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Respiratory Resource Center

How to Quit Smoking Part 2: Coping with Nicotine Withdrawal & Choosing a Quit-Smoking Medication

Mar 15, 2020 10:57:00 PM / by Devon Slavens

How to Quit Smoking Part 1: Overcoming Doubts & Finding Resources to Help You Quit (1)

Nicotine withdrawal is one of the most difficult challenges you will have to overcome when you first quit smoking. In fact, it's one of the main reasons that smokers tend to relapse in the first few days and weeks after quitting.

 

However, as long as you plan ahead, you can minimize your withdrawal symptoms and increase your chances of making it through those critical first weeks.

 

In this post, we're going to tell you all about nicotine withdrawal and what kinds of symptoms you can expect when you stop smoking. Then, we'll introduce you to some tools to help you cope with tobacco cravings, including strategic plans for distraction and quit-smoking medications that are scientifically proven to make it easier to quit.

 

In the final sections, we'll go over each type of quit-smoking medication one-by-one, including all the different forms of nicotine replacement therapy and non-nicotine medications like Chantix and Zyban. We'll go over their strengths, weaknesses, side-effects, and how to use each medication properly so you can better weigh your options and choose the ones that are best for you.

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What is Nicotine Withdrawal?

 

 

Nicotine
Nicotine, an addictive chemical in cigarette smoke.
 

 

 

Nicotine is one of the main reasons that smoking is so addictive, and it's also one of the biggest reasons that quitting smoking is so hard. Nicotine dependence is so powerful that most smokers start to get nicotine withdrawal symptoms just a few hours after their last smoke.

 

Soon after you quit smoking, nicotine withdrawal can cause a variety of physical and mental symptoms that make you feel worse for awhile. However, these symptoms are only temporary, and will disappear in a few weeks after your body adjusts to the change.

 

Nicotine withdrawal is essentially your body's reaction to no longer getting a steady supply of nicotine from smoke. Heavy smokers tend to have worse withdrawal symptoms than light smokers, and specific symptoms can vary widely from person to person.

 

 

smoking-4271096_1280

 

 

Physical Symptoms of Withdrawal:

  • Dry mouth
  • Headaches
  • Nausea
  • Fatigue
  • Sweating
  • Coughing
  • Digestive issues
  • Increased appetite
  • Difficulty staying asleep
  • Weight gain

 

Psychological Symptoms of Withdrawal:

  • Strong nicotine cravings
  • Irritability
  • Anxiety
  • Poor mood and mood swings
  • Feeling jittery or restless
  • Difficulty concentrating

 

Nicotine withdrawal symptoms usually start within 24 hours of your last cigarette and reach their peak in about three days. While those first days can be very difficult, once you make it through, you'll be more likely to succeed in staying smoke-free.

 

Your withdrawal symptoms should begin to get better after just a few days, improving little by little over the course of several weeks. By the time you make it one whole month without smoking, chances are that most of your symptoms will have already disappeared.

 

However, everyone experiences withdrawal differently, so don't be surprised if your symptoms are different from other smokers' or follow a different timeline. For example, many ex-smokers find that their nicotine cravings stick around for longer than the other symptoms.

 

Fortunately, your withdrawal symptoms will go away eventually, as long as you continue to abstain from smoking. In fact, you'll find that they'll quickly be replaced with a variety of positive mood and health benefits.

 

But until the withdrawal wears off, you'll need some strategies for coping with the initial negative symptoms. In the next sections, we'll show you some helpful strategies and tools (including quit-smoking medications) you can use to make it through.

 

Make a Distraction Plan

 

 

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It's much easier to ignore cravings and temptations when you have something—anything—else to focus on. That's why you should plan some activities you can use to keep yourself busy on the first day you quit and beyond.

 

Fun activities like hobbies, movies, and social activities with friends are a good place to start. Physical activities like walking and biking are also a great way to take your mind off your worries, and they give you the added satisfaction of doing something positive for your health.

 

Practicing self-care at home is another healthy way to take your mind off smoking; this includes relaxing activities like taking a bath, writing in a journal, and practicing mindfulness meditation. However, you should also find things to do outside of your home that get you away from your normal routine.

 

Just about anything you like to do can be an effective distraction from the desire to smoke, as long you actually remember to to do it. Unfortunately, it's easy to forget all the things you planned to do in the moments you need them the most.

