Nicotine withdrawal

Nicotine withdrawal
Classification and external resources
Specialty psychiatry
ICD-10 F17.2
ICD-9-CM 292.0
MedlinePlus 000953

Nicotine withdrawal is a group of symptoms that occur in the first few weeks upon the abrupt discontinuation or decrease in intake of nicotine. Symptoms include cravings for nicotine, anger/irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger or weight gain, and difficulty concentrating.[1] A quit smoking program may improve one’s chance for success in quitting nicotine.[1] Nicotine withdrawal is recognized in both the American Psychiatric Association Diagnostic and Statistical Manual and the WHO International Classification of Diseases.


The most documented symptoms are cravings for nicotine, anger/irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger or weight gain, and difficulty concentrating.[1] Symptoms are usually strongest for the first few days and then dissipate over 2-4 weeks.[2] Withdrawal symptoms make it harder to quit nicotine products and most methods for quitting smoking involve reducing nicotine withdrawal.[1] The most common symptoms are irritability, anxiety and difficulty concentrating. Depression and insomnia are the least common. Other withdrawal symptoms may include constipation, cough, dizziness, drowsiness, headache, impulsivity, fatigue, flu symptoms, mood swings, mouth ulcers, and increased dreaming.[2] Cessation of nicotine usually increases eating and weight, decreases memory, decreases the ability to pay attention and concentrate on tasks, and decreased heart rate. Cessation of tobacco can also require changes in levels of various medications.


Nicotine withdrawal is the effect that nicotine-dependent individuals experience after they discontinue or decrease nicotine use. Nicotine is an addictive substance found most commonly in tobacco and tobacco products including cigarettes, cigars, chewing tobacco, pipe tobacco, snus, snuff, and most e-cigarettes. Withdrawal is the body’s reaction to not having the nicotine it had become accustomed to. Withdrawal is most common and intense in cigarette smokers, intermediate in smokeless users, and rare in users of nicotine medications. The symptoms of nicotine withdrawal usually appear 2-3 hours after last intake of nicotine, peak in 2-3 days, and last for 2-3 weeks, although they can last longer in some users.[1] In a minority of smokers, cravings may last for years. Nicotine withdrawal causes few physical signs and is not life-threatening but associated cravings can be as severe as withdrawal from alcohol and illegal drugs. There is some evidence that stopping nicotine may make a prior psychiatric problem worse but this is uncertain. After the initial withdrawal period, anxiety, depression, and quality of life generally improve such that former smokers are better off than continuing smokers. If smokers regularly do not smoke in certain situations, entering these situations can precipitate withdrawal symptoms through a process called conditioned withdrawal.


Various etiological models have been proposed to explain the causes of nicotine withdrawal. Nicotine binds to nicotinic receptors in the brain that, in turn, cause an increase in dopamine. Dopamine is the major chemical that stimulates reward centers in the brain. The brain recruits an opposing force to dampen the effects of nicotine and this causes tolerance (the reduction in the effect of nicotine). The onset of this opposing force and the fact that the brain becomes used to and dependent on nicotine to function normally is known as physical dependence. When nicotine intake is decreased, the brain's opposing force is now unopposed and this causes withdrawal symptoms. It also appears that opiate, serotonergic, glutamic, cannabinoid, and corticotrophin receptors may play a role in nicotine withdrawal.


Gradually reducing nicotine intake causes less withdrawal than abruptly stopping. Another way to reduce nicotine withdrawal symptoms is to provide the body with an alternative source of nicotine (nicotine replacement therapy) for a temporary period and then taper this new nicotine intake. Other medications used for quitting smoking include bupropion, varenicline, cytisine, nortriptyline, and clonidine. Non-medications treatments such as increased exercise can also reduce nicotine withdrawal. Many behavior changes such as avoiding situations where one usually smoked, planning ahead to deal with temptations, and seeking the support of friends and family are effective in helping people quit smoking, but whether this is due to reduced withdrawal is unclear.


Most daily cigarette smokers have at least one of the above withdrawal symptoms when they try to stop and half have four or more.[3] Withdrawal can occur in non-daily users, however heavier users and those with a past or current psychiatric disorder tend to have more severe withdrawal. Genetics also influence the severity of withdrawal. Newborns of smokers do not suffer nicotine withdrawal.

See also


  1. 1 2 3 4 5 Linda J. Vorvick (2013-08-29). "Nicotine and Tobacco". Medline Plus. Retrieved 2015-05-21.
  2. 1 2 Hughes, JR (2007). "Effects of abstinence from tobacco: valid symptoms and time course". Nicotine & Tobacco Research. 9 (3): 315–27.
  3. Hughes, JR (2007). "Review: Effects of abstinence from tobacco: Etiology, animal models, epidemiology, and significance: A subjective review". Nicotine & Tobacco Research. 9 (3): 329–339.
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