Handling Nicotine Withdrawal and Triggers When You Decide To Quit Tobacco

Because the nicotine in tobacco is highly addictive, people who quit may experience nicotine withdrawal symptoms, especially if they have smoked or used other tobacco products heavily for many years. Although many of the examples in this fact sheet refer to smoking, the tips are relevant for those who are quitting the use of any tobacco product.

Common nicotine withdrawal symptoms include:

• nicotine cravings 
• anger, frustration, and irritability
• difficulty concentrating
• insomnia
• restlessness
• anxiety
• depression
• hunger or increased appetite

Other, less common nicotine withdrawal symptoms include headaches, fatigue, dizziness, coughing, mouth ulcers, and constipation (1, 2).

The good news is that there is much you can do to reduce nicotine cravings and manage common withdrawal symptoms. Also, it may help to know that nicotine withdrawal symptoms do subside over time. They are usually worst during the first week after quitting, peaking during the first 3 days. From that point on, the intensity of symptoms usually drops over the first month. However, everyone is different, and some people have withdrawal symptoms for several months after quitting (3, 4).

People who use tobacco products get used to having a certain level of nicotine in their body. After you quit, cravings develop when your body wants nicotine. This may occur long after your body is no longer addicted to nicotine. In addition to this physical craving, you may experience a psychological craving to use a tobacco product when you see people smoking or are around other triggers. Your mood may change when you have cravings, and your heart rate and blood pressure may go up.

The urge to smoke will come and go. You may start experiencing cravings within an hour or two after your last use of tobacco, and you may have them frequently for the next few days or weeks. As time passes, the cravings will get farther apart. However, you may have occasional mild cravings months or years after you quit.

Here are some tips for managing cravings:

• Try nicotine replacement products or ask your doctor about other medications.
• Remind yourself that cravings will pass.
• Avoid situations and activities that you used to associate with using tobacco products.
• As a substitute for smoking, try chewing on carrots, pickles, apples, celery, sugarless gum, or hard candy. Keeping your mouth busy may stop the psychological need to smoke.
• Try this exercise: Take a deep breath through your nose and blow out slowly through your mouth. Repeat 10 times.

Go online to Smokefree.gov, a website created by NCI's Tobacco Control Research Branch, and use the step-by-step personalized quit plan to learn about other tips for managing cravings.

Within 24 hours of quitting smoking or other tobacco products, you may feel tense and agitated. You may feel a tightness in your muscles—especially around the neck and shoulders. Studies have found that anxiety is one of the most common negative feelings associated with quitting. If anxiety occurs, it usually builds over the first 3 days after quitting and may last several weeks (1).

Here are some tips for managing anxiety:

• Remind yourself that anxiety will pass with time.
• Set aside some quiet time every morning and evening—a time when you can be alone in a quiet environment.
• Engage in an enjoyable physical activity, such as taking a walk.
• Reduce caffeine by limiting or avoiding coffee, soda, and tea.
• Try meditation or other relaxation techniques, such as getting a massage, soaking in a hot bath, or breathing deeply through your nose and out through your mouth for 10 breaths.
• Try nicotine replacement products or ask your doctor about other medications.

People who quit may gain weight due to increased appetite. Although the weight gain is usually less than 10 pounds, it can be troublesome for some people (8, 9). However, the health benefits of quitting far outweigh the health risks of a small amount of extra weight.

Here are some tips for managing weight gain after quitting:

• Balance your physical activity with your calorie intake. This will help you achieve and maintain a desired weight.
• Ask your doctor about the medication bupropion. Studies show that it helps counteract weight gain (7).
• Studies also show that nicotine replacement products, especially nicotine gum and lozenges, can help counteract weight gain (7).
• A nutritionist or diet counselor can be helpful.

Although the prospect of weight gain may be unwelcome, it is important to remember that quitting smoking is one of the most important things you can do to improve your health overall. Do not let fear of gaining weight discourage you from quitting.

Reminders in your daily life of situations when you used to use tobacco products may trigger your desire to do so again. 

Triggers may include:

• social triggers, such as being around others who use tobacco or in a social gathering or event
• emotional triggers, such as feeling stressed or anxious; bored, lonely, sad, or frustrated or upset after an argument; or happy, excited, or relieved
• pattern or activity triggers, such as starting the day, being in a car, drinking coffee or tea, enjoying a meal or an alcoholic beverage

Knowing your triggers for using tobacco helps you stay in control because you can choose to avoid those triggers or keep your mind distracted and busy when you cannot avoid them. More specific information on different types of triggers is on Smokefree.gov.

You may want to analyze situations in which watching others smoke triggers an urge in you to smoke. Figure out what it is about those situations that makes you want to smoke. Is it because you associate feeling happy with being around other smokers? Or is there something special about the situations, such as being around the people you usually smoked with? Is it tempting to join others for routine smoke breaks?

