Nicotine withdrawal is the combination of psychological and physical symptoms that occur as nicotine leaves the body.¹ Nicotine is a highly addictive substance found in cigarettes, cigars, pipe tobacco, e-cigarettes (or ‘vapes’) and smokeless tobacco products like chewing tobacco and snuff. When individuals who are regular nicotine users suddenly quit or significantly reduce their nicotine intake, they may experience a range of physical and psychological symptoms as their body adjusts to the absence of nicotine.

Nicotine Addiction

Nicotine and its Addictive Properties

Nicotine influences tobacco use and is the underlying cause of tobacco addiction. It also acts as a pharmacological aid to smoking cessation. Tobacco leaves contain nicotine, a naturally occurring alkaloid compound that functions as a natural insecticide. It constitutes approximately 95% of the total alkaloid content and accounts for approximately 1.5% by weight of commercial cigarette tobacco, making it the principal alkaloid. Oral snuff and pipe tobacco contain nicotine concentrations comparable to those of cigarette tobacco, whereas chewing tobacco and cigars contain approximately half the nicotine concentration of cigarettes.²    The majority of smokers engage in regular tobacco use due to nicotine addiction. Substance abuse and compulsive seeking and use, despite adverse effects, are defining characteristics of addiction. A majority of smokers wish to quit smoking permanently each year. However, just 6% of smokers succeed in quitting within a given year.  How nicotine is metabolised by the body contributes to its addictiveness. When the smoke from cigarettes enters the lungs, absorption of nicotine occurs rapidly in the blood and it is delivered rapidly to the brain, where the nicotine concentration reaches its maximum peak within 10 seconds of inhalation. However, the immediate impacts of nicotine and the corresponding sense of satisfaction diminish rapidly as well. This continuous cycle prompts the smoker to maintain the dosage to sustain the drug’s pleasant effects and avoid withdrawal symptoms.³ 

Nicotine Dependence and Impact on the Body

Withdrawal is an inevitable consequence of substance dependence, which develops when the body becomes accustomed to a drug’s presence. Regular nicotine users may develop symptoms including:

• Depression
• Anxiety
• Irritability
• Nicotine Cravings
• Cognitive and attention deficits
• Sleep disturbances
• Increased appetite
• Anger, frustration & irritability
• Restlessness
• Insomnia⁴

If they abstain for an extended period. The onset of these withdrawal symptoms can occur within a few hours of the final cigarette, prompting individuals to return to tobacco use without delay. 

Withdrawal symptoms peak within a few days following the cessation of smoking and typically diminish within a few weeks. However, symptoms may persist for months in certain individuals, and the intensity of the withdrawal symptoms seems to be predisposed by genetics.

Individuals undergoing nicotine withdrawal also exhibit neurocognitive impairments, including difficulties related to attention and memory. These neurocognitive withdrawal symptoms will contribute to continued smoking.

The enjoyable effects of smoking are often linked to the feel, smell, and sight of a cigarette, as well as the ritualistic process of acquiring, lighting, and smoking cigarettes. These elements can exacerbate withdrawal symptoms or cravings for individuals who smoke.³   

Timeline of Nicotine Withdrawal

Nicotine Withdrawal is so stressful because individuals typically experience multiple symptoms simultaneously after quitting the use of nicotine. 

Immediate withdrawal symptoms

Symptoms of nicotine withdrawal are most severe following the stoppage of nicotine use. The following are some symptoms that might be present:

• Having a strong desire to smoke
• A heightened sense of hunger
• Tingling in the hands and feet
• Sleep disturbances  

Short-term withdrawal effects

After more than 24 hours have passed, you will continue to experience significant nicotine withdrawal symptoms for several days. The following symptoms might persist at that time:

• Strong nicotine cravings
• Anxiety and Agitation
• Irritability
• Depressed mood
• Increased wheezing and sore throat 
• Sleep disturbances

Long-term withdrawal effects

You will observe a gradual reduction in the severity of withdrawal symptoms over the subsequent weeks following the initial week. The following symptoms may manifest during the period: 

• Occasional but manageable cravings
• Depressed mood
• Concentration difficulties

Factors Influencing Nicotine Withdrawal

The onset of symptoms occurs between 4 and 24 hours after the cessation of chronic use of nicotine-containing products. How nicotine is consumed predominantly influences the intensity of withdrawal symptoms. However, specific short nucleotide polymorphisms (SNPs), the most common type of genetic variation among people, have been linked to an increased tendency to consume nicotine in larger quantities more frequently and to experience more severe withdrawal symptoms.  Both Genetic and Environmental factors may influence nicotine withdrawal.

• Genetic Factors

Genetic factors may contribute to 29-53% of the variations observed in withdrawal symptoms.⁵  Genes play a significant role in determining an individual’s susceptibility to nicotine addiction, their ability to quit smoking, and the severity of withdrawal symptoms.  

