, the overwhelming symptoms could lead you back to smoking quickly
• Highly dependent smokers: If you smoke heavily, it might be too physically or mentally taxing to quit suddenly

What is gradual reduction?

Gradual reduction involves slowly decreasing nicotine intake over time. This can be achieved by reducing the number of cigarettes smoked or using nicotine replacement products in decreasing doses.

Methods of gradual reduction

• Timing control: Reducing the frequency of smoking throughout the day
• Scheduled reduction: Cutting out cigarettes that are easiest to give up first
• Behavioural training: Using coping strategies to resist environmental or emotional triggers

Advantages 

• Easier withdrawal process: Your body adjusts to lower levels of nicotine gradually, leading to milder withdrawal symptoms
• It builds new habits slowly: You have more time to identify triggers and develop coping strategies before facing full withdrawal
• Flexible: Gradual withdrawal allows you to taper your nicotine reduction based on personal comfort and requirements, which can feel less intimidating

Disadvantages

• Takes longer: Some people find the extended timeline hard to adhere to
• Risk of delay: It is easier to postpone quitting completely
• Mixed motivation: You could find it harder to stay focused because the goalpost feels farther away

Which method is more effective?

Research shows that both methods can work depending on your choice and the type of person you are. However, quitting abruptly is often more successful.⁷ Additionally, a study found that people who quit cold turkey had a bigger drop in smoking-related biomarkers (measures to track change) in their bodies as compared to those who quit gradually.⁸ 

Another study demonstrated that those who quit gradually can increase their success by using nicotine gum to facilitate the process of completely stopping. Furthermore, researchers have warned that delaying quitting can lower motivation.⁹ If you’re someone who thrives on decisive action, the cold turkey method could be for you. If you are scared of experiencing intense withdrawal, gradual reduction could be a better fit.

Tips to boost success

No matter what method you choose for yourself, quitting can be a daunting process, especially if undertaken without a robust support system. Professional tools such as nicotine replacement therapy, behavioural therapy and support groups can aid with the process of dealing with withdrawal. Patches, gum, and lozenges can help control cravings. 

Therapeutic interventions could help you identify situational triggers that reinforce the ritual of smoking. People smoke in certain instances, such as hanging out in cafes or bars with their friends, while driving, or after waking up. Emotional triggers can include feeling stressed or angry. 

Additionally, the act of smoking is highly ritualised in a few people who are regular users of nicotine. Exhaling smoke is repeated multiple times in the day for months and sometimes years on end. Therefore, it is postulated that the conditioning developed in smokers can be a major factor in relapses that occur in people years after they stop smoking. An extremely stressful situation combined with responsive nicotine receptors could be enough for you to start smoking again.¹⁰

How do I quit?

1. Set a date, mark it on your calendar, and tell someone you trust about your goal
2. Understand your triggers by yourself or with the help of a mental health professional. Triggers can include stress, boredom, alcohol, and certain people or places
3. Plan distractions such as walking, chewing gum, drinking water, or trying breathing exercises when cravings hit
4. Celebrate milestones to track and reward your progress
5. Don’t be too hard on yourself, as relapses happen more commonly than you might think. Focus on getting back on track as soon as possible
6. Know that relapsing doesn’t mean failure. It can be a part of the journey for many people. The key is to learn from the relapse, reasonably adjust your plan, and try again
7. The goal is to make progress, not to have the perfect journey

FAQs

Are there any medications that can help me quit smoking?

Yes. Options include:

• Nicotine Replacement Therapy (NRT): Gums, patches, lozenges
• Bupropion: A non-nicotine prescription tablet that reduces cravings
• Varenicline: Reduces cravings and blocks nicotine’s pleasurable effects

Always speak with a healthcare provider before starting any medication.

Who can I talk to for help?

You can reach out to:

• Doctors or primary care providers
• Counsellors or psychologists
• Support groups (online or in person)
• Friends and family who support your goal

Summary

Quitting smoking is a challenging but life-changing decision. Nicotine, the addictive substance in tobacco, affects brain chemistry, making cessation difficult due to withdrawal symptoms like cravings, irritability, and restlessness. There are two main strategies for quitting: cold turkey, which involves stopping abruptly, and gradual reduction, which involves slowly decreasing nicotine intake over time. 

Each method has its benefits and drawbacks. Cold turkey offers a faster detox and a sense of decisiveness, but may come with intense withdrawal symptoms. Gradual reduction provides a smoother transition with fewer withdrawal effects, though it requires more time and discipline. Ultimately, the best method is the one that aligns with your lifestyle, personality, and commitment.