 

 

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Your mind isn't always is the best place to think up distractions when you're already in the middle of a tobacco craving. So, instead of leaving it up to your brain when it's busy grappling with the temptation to smoke, you should put your plan down in writing somewhere you can reference it on the fly.

 

First, take some time to really think about activities you like to do that could work as potential distractions from smoking. Then, take the time to write them down on paper, or type them into a document on your phone.

 

Just make sure you keep your plan in a place that you can access it easily whenever a sudden craving hits. That way, you'll always have a handy list of strategies to choose from, even when your brain has trouble remembering the details of your quit-smoking plan on its own.

 

You might want to make a few separate lists of specific distractions you can use in different settings and situations. For example, you might want a list of activities you can do at home, a list of things you can do outside the house, and a list of quick and simple strategies you can use when you're on-the-go or just don't have a lot of time.

 

Here are a few ideas to get you started.

 

Home-Based Distractions:

  • Call or text a friend
  • Try cooking or baking a new recipe
  • Write in a journal
  • Read a book or magazine
  • Watch a movie or favorite TV show
  • Organize a cluttered area of your home
  • Finally do that deep cleaning project you've been putting off
  • Prep some ingredients for a delicious home-cooked meal
  • Color in a coloring book (there are plenty of adult coloring books to choose from that have much more detail than coloring books made for children)

 

 

adult-coloring-book-child-childhood-159583

 

 

Getting-Out-of-the-House Distractions:

  • Take a quick walk (around the block, on a trail, etc.)
  • Go out for coffee by yourself or with a friend
  • Visit a local museum, park, library, or other public place
  • Volunteer at an animal shelter or another organization
  • Join a club (e.g. a sports club, a book club, or a knitting club)

 

 

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Quick & Simple Distractions to Use On-the-Fly:

  • Drink a glass of water or eat a quick snack
  • Listen to a song that makes you feel good
  • Play a quick game on your phone (e.g. a relaxing matching or puzzle game)
  • Watch a short video online
  • Find a quiet place to relax, breathe, or meditate for a moment
  • Focus on your breaths and practice deep breathing exercises

 

 

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Quit-Smoking Medications

 

 

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Using a quit-smoking medication can significantly increase your chances of quitting and staying smoke-free after you quit. They can help you control cravings, reduce withdrawal symptoms, and even help prevent weight gain after you stop smoking.

 

There are two main types of quit-smoking medications: Nicotine replacement therapies and non-nicotine medications like Chantix and Zyban.

 

Nicotine Replacement Therapies

 

Nicotine replacement therapies are the most popular and most frequently recommended types of quit-smoking medications. They come in a variety of different forms, including patches, gum, pills, lozenges, and more; many of them are available over-the-counter, but some of them require a doctor's prescription.

 

Nicotine replacement medications are all designed to give you a specific dose of nicotine in a form that's much safer than inhaling it through smoke. When you use them throughout the day, they help stave off nicotine withdrawal, reducing both symptoms and tobacco cravings.

 

A large number of studies have shown that nicotine replacement therapies can significantly boost your chances of being able to stop smoking for good. In fact, the medications are so effective that many doctors and experts say that they should be an integral part of just about every smoker's plan to quit.

 

 

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The exceptions to this are people with certain health conditions, such as heart disease and diabetes, and women who are pregnant or breastfeeding. If you have an existing health problem, make sure you talk to your doctor before starting any type of quit-smoking medication.

 

Here are some of the main benefits of using a nicotine replacement therapy to help you quit:

  • Increases your chance of quitting smoking successfully by 50 to 70 percent
  • Reduces tobacco cravings
  • Prevents symptoms of nicotine withdrawal
  • Reduces weight gain after quitting (however, you may gain weight after you stop using the nicotine replacement therapy)

 

Nicotine replacement therapy can have some negative side effects, too, and they can vary based on the type of medication you use. Some of the most common negative symptoms are nausea, stomach problems, a racing heartbeat, and difficulty sleeping.

 

It is also possible to overdose on nicotine when you use nicotine replacement therapy, even though it is rare. That's why you should always follow the instructions on the medication and never take more than the maximum dose.

 

Which type of nicotine replacement therapy works best for you will depend on your personal lifestyle and preferences. For example, you might find that certain forms of nicotine replacement medications are easier to use or fit better into your daily routine.

 

You should also consider using more than one type of nicotine replacement at the same time when you quit. Research shows that people who use a combination of nicotine replacement therapies are more likely to succeed in staying smoke-free than those who use just one.

