Nicotine Dependence and Withdrawal

Last updated: 02 October 2007

Low or high level of nicotine dependence?

The six questions below will show how dependent you are on the nicotine in tobacco.

So what's the good news?

Within 20 minutes of quitting, your body begins a series of changes that continue for years. For example, four hours after quitting smoking, the nicotine level in your blood is reduced by half. Within hours carbon monoxide in the blood decreases and the oxygen level in blood increases. Within days the ability to smell and taste has improved and physical activity becomes easier. Within three months, coughing, sinus congestion and shortness of breath decrease.

What your score means:

The higher your score on the test, the more likely you are to benefit from using nicotine replacement therapy (NRT) or Zyban to assist with withdrawal symptoms and to quit. Those with a score above five should consider using a higher dose of NRT. Those with a score of four or less may benefit from a lower dose of NRT. The fact sheet Products to help you quit smoking contains more information.

If you have had a health problem, such as a heart attack or stroke see your doctor before you quit. If you're pregnant or planning to start a family it is very important to discuss your quit plan with your doctor.

Nicotine Withdrawal

Nicotine withdrawal is usually worst in the first 24-48 hours of quitting. Few people experience all the symptoms and they don't all happen at once. The symptoms you might experience are a normal and expected part of quitting smoking. The symptoms will gradually decline in intensity and the worst is usually over after a couple of weeks.

Withdrawal is your body's response to ridding itself of dependence on nicotine. Some people think of the withdrawal as 'recovery symptoms'. After about two weeks 'recovery symptoms' should be less severe. If you have a moderate or high level of nicotine dependence and expect withdrawals, using nicotine replacement therapy (NRT) is a smart move.

It's a good idea to let members of your family, friends and workmates know what you're going through. Some of the symptoms of nicotine withdrawal you may experience include:

Irritability and anxiety
Feelings of irritability or anxiety may be experienced as your body adjusts to being without nicotine. It's common to feel anxious when you make a big change in your life. To counter this effect, reduce the amount of stress in your life in the first two weeks of your quit attempt. Do things that relax you while you're quitting. If you only have time for a short break, then a brief walk and change of environment may help.

Difficulty concentrating
The physical changes that are happening in your body and the cravings for a cigarette may make it more difficult to concentrate. Your body is now receiving more oxygen and will adjust to this in a few days. Complete your tasks or activities in small 'bite-size' chunks. You can do this by taking regular breaks and doing something active during those breaks. Your concentration levels will return to normal in a few weeks time.

Restlessness
Some people feel as though they can't sit still and that they need to move about or do something with their hands. Use this restlessness in a positive way by doing some physical activity that you enjoy. As your body is removing nicotine it is able to absorb more caffeine. It may be helpful to reduce your intake of tea, coffee and cola drinks by half. Read the labels on chocolate bars and energy drinks as some of these items also contain caffeine. An increase in caffeine levels may add to your feelings of restlessness or insomnia.

Problems falling asleep or frequent waking
Your sleep patterns may be affected as your body withdraws from nicotine.3 This should ease after about a week. Some people report having unusual or strong dreams, others find that they sleep better. Do something that you find relaxing before you go to bed.

Craving for tobacco
Some people think of cravings as 'desires' for a cigarette. Cravings are normal and expected. They last only a few minutes and have a beginning, middle and an end. As time passes your cravings will be less intense, shorter and happen less often. You may like to think of cravings as 'time limited desires'. Some people keep a diary to document how they feel, including the frequency and intensity of their cravings. This can help to demonstrate that things are improving.

Tingling sensations and dizziness
Tingling in your fingers and toes and dizziness show that the blood circulating through your body has more oxygen in it. Some of the aches and pains you experience are signs that your circulation is improving. This is because more of your smaller blood vessels are opening up and your body is adapting to having more oxygen.

Coughing
Coughing means that your lungs are getting rid of tar and mucus. Try to think of coughing as your lungs now working better to clean themselves.

Appetite changes
Some people start to feel more hungry once they have quit smoking. This is because nicotine reduces the appetite. You may find that you develop a 'sweet tooth'. It may be helpful to take glucose, which is low in kilojoules and may help to satisfy the desire for sweet foods, without eating foods like chocolate cake or ice-cream that can add to your body weight. Glucose is available in liquid or tablet form from pharmacies. People with diabetes should consult their doctor before using any product containing sugars.

A final note
Coping with nicotine withdrawal is a challenge, especially in the first few days. Most withdrawal symptoms gradually reduce over the first couple of weeks. The long-term benefits of quitting will definitely outweigh the short-term difficulties. Stay positive and be kind to yourself while you're experiencing 'recovery symptoms'. And remember, nicotine replacement therapy (NRT) can reduce your body's addiction to nicotine and reduce the symptoms of withdrawal, while you think about changing your habits and triggers for smoking.

Further Information

• If you would like to quit smoking contact the Quitline 131 848 or speak with your doctor or pharmacist.
• Nicotine and other poisons - fact sheet.
• - fact sheet.

• Quitline  http://www.quitnow.info.au