Here are some tips:

• Limit your contact with smokers, especially in the early weeks of quitting.
• Do not buy, carry, light, or hold cigarettes for others.
• If you are in a group and others light up, excuse yourself and don’t return until they have finished.
• Do not let people smoke in your home. Post a “No Smoking” sign by your front door.
• Ask others to help you stay quit. Give them specific examples of things that are helpful (such as not smoking around you) and things that are not helpful (like asking you to buy cigarettes for them).
• Focus on what you’ve gained by quitting. For example, think of how healthy you will be when all smoking effects are gone from your body and you can call yourself smokefree. Also, add up how much money you have saved already by not purchasing cigarettes and imagine (in detail) how you will spend your savings in 6 months.

Living with someone who smokes can present additional challenges for a person who wants to quit. Here are some tips for people in such a situation:

• Make your home a no-smoking environment. Remove all cigarettes, ashtrays, and lighters and don’t allow friends or family to smoke anywhere inside your home.
• If the smokers you live with will not go outside to smoke, consider making one room of the home smokefree so you have a nonsmoking indoor area available to you.
• Ask the smokers you live with not to offer you any tobacco products or purchase them for you, even if you ask for them. Enlist their help in keeping you smokefree.

Many smokers light up a cigarette right after they wake up. After 6 to 8 hours of sleep, a smoker’s nicotine level drops and they need a boost of nicotine to start the day. After you quit, you must be ready to overcome the physical need and routine of waking up and smoking a cigarette. Instead of reaching for your cigarettes in the morning, here are some tips:

• The morning can set the tone for the rest of the day. Plan a different wake-up routine to divert your attention from smoking.
• Be sure no cigarettes are available. Instead, keep sugar-free gum, mints, or nuts in the locations where you previously kept your cigarettes so when you automatically reach for cigarettes a healthy alternative is at hand.
• Before you go to sleep, make a list of things you need to avoid in the morning that will make you want to smoke. Place this list where you used to place your cigarettes.
• Begin each day with a planned activity that will keep you busy for an hour or more. Keeping your mind and body busy will distract you from thinking about smoking.
• Begin each day with deep breathing and by drinking one or more glasses of water.

Most smokers report that one reason they smoke is to handle stress. Smoking cigarettes causes temporary changes in your brain chemistry that can cause you to experience decreased anxiety, enhanced pleasure, and alert relaxation. Once you stop smoking and your brain chemistry returns to normal, you may become more aware of stress.

Everyday worries, responsibilities, and annoyances can all contribute to stress. As you go longer without smoking, you will get better at handling stress, especially if you learn stress reduction and relaxation techniques.

Here are some tips:

• Know the causes of stress in your life (your job, traffic, your children, money) and identify the stress signals (headaches, nervousness, or trouble sleeping). Once you pinpoint high-risk trigger situations, you can start to develop new ways to handle them.
• Create peaceful times in your schedule. For example, set aside an hour where you can get away from other people and your usual environment. Or try visualizing yourself in a peaceful setting.
• Try relaxation techniques, such as progressive muscle relaxation or yoga, and stick with the one that works best for you.
• Try this breathing exercise: Take a deep breath through your nose and blow out slowly through your mouth. Repeat 10 times.
• Try meditation involving focused breathing or repetition of words or phrases to quiet your mind. 
• Rehearse and visualize your relaxation plan. Put your plan into action. Change your plan as needed.
• You may find it helpful to read a book about how to handle stress.

You may have become used to smoking while driving—to relax in a traffic jam or to stay alert on a long drive. Like many smokers, you may like to light up when driving to and from work to relieve stress, stay alert, relax, or just pass the time. 

Tips for short trips:

• Remove the ashtray, lighter, and cigarettes from your car.
• Keep healthy substitutions, such as sugar-free gum, mints, or nuts, in your car.
• Turn on your favorite music and sing along.
• Take an alternate route to work or try carpooling.
• Clean your car and use deodorizers to reduce the tobacco smell.
• Tell yourself:
  • “This urge will go away in a few minutes.”
  • “So, I’m not enjoying this car ride. Big deal! It won’t last forever!”
  • “My car smells clean and fresh!”
  • “I’m a better driver now that I’m not smoking while driving.”

When you are driving or riding with other people:

• Do not allow passengers to smoke in your car.
• If you’re not driving, find something to do with your hands.

Your desire to smoke may be stronger and more frequent on longer trips. On long trips:

• Take stretch breaks.
• Take healthy snacks along.
• Plan rest stops.

You may be used to smoking when drinking coffee or tea (for example, during or after meals or during work breaks), and you may associate good feelings with drinking a hot beverage. When you give up smoking, expect to feel a strong urge to reach for a cigarette while drinking coffee or tea. Some people quit drinking coffee or tea temporarily while they’re quitting cigarettes to avoid the urge to smoke. Although you do not have to give up coffee or tea to quit smoking, you should expect that coffee or tea will not taste the same without a cigarette.

Here are some tips:

• If you used to smoke while drinking coffee or tea, tell people you have quit, so they won’t offer you a cigarette.
• Between sips of coffee or tea, take deep breaths to inhale the aroma. Breathe in deeply and slowly while you count to five, and then breathe out slowly, counting to five again.
• Try changing your routine around drinking coffee or tea. For example, try switching what drink you consume or try having your coffee or tea in a different location than when you were smoking to help change the routine.
• Keep your hands busy by nibbling on healthy foods, doodling, playing games on your phone, or making a list of tasks for the day.
• If the urge to smoke is very strong, drink your coffee or tea more quickly than usual and then change activities or rooms.
• When you quit smoking, drinking coffee or tea without smoking may make you feel sad. Focus on what you’ve gained by quitting.