 

However, it's still a good idea to talk to your doctor first, even if you plan to use an over-the-counter nicotine replacement therapy. He can help you explore your options, give you helpful advice about side-effects and dosage, and answer any questions or concerns you might have.

 

Most nicotine replacement medications come in a variety of different nicotine doses, and you can estimate how much nicotine you need based on how many cigarettes you're used to smoking every day. In general, heavier smokers need a higher dose of nicotine in order for the therapy to be effective.

 

Now lets take a look at the pros and cons of the different types of nicotine replacement medications.

 

Nicotine Patches

 

 

Nicoderm

 

 

The nicotine patch is one of the most popular forms of nicotine therapy because it's so easy to use. All you have to do is put a sticky patch on your skin, and then you can forget about it for the rest of the day.

 

Nicotine patches work by releasing a slow, steady amount of nicotine that you absorb into your body through your skin. That way, you have a constant supply of nicotine throughout the day to help stave off cravings and withdrawal.

 

One patch lasts 24 hours, so you'll only need to use one patch every day. Because of this, however, you can't adjust the dose in response to sudden cravings; that's why many people pair the patch with another type of nicotine replacement therapy.

 

The patch is waterproof and resilient so it should stay stuck to your skin through showers and other normal daily activities. If it does come off, you can simply replace it with a new nicotine patch.

 

How to Use a Nicotine Patch:

  • Place one nicotine patch on an area of dry, clean, and hairless skin (common places include the stomach, side, and upper arms).
  • After 24 hours, replace with a new patch.
  • You can continue using the patch for 8-12 weeks, or until your cravings and withdrawal symptoms subside (talk to your doctor if you think you need to use it longer).

 

Pros of Nicotine Patches

  • Simple to use
  • Last for 24 hours
  • Can be used in combination with other nicotine replacement therapies
  • Available over the counter

 

Cons of Nicotine Patches

  • Can't adjust the dose
  • Can cause skin irritation (especially if you have a skin condition such as eczema or psoriasis)
  • Can cause side effects, including:
    • Skin irritation and discomfort around and under the patch
    • Skin tingling and itching around and under the patch
    • Nausea
    • Headaches
    • Dizziness
    • Racing heartbeat
    • Muscle pain
    • Difficulty sleeping

 

Nicotine Gum

 

 

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Another option for nicotine replacement therapy is nicotine gum. This is simply a small piece of gum that releases nicotine as you chew it.

 

While nicotine gum is relatively easy to use, you have to chew it for an extended period of time using a stop-start technique. You start by chewing the gum until you feel a tingling sensation in your mouth, then you stop until the tingling subsides.

 

Then, you begin chewing again, stopping once you feel the tingling sensation once more. You have to continue repeating these steps for about thirty minutes in order to get the full nicotine dose.

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This prolonged process is inconvenient for some people, but others find it satisfying to have something to do with their mouth and jaw. By engaging your mouth, like smoking does, it can satisfy oral fixation impulses and make cravings easier to resist.

 

How to Use Nicotine Gum:

  • Avoid eating or drinking 15 minutes before using the gum (and while chewing it).
  • Start by chewing one piece of gum every hour or two (you should use at least 9 pieces a day for the first 6 weeks).
  • After 6 weeks, reduce the number of pieces you use per day by about half, using one piece every 2-4 hours.
  • After 9 weeks, reduce your number of doses by half again, using one piece every 4 to 8 hours.
  • Never swallow the gum.
  • You should stop using the gum after about 12 weeks, or until your cravings and withdrawal symptoms subside (talk to your doctor if you think you need to use it longer).

 

Pros of Nicotine Gum

  • Satisfies oral fixation by engaging your mouth and jaw
  • Lower doses are available over the counter
  • You can adjust the number of doses as needed to curb cravings and withdrawal symptoms

 

Cons of Nicotine Gum

  • Must chew gum frequently throughout the day
  • Must chew each piece of gum for an extended period of time
  • Can leave a bad taste in your mouth
  • Causes a tingling feeling in your mouth
  • Can cause negative side effects, including:
    • Mouth irritation
    • Nausea
    • Jaw pain
    • Getting stuck to dental work
    • Racing heartbeat

 

Nicotine Lozenges

 

 

 

 

A nicotine lozenge is a small tablet that releases nicotine as it dissolves slowly in your mouth. They are quick and simple to use, but you have to use them frequently throughout the day.