• Environmental Factors 

Environmental factors play a significant role in influencing the experience of nicotine withdrawal. Certain environmental factors that may influence nicotine withdrawal may include:

1. Having a supportive social network can greatly influence the success of quitting smoking.
2. The availability of cigarettes in the environment can contribute to smoking and impact withdrawal.
3. High stress can contribute to smoking and impact withdrawal
4. Cultural and social norms surrounding smoking can affect an individual's perception of quitting. 

Treatment 

A healthcare provider is prepared to discuss potentially beneficial medications when you are prepared to quit smoking. Nicotine Replacement Therapy may help to reduce withdrawal symptoms. Nicotine is present in trace amounts in replacement therapies, but cancer-causing and other toxic compounds found in tobacco products are absent. With this minute quantity of nicotine, withdrawal symptoms are reduced. Enhancing your well-being and comfort will help the process of quitting tobacco products.

Nicotine Replacement therapy is available as:

• Skin Patches
• Chewing Gum
• Lozenges
• Nasal Spray
• Inhaler

Other medications include Varenicline and the antidepressant Bupropion, which are employed to manage withdrawal symptoms. Varenicline functions as a smoking cessation aid by inhibiting the pleasant effects of nicotine on the brain. 

Nicotine Replacement Therapy and other medications treat only physical nicotine dependence. To manage the psychological and emotional challenges associated with dependence, additional assistance will be required. 

Non-medical ways to manage withdrawal symptoms

• Engage in physical activity regularly to maintain an active body
• Spend time with non-smoking friends
• Keep your hands busy. Find your preferred stress ball that would keep your hands busy
• Take a deep breath whenever the desire to use nicotine arises
• Distract yourself¹ 

Coping Strategies

• Try nicotine replacement products, or consult your physician regarding alternative treatments
• Bear in mind that cravings are temporary
• Steer clear of situations and activities that you used to associate with using tobacco products
• Try chewing on carrots, or chewing gum as an alternative to smoking. Keeping your jaws occupied can reduce the psychological urge to smoke
• Consider this exercise: Inhale deeply through your nostrils and exhale gradually through your mouth. Perform this exercise at least 10 times⁴ 

 Challenges in Nicotine Withdrawal

• You will feel irritable or on edge
• Difficulty falling asleep
• You will feel a difficulty in thinking clearly
• Reduced heart rate
• Increase in hunger 

What are the triggers for tobacco use?

• Social triggers include being in the presence of tobacco users or participating in social gatherings or events
• Emotional triggers include feelings of stress, anxiety, boredom, loneliness, sadness, or frustration following an argument
• Pattern or activity triggers include commencing the day, being in a car, consuming tea or coffee, and enjoying a meal or an alcoholic beverage⁴ 

 Benefits of Nicotine Withdrawal

• Promotes overall well-being and improves quality of life
• Reduces the risk of mortality and can increase life expectancy by up to 10 years
• Decreases the likelihood of developing cancer, cardiovascular disease, chronic obstructive pulmonary disease, and poor reproductive health outcomes⁶ 

FAQs

What are the main withdrawal symptoms of nicotine?

• Having urges or cravings to smoke.
• Feeling irritated, grouch or upset
• Feeling jumpy and restless
• Having a hard time concentrating
• Having trouble sleeping
• Feeling hungrier or gaining weight
• Feeling anxious, sad or depressed.⁷ 

What do nicotine cravings feel like?

• Physical Cravings: The withdrawal symptoms can be physically experienced by the individual.  Physical cravings are frequently accompanied by sensations of anxiety or tension and manifest as a tightness in the throat.
• Psychological Cravings: These are triggered by everyday events. Individuals who smoke can develop a variety of indicators that indicate they require a cigarette. You might choose to light up a cigarette when facing stress, while driving, dining or engaging in social activities. 

How long does it take to recover from nicotine?   

After two to four weeks, withdrawal symptoms typically vanish entirely for many individuals.

What is the timeline for nicotine withdrawal?

The onset of withdrawal symptoms occurs between 4 and 24 hours after the last cigarette is smoked.

Summary

Nicotine Withdrawal is the psychological and physical symptoms that occur as nicotine leaves your body. Nicotine is a highly addictive substance and you may experience negative symptoms as your body adjusts to the absence of nicotine. Withdrawal is an inevitable consequence of substance dependence. Symptoms of nicotine withdrawal include nicotine cravings, anger, difficulty concentrating, insomnia, restlessness, anxiety, depression, hunger, or increased appetite. 

Both genetic and environmental factors influence withdrawal symptoms. Nicotine withdrawal symptoms can be managed by both medical and non-medical approaches. Nicotine Replacement Therapies can help to reduce nicotine withdrawal symptoms. Non-medical approaches may include engaging in physical activity, spending time with non-smoking friends, and keeping your hands busy. Several coping strategies can be employed to reduce nicotine withdrawals. Although quitting the use of tobacco products is challenging, various benefits can be associated with the decision to quit smoking.