Nicotine Withdrawal: Symptoms, Timeline, & Treatment

What Is Nicotine Withdrawal?

Withdrawal occurs when someone cuts back or quits substances, including alcohol, nicotine, and other mood-altering drugs. It’s possible to become both physically and psychologically dependent on nicotine. This means that the body relies on it to feel normal, and it can feel like you psychologically need the drug to function in certain or most situations.²

Specific nicotine withdrawal symptoms vary from person to person. While they can feel distressing, they are not life-threatening. Most people note that the hardest part of withdrawal is the intense cravings they have for nicotine. These cravings make it difficult to quit cigarettes or other forms of nicotine.

Nicotine Withdrawal Symptoms

Cravings are among the most common nicotine withdrawal symptoms. These cravings pass, but they can be strong at the beginning of the withdrawal process. Many people also experience mood changes during this time. They may feel more irritable, depressed, or anxious in the first few days and weeks after quitting nicotine. They might also experience some sleep problems or appetite changes.³

Psychological symptoms of nicotine withdrawal include:

• Strong cravings for nicotine
• Increased anxiety
• Difficulties with concentration
• Insomnia or other sleep problems
• Restlessness
• Depression symptoms

Physical symptoms of nicotine withdrawal include:

• Headaches
• Sore throat
• Coughing
• Constipation or other gastrointestinal distress
• Increased heart rate
• Breathing problems
• Fatigue
• Increased appetite
• Dizziness

Timeline Of Nicotine Withdrawal

The symptoms of nicotine withdrawal tend to be strongest during the first 24-72 hours after last using nicotine. Approximately 4 hours after the last nicotine use, the body will start experiencing cravings. Within about 10 hours, cravings will intensify, and people may notice that they feel hungrier than usual. Some will also experience tingling sensations in their extremities.⁴

Symptoms of depression and anxiety may peak around 48-72 hours. This is normal, and it may be due to the brain adjusting to the lack of nicotine. Within the next few weeks, ongoing cravings will still occur, but most people find that they feel more manageable. Using nicotine at any point during this time, however, prolongs the quitting process and can make the cycle feel worse.⁴

How Long Does Nicotine Withdrawal Last?

The most intense nicotine withdrawal symptoms typically pass within a few days. However, lingering symptoms can still occur for several months. After the body has physically detoxed from nicotine, many people still experience psychological cravings. For example, if you always smoked while driving, you may still have cravings when you get into the car.

Nicotine withdrawal may be harder for people with underlying mental health issues. Furthermore, those who used nicotine at a high frequency for many years may note more pronounced withdrawal symptoms. That said, it can be helpful to remember that “sticking it out” will eventually help the withdrawal symptoms pass and subside.

Can Quitting Nicotine Cause Anxiety?

Research shows that many people experience increased anxiety when quitting nicotine. It can be helpful to be prepared for this symptom in advance. Anxiety tends to build over the first 72 hours, but it can last for a few weeks after nicotine use.⁵ Those with preexisting anxiety disorders may be more prone to experiencing anxiety after quitting.

Some tips for coping with anxiety during nicotine withdrawal include:

• Name your anxiety (rather than try to suppress or deny it)
• Get physically active
• Practice deep breathing
• Call a supportive friend
• Journal about your feelings
• Take a warm bath or shower
• Listen to music
• Distract yourself with chores or other activities

Treating Nicotine Withdrawal

Many people quit nicotine using the cold turkey method. They decide to stop and allow the body to naturally move through its withdrawal process. Others may engage in a harm reduction approach where they gradually decrease the amount of nicotine they use each day or week. Some may use medications or nicotine replacement therapy to support the withdrawal process.

Nicotine Replacement Therapy

Nicotine replacement therapy (NRT) comes in various forms, including nasal sprays, inhalers, gum, and lozenges. Numerous studies indicate that using NRT can help increase the chance of successfully quitting smoking. NRT helps with challenging cravings and withdrawal symptoms. It can be started just after stopping nicotine, and it’s best to take it when you first quit.⁶

NRT methods can be used alone or in combination. No one type is inherently better than another, but it’s beneficial to consider your preferences and lifestyle. For example, some people like how inhalers closely mimic the use of cigarettes, whereas others prefer the convenience of applying a patch just once a day. Some common NRT side effects include headaches, coughing, runny nose, and mouth irritation.

Examples of nicotine replacement therapy include:

• Chewing gum
• Lozenges
• Nasal sprays
• Inhalers
• Patches

Medication

The FDA has approved 5 different NRTs for quitting nicotine. However, they have also approved two quit-smoking pills, including bupropion and varenicline. Bupropion works by reducing cravings and curbing unpleasant nicotine withdrawal symptoms. Varenicline also decreases the desire to smoke, and it reduces how enjoyable nicotine feels if someone does use it.⁷

E-Cigarettes or Vapes

Some people use e-cigarettes (also known as vapes) as a form of harm reduction. Current research examining 78 studies over 22,000 people shows that these methods are less harmful than smoking, and they are also more effective than standard NRT measures. This is likely due to the gradual cessation of nicotine use coupled with the mimicked rituals associated with smoking.⁸

When to Seek Professional Help

Nicotine addiction and dependence can lead to serious emotional and physical health consequences. It’s estimated that approximately one out of every five deaths in the U.S. is associated with cigarette smoking. The good news is that quitting before the age of 40 can reduce the chance of death from smoking-related diseases by about 90%.⁹

If you’re struggling to quit on your own, therapy can help support you during the difficult process of nicotine withdrawal. It’s important to seek a provider who specializes in addiction. You can look through our online therapist directory or an online therapy platform to find the right professional. Consider meeting with an in-person or online psychiatrist to review medication options.