 

Nicotine lozenges usually only contain a small amount of nicotine (2 or 4 mg), and are often used in combination with other nicotine replacement therapies like the nicotine patch. You can also get mini nicotine lozenges that dissolve more quickly than regular-sized lozenges.

 

How to Use Nicotine Lozenges:

  • Avoid eating or drinking 15 minutes before using the lozenge (and while the lozenge is in your mouth).
  • Place the tablet between your cheek and your gums.
  • Slowly suck on the tablet until it dissolves completely.
  • For the first 6 weeks, use one lozenge every one or two hours.
  • After 6 weeks, reduce your dosage frequency to one every 2-4 hours.
  • After 9 weeks, reduce the number of doses again to one lozenge every 4-8 hours.
  • Do not chew or swallow the tablet.
  • Do not use more than 5 tablets per 6 hours or use more than 20 lozenges per day.
  • You can continue using them for about 12 weeks (talk to your doctor if you think you need to use them longer).

 

Pros of Nicotine Lozenges

  • Available over the counter
  • Can adjust the frequency of your doses according to cravings and withdrawal symptoms
  • Will not stick to fillings and dental appliances like nicotine gum can

 

Cons of Nicotine Lozenges

  • Must use repeatedly throughout the day in order to be effective
  • Can cause side effects, including:
    • Coughing
    • Heartburn
    • Nausea
    • Gas
    • Hiccups
    • Racing heartbeat
    • Difficulty sleeping

 

Nicotine Nasal Sprays

 

 

Nicorette_Nasal_Spray

 

 

Another type of nicotine replacement therapy comes in the form of a nasal spray. It works by squirting a nicotine-containing liquid directly into your nose, where you absorb it through your nasal lining.

 

With this method, nicotine absorbs into your bloodstream more quickly than most other forms of nicotine replacement therapy, including nicotine lozenges and gum. This makes it particularly useful for quickly countering sudden tobacco cravings.

 

How to Use a Nicotine Nasal Spray

  • You will need to prepare (or prime) the spray before using a new spray bottle for the first time; to do this, simply spray the bottle several times into a sink or towel until you see a fine mist.
  • To take one dose, tilt your head slightly backward and squirt one quick spray (without sniffing or inhaling) into both nostrils.
  • If it begins to run out of your nose, keep your head tilted and sniff gently to keep the medication in your nostrils.
  • In most cases, you should start out by using the nicotine spray once or twice per hour.
  • You can continue using the nicotine nasal spray for 12-14 weeks (talk to your doctor if you think you need to use it for longer).

 

Pros of Nicotine Nasal Sprays:

  • Works faster than most other nicotine replacement medications
  • Can adjust dose frequency according to cravings and withdrawal symptoms

 

Cons of Nicotine Nasal Sprays:

  • Only available by prescription
  • Must use repeatedly throughout the day in order to be effective
  • Not recommended for people with existing nasal or sinus problems
  • Can trigger allergy-like symptoms (sneezing, coughing, watery eyes)
  • Can cause other side effects, including:
    • Nose and throat irritation
    • Headache
    • Racing heartbeat
    • Nervousness

 

Nicotine Inhalers

 

 

 

Nicorette_Inhalator

 

 

Nicotine inhalers are small devices that you use to inhale nicotine into your mouth. This makes using a nicotine inhaler feel similar to smoking, which is a major part of its appeal.

 

Most nicotine inhalers look very different from the types of inhalers prescribed for health conditions like asthma. They generally have two parts: a mouthpiece and matching nicotine-containing cartridges.

 

When you attach the cartridge to the mouthpiece and take a puff, it turns the nicotine into a vapor that you can suck into your mouth. Despite its name, however, you do not inhale the vapor all the way into your lungs; instead, you hold the vapor in your mouth for several seconds before blowing it out.

 

How to Use a Nicotine Inhaler:

  • The number of doses you take each day, and how frequently you take them, will depend on the type of inhaler you use as well as your doctor's recommendation.
  • Follow the instructions given to you by your doctor and the directions listed on the medication to use your nicotine inhaler properly.
  • You should practice using your inhaler in front of your doctor to make sure you use the correct technique.

