Quitting smoking is hard because smoking combines a physical dependence on nicotine with a psychological and behavioural dependence. This article explains both dimensions, the withdrawal symptoms, the benefits of quitting and the help available.
Both a physical and a psychological dependence
According to UCSF, a few minutes after the first puff, nicotine triggers the release of dopamine and other neurotransmitters, which reinforces the urge to continue: this is physical dependence. Many people also keep smoking to avoid withdrawal symptoms.
Psychological and behavioural dependence comes from seeking the effect of nicotine and from the habits attached to it: a cigarette with coffee, after a meal, or when feeling stressed, anxious or angry. The two dependences feed each other, which is why willpower alone is rarely enough.
What are the withdrawal symptoms?
According to the NHS, withdrawal can begin a few hours after the last cigarette. Symptoms are generally strongest during the first week, especially the first three days, and last three to four weeks on average, sometimes a few months in some people. They include:
- strong cravings to smoke;
- difficulty concentrating, restlessness and sleep problems;
- irritability, frustration or anger;
- anxiety, tension or low mood.
Mayo Clinic also lists increased appetite. UCSF mentions possible weight gain. These effects are temporary: cravings ease over time.
Why quit: the risks of smoking and the benefits of stopping
Smoking increases the risk of heart disease, cancer and reproductive problems. By contrast, the WHO describes benefits of quitting that appear gradually:
- 20 minutes: heart rate and blood pressure drop;
- 12 hours: carbon monoxide in the blood returns to normal;
- 2 to 12 weeks: circulation and lung function improve;
- 1 year: the risk of coronary heart disease is about half that of a smoker;
- 10 years: the risk of lung cancer is about half, and the risk of several other cancers (mouth, throat, oesophagus, bladder, cervix, pancreas) falls;
- 15 years: the risk of coronary heart disease is the same as that of a non-smoker.
The WHO also states that quitting after a heart attack reduces the risk of having another by 50%, and that quitting around age 30 gains nearly 10 years of life expectancy compared with continuing to smoke. Quitting also protects people around you who are exposed to smoke.
What methods can help you quit smoking?
Support and medication improve the chances of success. According to UCSF, individual counselling, support groups and telephone helplines roughly double quit rates, and medicines double or triple the chance of quitting; quitting “cold turkey” without help succeeds in about 5% of people after one year. The same source states that there is little evidence that hypnosis or acupuncture do better than medication alone.
- Nicotine replacement: patch, gum, lozenge, inhaler, nasal spray. They supply nicotine without the harmful substances in smoke. The NHS notes that combining a fast-acting product with a slow-release patch is effective.
- Prescription medicines, to be discussed with a doctor because they come with precautions.
- Behavioural support to identify risky situations and change habits.
Ask your doctor or pharmacist for advice to choose a suitable method.
How can you reduce the risk of relapse?
According to the NHS:
- write down your reasons for quitting and keep them in sight;
- avoid places and situations linked to smoking during the first 28 days;
- do a short burst of physical activity or slow breathing when a craving hits;
- keep your mouth busy with sugar-free gum or crunchy vegetables;
- remember that a single cigarette can restart the cycle of cravings and withdrawal.
According to UCSF, most people need several attempts, and a treatment plan can be adjusted if cravings lead you to smoke before the end of the first two weeks. A relapse is therefore not a final failure.
When to see a doctor
Talk to your doctor as soon as you are thinking about quitting, especially if you have heart or lung disease or are pregnant. More intensive support may be useful in case of anxiety, depression or other conditions, according to UCSF. Also seek advice if the withdrawal symptoms seem too hard to bear or last several months.
In Tunisia, ask your doctor about the smoking cessation clinics in your area.
Further reading at La Rose Clinic
Frequently asked questions
How long do withdrawal symptoms last?
According to the NHS, they peak during the first three days and last three to four weeks on average, sometimes a few months.
Are nicotine replacement products useful?
Yes. They relieve cravings without the harmful substances in smoke, and the NHS recommends combining fast-acting and slow-release products.
Does a relapse mean quitting is impossible?
No. According to UCSF, most people make several attempts before succeeding.
Is it still worth quitting at an older age?
Yes. The WHO reports gains in life expectancy even at age 60, about 3 years compared with continuing to smoke.
References
- Tobacco: Health benefits of smoking cessation (WHO) (who.int)
- Managing nicotine withdrawal symptoms (NHS) (nhs.uk)
- Nicotine dependence (UCSF Health) (ucsfhealth.org)
- Nicotine withdrawal (Mayo Clinic Care Network) (mymlc.com)
This article is for information only. It does not replace a medical consultation: if in doubt, talk to your doctor.
