Addiction Nicotine Use Nicotine Withdrawal 7 Symptoms of Nicotine Withdrawal Knowing the signs can help you prepare By Terry Martin Terry Martin Facebook Twitter Terry Martin quit smoking after 26 years and is now an advocate for those seeking freedom from nicotine addiction. Learn about our editorial process Updated on January 14, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by John C. Umhau, MD, MPH, CPE Medically reviewed by John C. Umhau, MD, MPH, CPE John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). Learn about our Medical Review Board Print PeopleImages / Getty Images Nicotine withdrawal is the one thing that many smokers fear when embarking on a smoking cessation plan. It can be a distressing experience for some, triggering a host of physical and psychological symptoms. This doesn't mean that everyone will experience nicotine withdrawal in the same way. People who quit "cold turkey" usually have worse symptoms than those who take a cohesive approach with counseling, support systems, and quit smoking aids including nicotine replacement therapy (NRT). While nicotine withdrawal can be challenging, it's important to remember that it's only temporary. With a little preparation and persistence, you will get through it. What Is Nicotine Withdrawal? Nicotine withdrawal refers to what happens in the body when someone who has been using nicotine regularly stops or cuts down their intake. The symptoms, which can begin within two to three hours after the last use and are strongest a few days later, can be physical and psychological. Nicotine withdrawal is one of the main reasons why quitting smoking or other forms of tobacco is so difficult. The Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines criteria for tobacco withdrawal. This condition was changed from "nicotine withdrawal" in the DSM-IV. The symptoms discussed here are not all the same as the criteria listed in the DSM-5. By understanding some of the signs and symptoms of nicotine withdrawal, you can better prepare for them and know how to act if and when they occur. 1 Nicotine Cravings Smoking urges, commonly known as nicotine cravings, are one of the most challenging and persistent symptoms of nicotine withdrawal. The cravings you feel are caused by nicotinic receptors in the brain. When suddenly deprived of nicotine, the brain will no longer release the "feel-good" hormone dopamine which the body has grown accustomed to. A craving is a physiological response in which the body yearns for something to which it has adapted and become tolerant. Nicotine cravings typically last for five to 10 minutes. They may be extremely uncomfortable, but try to wait them out and remind yourself that the feeling will pass. Chewing nicotine gum or taking a long, brisk walk usually helps. 2 Weight Gain The urge to snack is about more than just replacing cigarettes with food. Nicotine causes changes to cells that make so they don't respond as well to insulin, which can increase your body's blood sugar levels. As a result, when you stop smoking, you can experience a drop in blood sugar and feel the need to consume carbs, sweets, and other foods to satiate this sudden and often unexplained hunger. Thankfully, this effect will stabilize as your body adjusts to being nicotine-free. Research shows that people who quit cigarettes will gain an average of 10 pounds after one year with most of the gain occurring during the first three months. 3 Sleep Disturbances Sleep problems are common side effects of nicotine withdrawal and can run the gamut from insomnia to needing extra sleep during the day. The symptoms are also closely linked to the dysregulation of dopamine, which is also involved in sleep regulation. While sleep disturbances and insomnia are symptoms of nicotine withdrawal, research has indicated that smokers experience worse sleep than non-smokers. 4 Persistent Cough Some people develop a persistent cough after they quit smoking. As odd as this may seem, coughing at this stage is a sign that your lungs are getting better, not worse. When you smoke, the tiny finger-like projections in the lining of your airways, called cilia, will become immobilized and eventually flatten out. After you quit, the cilia will return to their normal shape and function, pushing toxic deposits out of the lungs to be coughed up. You can help relieve this symptom by staying well-hydrated, humidifying the air, and using honey or an over-the-counter cough drop to ease any throat irritation. 5 Flu-Like Symptoms While in the process of quitting, you may experience something popularly referred to as the "quitter's flu." The condition, characterized by a mild fever, malaise, sinusitis, coughing, and body aches, is simply your body's response to an unfamiliar state. The sudden cessation of smoking can trigger an immune response in much the same way as it would respond to a bacteria or virus it considers abnormal. In most cases, a quitter's flu will last for only a couple of days. Nicotine replacement therapy, along with over-the-counter pain relievers, may help ease the symptoms. 6 Mood Changes Stress and irritation are common symptoms of early nicotine withdrawal, triggered by the profound dysregulation of the endocrine (hormonal) and central nervous systems. This stress can not only cause extreme changes in mood, including sudden and irrational outbursts, but it can also trigger short-term physiological changes, including increased blood pressure and heart rate. Memory problems, difficulty concentrating, and dizziness are also common. The psychological symptoms can further deepen if you are sleep-deprived, leading to bouts of anxiety or depression that may require medical treatment. 7 Constipation In addition to the lungs and brain, the digestive tract can be affected when you suddenly stop smoking. Stopping the use of nicotine alters the motility and contraction of the intestines, dramatically slowing the speed by which food is digested. Older research from 2003 revealed that as many as one in six people who quit cigarettes will experience bouts of constipation, generally lasting for one to two weeks. This symptom may be further exacerbated by the "munchies" some people experience while quitting, increasing both the volume of food you eat and intake of foods more likely to cause constipation (such as white bread, chocolate, potato chips, and ice cream). Drinking plenty of water and increasing your intake of dietary fiber can usually help normalize bowel movements. Causes and Treatment for Nicotine Withdrawal Nicotine withdrawal occurs because the body has become dependent on it. Specifically, nicotine stimulates the release of dopamine in your brain, so when you stop using nicotine, there is less released, and this can result in withdrawal symptoms. Nicotine affects other neurotransmitters as well. Behavioral factors are also thought to influence these withdrawal symptoms; for example, just seeing someone smoking or smelling a cigarette can increase cravings. There are a few treatments to help with nicotine withdrawal, including: Nicotine replacement therapies (NRTs): Examples of NRTs include nicotine gum, patches, lozenges, which are available over the counter. Nicotine nasal sprays and inhalers are available with a prescription. Prescription medications: The antidepressant Zyban (bupropion) (also sold under the brand name Wellbutrin) and the smoking cessation aid Chantix (varenicline) can help with symptoms. Speak to a healthcare provider about what treatment might be best for you. In addition to medications and NRTs, you can seek psychological support from a support group, quit-tobacco program, or mental health professional. If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. A Word From Verywell Nicotine withdrawal can be intense and uncomfortable. But this phase of smoking cessation won't last forever and, if prepared, you can learn to manage and cope with the symptoms as they come. Try not to get ahead of yourself and worry about never smoking again. Just focus on today, and do whatever you can to remain smoke-free. In the end, the benefits of quitting far outweigh any short-term discomfort you may experience through withdrawal. 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