 

Pros of Nicotine Inhalers

  • Can be used in combination with other nicotine replacement therapies
  • Can adjust dose frequency according to cravings and withdrawal symptoms
  • Mimics the hand-to-mouth feeling of smoking and helps satisfy oral fixation

 

Cons of Nicotine Inhalers

  • Only available by prescription
  • Can be difficult to use correctly
  • Not recommended for people with asthma and other lung conditions
  • Can cause side effects, including:
    • Mouth and throat irritation
    • Runny nose
    • Headache
    • Nausea
    • Nervousness
    • Racing heartbeat

 

Other Quit-Smoking Medications

 

 

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Bupropion (Zyban)

 

 

Zyban

 

Bupropion, which is also known by the brand name Zyban, is in an altogether different category from nicotine replacement medications. In fact, bupropion is classed as an antidepressant, always requires a prescription, and doesn't contain any nicotine at all.

 

Instead, bupropion works directly in the brain, altering chemical signals to curb nicotine cravings and reduce withdrawal symptoms. According to research, bupropion actually blocks the effects of nicotine in your brain and can double your long-term chances of quitting.

 

Bupropion isn't for everyone because it can have serious side effects, and you must monitored by your doctor the whole time you take it. However, since it has antidepressant properties as well as smoking-cessation benefits, bupropion can be particularly helpful for smokers who also have depression.

 

It takes awhile for the chemical changes caused by bupropion to take effect, so you'll need to begin taking the medication at least a week before you quit smoking. With your doctor's permission, you can use bupropion by itself or in combination with a nicotine replacement therapy.

 

In most cases, your doctor will prescribe the medication for seven to nine weeks. Toward the end of the treatment, however, you might take a smaller dose in order to ease you gradually off the treatment.

 

Pros of using Bupropion:

  • Reduces symptoms of nicotine withdrawal
  • Reduces how much you enjoy smoking
  • Reduces weight gain after quitting
  • Taken as a pill
  • You may be able to use it in combination with nicotine replacement therapy

 

Cons of using Bupropion:

  • Prescription only
  • Can have side effects, including:
  • Insomnia
  • Dry mouth
  • Anxiety
  • Irritability and agitation
  • Increased heart rate
  • Depression
  • Headaches
  • Dizziness
  • Abdominal pain
  • Back pain

 

Varenicline (Chantix)

 

 

Champix

 

 

Like bupropion, the quit-smoking medication Varenicline—more commonly known as Chantix—does not contain nicotine. However, it is not an antidepressant, and it actually works somewhat similarly to nicotine replacement therapies.

 

Chantix works primarily by activating nicotine receptors in the brain, while at the same time preventing actual nicotine from being able to activate those same receptors. This does two important things:

 

First, it reduces nicotine cravings and withdrawal symptoms by “tricking” your brain in to thinking that it's getting nicotine when it's not. It also makes smoking less enjoyable, because any nicotine you smoke won't be able to trigger the good, pleasurable feeling in your brain like it used to.

 

In order for Chantix to start working by the time you quit, you will need to start taking it at least one week in advance. Most people need to continue taking the medication for about twelve weeks.

 

Pros of Using Chantix:

  • Reduces the enjoyment of smoking
  • Reduces cravings and withdrawal symptoms
  • Reduces weight gain after quitting smoking
  • Taken as a pill
  • Can be used in combination with nicotine replacement therapy
  • You can begin taking Chantix before you quit, while you are still smoking

 

Cons of Using Chantix:

  • Prescription only
  • Treatment lasts longer than some other quit-smoking medications (12-24 weeks)
  • It can have side-effects, including:
    • Nausea
    • Indigestion
    • Stomach pain
    • Constipation
    • Gas
    • Vomiting
    • Headaches
    • Dry mouth
    • Drowsiness
    • Insomnia
    • Unusual dreams

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Conclusion (Until Part 3)

 

Now that you understand nicotine withdrawal and know some basic ways to manage it, you're well on your way to gathering all the resources you need for a successful quit-smoking plan. In part 3 of this guide, we'll show you how to put everything you've learned together and take that next step to actually quit.

 

We'll also introduce to you to a variety of practical strategies you can use to stay quit and continue to manage tobacco cravings throughout your daily life. These techniques are indispensable tools for staying quit long-term and embracing smoke-free living as your new—and improved!—normal.

 

How to Quit Smoking Part 3: Taking the First Steps and Strategies for Staying Smoke Free

Topics: COPD, Medication and Treatment, Respiratory Resource Center, Tips and Hacks

Devon Slavens

Written by Devon Slavens

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