Food often tastes better after you quit smoking, and you may have a bigger appetite. Expect to want to smoke after meals. Your desire to smoke after meals may depend on whether you are alone, with other smokers, or with nonsmokers.

Your urge to smoke may be stronger with certain foods, such as spicy or sweet foods. Also, the urge to smoke may be stronger at different mealtimes.

Here are some tips:

• Know what kinds of foods increase your urge to smoke and stay away from them.
• If you are alone, call a friend or take a walk as soon as you’ve finished eating.
• Brush your teeth or use mouthwash right after meals.
• Wash the dishes by hand after eating—you can’t smoke with wet hands!

You may be used to smoking when drinking beer, wine, liquor, or mixed drinks. When you quit smoking, you may feel a strong urge to smoke when you drink alcohol. Know this up front if you are going to drink because your ability to resist triggers to smoke may be impaired under the influence of alcohol. 

Here are some tips for the first few weeks after quitting smoking:

• Many people find it helpful to drink less alcohol or avoid it completely.
• If you do drink, choose different alcoholic beverages than you used to have when smoking.
• Stay away from the places you usually drink alcohol.

When you quit smoking, you may miss the increased excitement and good feeling that nicotine gave you. This may be particularly true when you are feeling bored.

Here are some tips:

• Plan more activities than you have time for.
• Make a list of things to do when confronted with free time.
• Move! Do not stay in the same place too long.
• If you feel bored when waiting for something or someone (a bus, your friend, your kids), distract yourself with a book, magazine, puzzle, or your phone.
• Look at and listen to what is going on around you.
• Carry something to keep your hands busy.
• Listen to a favorite song.
• Go outdoors, if you can, but not to places you associate with smoking.

Yes. Nicotine replacement products deliver measured doses of nicotine into the body, which helps to relieve the cravings and withdrawal symptoms often felt by people trying to quit tobacco use. Nicotine replacement products are effective treatments that can increase the likelihood that someone will quit successfully (7, 10).

Five forms of nicotine replacement therapy have been approved by the US Food and Drug Administration (FDA):

• The nicotine patch is available over the counter (without a prescription). A new patch is worn on the skin each day, supplying a small but steady amount of nicotine to the body. The nicotine patch is sold in varying strengths, usually as an 8- to 10-week quit-smoking treatment. Typically, the nicotine doses are gradually lowered as treatment progresses. The nicotine patch may not be a good choice for people with skin problems or allergies to adhesive tape. Also, some people experience the side effect of having vivid dreams when they wear the patch at night. These people may decide to wear the patch only during the daytime.
• Nicotine gum is available over the counter in two strengths (2 and 4 milligrams). When a person chews nicotine gum and then places the chewed product between the cheek and gum tissue, nicotine is released into the bloodstream through the lining of the mouth. To keep a steady amount of nicotine in the body, a new piece of gum can be chewed every 1 or 2 hours. The 4-milligram dose appears to be more effective among highly dependent smokers (those who smoked 20 or more cigarettes per day) (11, 12). Nicotine gum might not be appropriate for people with temporomandibular joint disease or for those with dentures or other dental work, such as bridges. The gum releases nicotine more effectively when coffee, juice, or other acidic beverages are not consumed at the same time.
• The nicotine lozenge is also available over the counter in 2 and 4 milligram strengths. The lozenge is used similarly to nicotine gum; it is placed between the cheek and the gums and allowed to dissolve. Nicotine is released into the bloodstream through the lining of the mouth. The lozenge works best when used every 1 or 2 hours and when coffee, juice, or other acidic beverages are not consumed at the same time.
• Nicotine nasal spray is available by prescription only. The spray comes in a pump bottle containing nicotine that tobacco users can inhale when they have an urge to smoke. Nicotine is absorbed more quickly via the spray than with other nicotine replacement products. Nicotine nasal spray is not recommended for people with nasal or sinus conditions, allergies, or asthma or for young tobacco users. Side effects from the spray may include sneezing, coughing, and watering eyes, but these problems usually go away with continued use of the spray.
• A nicotine inhaler, also available by prescription only, delivers a vaporized form of nicotine to the mouth through a mouthpiece attached to a plastic cartridge. Even though it is called an inhaler, the device does not deliver nicotine to the lungs the way a cigarette does. Most of the nicotine travels only to the mouth and throat, where it is absorbed through the mucous membranes. Common side effects include throat and mouth irritation and coughing. Anyone with a breathing problem such as asthma should use the nicotine inhaler with caution.

Using a long-acting form of nicotine replacement therapy (like the patch) along with a short-acting form (like the gum or the lozenge) can be especially helpful for managing nicotine withdrawal (10). Nicotine replacement therapy is more effective when combined with advice or counseling from a doctor, dentist, pharmacist, or other health care provider.