Each year, nearly 450,000 Americans die from smoking related illnesses. That’s more than all deaths from HIV/AIDS, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined. So why do smokers continue to light up when statistics like these make it clear that they should quit? Nicotine addiction is powerful, which makes quitting difficult—but it is possible. There are now 45 million smokers, but 47 million successful quitters. By understanding nicotine addiction and withdrawal, you can be better prepared to crush out this destructive habit for good.
Understanding the Addiction
When you smoke, nicotine speeds to receptors that trigger the release of dopamine, your body’s feel-good chemical. Nicotine causes dopamine to be released in several parts of the brain: the mesolimbic pathway, the corpus striatum, the nucleus accumbens and the frontal cortex (highlighted above). Over time, the receptors where nicotine can connect become desensitized. This means that they lose some of their ability to send signals that result in the release of dopamine, and other neurotransmitters. As a result, more nicotine receptor sites are created. The overall effect is that smokers who have developed additional receptors need more nicotine to avoid having withdrawal symptoms.
The longer you smoke, and the more you smoke each day, the more severe nicotine addiction becomes. The craving for nicotine intensifies and becomes more frequent. Ignoring the cravings brings on unpleasant withdrawal symptoms. And what alleviates those? Yes, more nicotine.
The Rewards of Nicotine
Let’s face it: If there were no positive outcomes to smoking, no one would ever do it. “There are many motivations to smoke,” says Michael D. Stein, M.D., Professor of Medicine and Community Health at Brown University and author of The Lonely Patient and The Addict. “The dominant one is physical dependence—that is, smokers who try to stop have withdrawal symptoms, and cigarettes relieve the symptoms. But nicotine can also improve attention and vigilance. Smokers smoke when they need to concentrate or focus. Smoking helps some people feel in a better mood, or they feel a high, a buzz. Some smokers enjoy the taste and smell of a cigarette. Finally, smoking serves as an appetite suppressant. People smoke to control their weight.” While all medical experts agree that the health risks are not worth these beneficial aspects, many smokers have a real fear of losing the sense of control and other pleasurable sensations when they stop. So, how can quitters learn to conduct their daily routine smoke-free? Understanding what to expect and planning for withdrawal symptoms is a great place to start.
Managing Nicotine Withdrawal
The physical symptoms of nicotine withdrawal are rough stuff. The brain and body still crave nicotine’s positive effects, so its absence causes quite an uproar. Quitters can experience any combination of irritability, anxiety, depression, sweating, headaches, insomnia, confusion, cramps and weight gain. Understanding what feelings and symptoms accompany nicotine withdrawal is important, because there are steps you can take to manage your symptoms.
1. Craving for nicotine If you aren’t using a nicotine replacement treatment, you may have cravings. Cravings last only a few minutes, but will feel much longer at first. Stay busy, especially during the times when you used to smoke. Plan a small snack or distracting task during these times.
2. Irritability The frustration of leaving your desire for nicotine unfulfilled affects your mood. Know that your emotions will be intensified for the first few weeks after you quit. Talk about your mood, and the fact that you’ve quit smoking, to anyone in the line of fire. Going for a walk or other exercise can take the edge off.
3. Anxiety Smokers with pre-existing anxiety disorders have a harder time quitting. Other quitters may have new feelings of anxiety. Anticipating this frame of mind, and knowing that it’s related to quitting is the first step. Try to wait it out, or take a break to talk to a friend who knows what you are going through.
4. Depression Some of the prescription drugs for smoke cessation treatment also treat depression. If you are quitting without those, realize that you may start to feel down. If you have planned a support system and engaging distractions for your transition to the non-smoking life, rely on them.
5. Sweating Metabolic changes and increased circulation after quitting smoking may bring on sweating. Dress to stay cool, and drink plenty of water.
6. Tingling in hands and feet Your circulatory system is making positive adjustments after you quit, which can create some new sensations. A tingle in the extremities is a good thing. Just wait it out.
7. Headache Could be a circulatory effect, or a result of tension and anxiety from craving. Take ibuprofen or acetaminophen if you usually do. Try deep breathing or meditation to relieve tension.
8. Cramps and nausea Smoking can cause peptic ulcers and other digestive ailments. As your digestive tract recovers from your time as a smoker, you can feel temporary discomfort. Avoid spicy, irritating foods as you wait for this phase to pass.
9. Insomnia Nicotine is a stimulant, so it has definitely affected your sleep-wake cycle. Treat yourself to extra soothing activities before bedtime: a warm bath, a massage, total quiet.
10. Mental confusion Nicotine gives smokers focus and clarity. Its absence can make you feel a bit foggy. When confusion takes over, stop. If you’re in the middle of a task, take a break. Confusion gradually dissipates as you adjust to the absence of nicotine.
11. Weight gain Some smokers fear gaining weight so much they don’t attempt to quit. Most quitters gain fewer than 10 pounds. “Weight gain following smoking cessation is mostly due to decreased metabolic rate, increased food intake, and decreased physical activity” after quitting, says Michael D. Stein, M.D., Professor of Medicine and Community Health at Brown University. “Also, an enzyme called lipoprotein lipase (LPL), which affects fat cells’ metabolism, becomes more active after you quit. And some appetite control agents, including leptin and neuropeptide Y, are influenced by nicotine.” Dr. Stein notes that those who are concerned about gaining weight are more likely to relapse after quitting. Exercise would be a great substitute for smoking, if you’re concerned about gaining weight.
Most of the nicotine withdrawal symptoms are short-lived and symptoms pass in time, usually in less than a week. Withdrawal is the most uncomfortable part of quitting, but getting past this rough patch is the first real challenge in staying away from tobacco for good!
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