Overview, Causes, & Risk Factors
Smoking cessation is the process of quitting smoking. It involves withdrawal from nicotine addiction and a change in habits.
What is going on in the body?
At least 70% of smokers in the United States have made at least one quit attempt. The nicotine in tobacco is as addictive as cocaine. It is because of this addiction that quitting can be so difficult. Nicotine is a poisonous chemical found in tobacco. It is the substance that produces many of the effects of tobacco. Nicotine withdrawal occurs when the person takes in a lesser amount of nicotine. To stop smoking, a person must deal with nicotine addiction. The individual also needs to change learned associations, or habits.
What are the causes and risks of the condition?
People quickly become dependent on nicotine when using tobacco products. Anyone who uses these substances is at risk of experiencing withdrawal symptoms. A trigger is anything that creates an impulse to use tobacco. Triggers can be feelings, such as stress, anxiety, depression, or boredom. They can be visual, such as a picture of a poised glamorous movie star taking a long, seemingly satisfying drag. Triggers can even be certain times of the day, such as work breaks or meals.
Symptoms & Signs
What are the signs and symptoms of the condition?
The symptoms of nicotine withdrawal are actually good news. They are signs that the person's body is flushing out the harmful tobacco chemicals. They won't last long, usually from a few days to 2 to 3 weeks. Few people experience all of the withdrawal symptoms listed. For the first few days, the person may have the following:
dry mouth or throat
For the first few weeks of smoking cessation, the person may have:
Diagnosis & Tests
How is the condition diagnosed?
Someone who is addicted to nicotine will have strong cravings for it. When the person doesn't smoke for a period of time, he or she will have nicotine withdrawal symptoms.
Prevention & Expectations
What can be done to prevent the condition?
Once a person starts smoking, he or she quickly becomes addicted to nicotine. The key is to never start smoking. Antismoking campaigns can be effective in getting this message out.
What are the long-term effects of the condition?
There are typically no long-term effects from nicotine withdrawal. The most intense symptoms last only a few weeks. Craving for nicotine is the only symptom that persists longer than a month.
The health risks from the chemicals found in tobacco are enormous. Tobacco use can cause the following diseases:
coronary artery disease and other forms of heart disease
gastroesophageal reflux disease
Tobacco use can also cause the following conditions:
decreased life expectancy
erectile dysfunction, or impotence
gray hair and baldness
high blood pressure and circulation problems
infertility in men and women
osteoporosis and increased risk for bone fractures
weakened immune system
The good news is that the health damage caused by tobacco is preventable and may be reversible. Within 20 minutes of quitting, the healing begins. By year 15, the person's risk of heart disease and early death is almost the same as that of people who have never smoked. In addition, an individual's risk of dying from chronic bronchitis or emphysema decreases as long as he or she remains smoke free.
An individual who quits smoking will have the following advantages:
circulation to the hands and feet will improve
food will taste better
general health will improve
risk for serious illness will decrease
sense of smell will improve
skin will look healthier
What are the risks to others?
Smoking cessation poses no risk to others. In fact, it will reduce the amount of secondhand smoke that friends and family are exposed to.
Treatment & Monitoring
What are the treatments for the condition?
The first step in smoking cessation is setting up a Quit Plan. A Quit Plan includes the following:
quit date and written commitment to stop smoking
preferred quit option(s)
preferred quit method(s)
coping strategies for dealing with triggers, withdrawal symptoms, and other challenges
There are a number of methods for quitting smoking that address the addiction to nicotine. Going cold turkey, which means stopping smoking abruptly, is one method. Two other methods are non-nicotine medication and various forms of nicotine replacement therapy. The person's level of nicotine dependence and any prior quit attempts should be taken into consideration. The individual can work with the healthcare provider to choose the best method.
Regardless of the method chosen, the person must also pay attention to breaking the smoking habit. Research shows that smokers who use behavior modification strategies in addition to addressing the physical addiction have a better chance of succeeding.
Nicotine replacement products help reduce the physical withdrawal symptoms that occur with smoking cessation. These medicines reverse the process in which the person's body learned to crave more and more nicotine. Over time, they help the person's body stop craving nicotine. Nicotine replacement therapy doesn't completely eliminate withdrawal symptoms. It doesn't give the individual any more willpower. It does let the person focus on breaking the habit of smoking as the body adjusts to lower levels of nicotine.
Following are the types of nicotine replacement therapy:
nicotine gum, which is available over-the-counter or by prescription
nicotine inhalers, which are available by prescription
nicotine nasal spray, which is given by prescription
nicotine patches, which are available over-the-counter in various strengths
Since these products replace the nicotine the person would have gotten from a cigarette, nothing new is being introduced into the body. The direct effect from nicotine is the same.
A person using nicotine replacement products should not continue to smoke. Nicotine can cause serious medical problems, including death, if it is abused. Nicotine replacement products are not recommended in certain situations:
people who have had a heart attack within the past 2 weeks
people who have serious arrhythmias, or irregular heartbeats
people who have angina, the chest pain associated with heart disease
women who are pregnant, unless their healthcare provider recommends it
Zyban, or bupropion, has been approved by the FDA for smoking cessation. How Zyban works is largely unknown. It is thought to act on certain pathways in the brain that are involved in nicotine addiction and withdrawal. The person feels less of an urge to smoke. Zyban also helps reduce some of the more bothersome nicotine withdrawal symptoms associated with smoking cessation. For example, it can reduce anxiety, irritability, frustration, difficulty concentrating, and restlessness.
What are the side effects of the treatments?
The most frequently reported side effect from the nicotine patch is skin irritation. Those who use a 24-hour patch sometimes report having vivid dreams. The patch may also cause headache or joint pain.
Nicotine gum can cause some minor mouth, tongue, and throat irritation. It may also cause an arrhythmia and palpitations. Swallowing the gum can cause nausea or vomiting.
The most common side effects from the nasal spray are irritation of the nose and throat, watering eyes, sneezing, and cough. These side effects may lessen in intensity after the first week of use.
The most common side effect of the nicotine inhaler is irritation of the lining of the mouth and throat. Some people may experience cough, runny nose, or nausea.
The most common side effects of Zyban include dry mouth and insomnia. If side effects occur, they are generally mild and disappear after a few weeks. Other side effects include shakiness, skin rash, dizziness, and anxiety.
What happens after treatment for the condition?
Withdrawal symptoms are temporary. They usually last only 1 to 2 weeks. The person can derail smoking triggers by using counteractions. Counteraction involves actively responding to the trigger, but not in the usual way. Instead of smoking, the individual comes up with a different and healthier response. There are three main ways to cope with triggers.
Avoid the situation. Someone who smoked while driving a car can choose a different route that requires more concentration.
Change the situation. The person may choose to sit in the nonsmoking section of restaurants.
Find a substitute for a cigarette. Pens, small toys, or rubber bands are good options. Chew sugarless gum or hard candy, or try carrot sticks.
A relapse occurs when a person who has stopped smoking slips and has a cigarette. Following are some keys to dealing with a relapse.
Learn from the relapse and move on.
Figure out the details that led to the slip.
Review the Quit Plan and reasons to stop smoking.
Revise the Quit Plan and set a new quit date.
How is the condition monitored?
To remain nicotine free, smokers should avoid tempting situations and do something else when the urge to smoke arises.