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Smoking withdrawal symptoms

Hi Alice...

I would like to know all the withdrawal symptoms of quitting smoking. Also how long do these symptoms last and do they come all at once or one by one? Without using nicotine replacements, how does one deal with them? Plus, any suggestions to avoid weight gain?

How long does it take to get rid of withdrawal symptoms? What do you do if you have a headache — have a normal pain killer or what?

Dear Reader, 

Quitting smoking can certainly be a challenge, but with some preparation, some of the more common setbacks can be anticipated. When it comes to withdrawal symptoms, people may experience both physical and emotional symptoms (more on these in a bit), which can last from a few days to a few weeks. Each person experiences withdrawal differently, so the intensity and the types of symptoms may vary depending on how long, how much, and how recently someone has smoked. While nicotine replacement therapies are recommended aids for those trying to quit smoking, some people have found help through alternatives such as mindfulness, counseling, coaching, and other behavioral interventions. 

Nicotine is an addictive drug naturally occurring in tobacco and added to most cigarettes, e-cigarettes, and tobacco products. It typically produces pleasant feelings in the body. When the body doesn't receive the nicotine it craves, uncomfortable withdrawal symptoms can set in. These symptoms typically include: 

  • Intense craving for nicotine 
  • Irritability 
  • Headaches 
  • Difficulty concentrating 
  • Trouble sleeping 
  • Increased appetite and weight gain 
  • Anxiety 
  • Restlessness 

Most smokers who quit experience some form of nicotine withdrawal. Luckily, the discomfort of withdrawal is often short-lived, with symptoms often most noticeable within the first days after quitting and gradually subsiding over time. Although quitting can be tough and uncomfortable, there are some benefits that can occur almost immediately after the last puff. 

  • Twenty minutes after quitting: Heart rate and blood pressure drop. 
  • A few days after quitting: The carbon monoxide level in the blood drops to normal. 
  • Two weeks to three months after quitting: Blood circulation improves and lung function increases. 
  • One to nine months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection. 
  • One year after quitting: The excess risk of coronary heart disease is half that of a smoker. 
  • Five years to ten years after quitting: The risk of mouth, throat, and voice box (larynx) cancers is cut in half. Your stroke risk decreases. 
  • Ten years after quitting: Your risk of lung cancer is about half that of a person who is still smoking (after 10 to 15 years). Your risk of cancer of the bladder, esophagus, and kidney decreases. 
  • Fifteen years after quitting: The risk of coronary heart disease is close to that of a nonsmoker. 

List adapted from the American Cancer Society 

For help with starting to quit smoking, you may consider a few avenues. Nicotine replacements can help mitigate physical dependence and lessen the symptoms of withdrawal. Typically, these replacement items contain smaller amounts of nicotine to help swap out what you would get from a cigarette and the smaller amount helps reduce your intake over time. The U.S. Food and Drug Administration (FDA) has also approved several medications for smoking cessation, including options that don't contain nicotine. 

For those not interested in using nicotine replacements or other medications, there are alternative methods. Some people decide to go cold turkey (where they stop using cigarettes entirely and don’t use any nicotine replacement). Others start to wean off gradually by reducing the amount they smoke each day or opting for cigarettes with less nicotine in them. Another option is using e-cigarettes as a cessation tool. However, it may be helpful to know the evidence is inconclusive and that using e-cigarettes to quit may cause dual use of e-cigarettes and cigarettes. If none of these options resonate or have worked in the past, others have reported that acupuncture, hypnosis, yoga, or meditation have helped them quit as well, though there isn't conclusive evidence to support the effectiveness of these methods. If you're interested in exploring more, consider other tips from the American Cancer Society that highlight different behavioral strategies. 

Note that quitting without medication can make the physical symptoms of withdrawal more pronounced as compared to using medication. The current recommended treatment is a combination of medication and behavioral interventions to address both the physical and emotional symptoms of withdrawal. 

Weight gain can be a common concern for those quitting, and it may be helpful to know most studies indicate the average amount of weight gained when quitting is less than ten pounds. It can be beneficial to focus on quitting smoking first and then managing any weight that may have been gained. Since nicotine can suppress someone's appetite, reducing the amount you smoke may cause someone to feel hungrier. If you’re looking to mitigate any weight gain, it may be helpful to include physical activity in your daily routine and opt for nutritious meals and snacks. Not only may these lifestyle behaviors help prevent weight gain, but they can also serve as stress relief, making it easier to quit smoking. Additionally, it may be helpful to get connected to a medical professional or nutritionist to discuss changes in eating habits and physical exercise to make sure you’re changing your habits in a way that works best for you. 

Headaches can be another common withdrawal symptom that over-the-counter medications may help relieve. Medications such as acetaminophen and ibuprofen may offer some short-term relief; however, it may be worth noting that nicotine can reduce the effectiveness of many medications. Nicotine not only suppresses appetite but can impact the way medications are processed in the body, causing them not to be absorbed as well or eliminated from the body at a faster rate. Because of this, if you’re having trouble with headache relief, it may be helpful to connect with a medical provider to discuss dosage or if you need a prescription-strength pain reliever. 

Smokers wanting to quit may also choose to make use of another non-medical strategy: getting support from an array of groups and phone counseling programs. Smokefree.gov is an example of an online resource that provides information on smoking, quitting techniques, and withdrawal and cessation support. If you're a student looking to quit, check if your campus' health services offer cessation support, as many schools have similar programs. Additionally, if you're an employee at a company that offers benefits to their employees, it may be worth investigating whether or not they offer help with smoking cessation. 

All the best, 

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Last updated Nov 03, 2023
Originally published Jun 20, 2008