How to Break a Dependence on Nicotine & Quit Smoking
Why quit smoking?
Cigarette smoking is the leading preventable cause of death in the U.S., according to the CDC. Smoking increases your risk of:
- Heart attack
- Emphysema and chronic bronchitis (also called chronic obstructive pulmonary disease or COPD)
- Lung cancer and many other cancers
- Erectile dysfunction
- Pregnancy complications
- Periodontal (gum) disease
- Hip fracture (in women)
Quitting can drastically reduce these risks, no matter how long you’ve smoked. Even smoking fewer than 10 cigarettes per day can still lead to health issues.
Quitting smoking at any age will increase your life expectancy. The earlier you quit the better, but even in people over 80 years old, quitting smoking can extend their life.
Most smokers know that quitting is good for their health. But if you’ve become physically and psychologically dependent on smoking, the idea of quitting can seem daunting.
Nicotine is the main drug in tobacco that makes quitting challenging. It triggers the release of chemicals in your brain (dopamine) that make you feel good. With time, nicotine changes how your brain works, creating the feeling that you need nicotine to feel normal.
Psychologically, smoking becomes part of daily routines, like having a cigarette with your morning coffee, while you drive, or in response to stress. The good news is that there are ways to break the associations you’ve made with smoking to help you quit.
People often think: I’ve been smoking so long that there is no benefit to quitting now. Not true! The day you quit smoking your body starts to heal. Within a few years of quitting your risk of heart disease and stroke is drastically reduced. —Dr. Benjamin Ranard
Health benefits of quitting
Giving up smoking can dramatically improve many aspects of your health, with some benefits happening immediately, according to the CDC. While you’ll get the most benefits if you quit smoking earlier in life, you’ll improve your health no matter when you break the habit, even if you’ve smoked for many years. Benefits include:
- Lower risk of premature death. Quitting can add as many as 10 years to your life expectancy.
- Reduced risk of cancer. Three out of 10 cancer deaths are caused by smoking. By quitting, you’ll lower your risk of many types of cancer, including mouth, throat, lung, liver, stomach, pancreas, colon, and others.
- Lower risk of heart disease and stroke. In only 1 to 2 years after you quit, your risk of heart disease drops significantly. If you already have coronary artery disease, quitting can lower your risk of having a heart attack and dying from heart disease.
- Healthier lungs. Kicking the habit can reduce everyday issues caused by smoking (coughing, wheezing) and your risk of infections (like bronchitis and pneumonia), emphysema, and chronic obstructive pulmonary disease (COPD). People who already have COPD and quit smoking can slow the disease’s progression.
- Lower risk of diabetes. Smokers are 30% to 40% more likely to develop type 2 diabetes.
- A healthier pregnancy. If you smoke and plan to get pregnant, it’s important to quit as soon as possible. This lowers your risk of having a baby with a low birth weight, and it eliminates the harmful effects that smoking has on the growth of your fetus. Quitting may also reduce the chance of an early delivery.
- Reduced risk of vision loss. By continuing to smoke, you’re more likely to develop macular degeneration and cataracts, both of which can cause vision loss or blindness.
- Better dental health. Smokers are more vulnerable to gum disease than non-smokers.
- Younger-looking skin. Smoking is a major cause of premature skin aging, so quitting can help you maintain a more youthful appearance.
Are you ready to quit?
Giving up a dependence is always going to be challenging, but there’s a lot you can do to empower yourself and make the process more successful.
These are all proven to increase your success in quitting smoking:
- Talk to your doctor about quitting smoking. They can counsel you on strategies and discuss medications that reduce cravings and make it easier to quit. Your doctor can also refer you to counseling and other services.
- Call the national quitline at 1-800-QUIT-NOW. Available services include advice about quitting, individual counseling, support groups, and discounted or free medications.
- Sign up for support. There are a variety of ways to access counseling and support.
—Call 877-44U-QUIT (877-448-7848) to speak to a trained counselor from the National Cancer Institute
— Online chat a counselor at livehelp.cancer.gov/ (from the National Cancer Institute) or freedomfromsmoking.org (from the American Lung Association)
—Sign up for a text messaging program at smokefree.gov
- Use resources on the internet.
— Smokefree.gov, from the National Cancer Institute, has information, personalized quit plans, text messaging service, and guides for planning quitting.
—Freedomfromsmoking.org, from the American Lung Association, is a highly effective program that helps you build a customized quit plan, learn strategies to help quit, attend in-person support groups, and receive live chat support.
- Schedule a quit date. Be prepared to quit completely on that day. Share the date with family and friends so they can offer support.
- Come up with distractions and rewards. Find activities that make you feel good, healthy, and energetic. Plan to do them during the first few weeks of quitting to take your mind off cigarettes and to reward yourself.
- List your reasons for quitting. Look at your list every night before bed and repeat one of the reasons 10 times aloud or in your head.
- Join a support group. Smoking cessation groups can help you cope with quitting and prevent you from falling back into the habit. You can find a group at your local hospital or local chapters of the American Lung Association, American Heart Association, and the American Cancer Society.
- Start exercising. People who exercise are more successful at quitting smoking than those who are sedentary. Working on your fitness will also boost your energy level and help prevent weight gain.
- Stay away from smoky environments. It’s also a good idea to limit time spent with other smokers whenever possible.
- Avoid alcohol, coffee, and other caffeinated drinks. These can increase your desire to smoke.
- Practice deep breathing. When you feel the urge to smoke, take several deep, slow breaths followed by a drink of water. You may need to do this frequently during the first week or two.
There are so many ways to get support to help you quit smoking. Prefer something made by the expert researchers from the National Institutes of Health? That is available. Prefer online tools produced by the American Lung Association? Those are available. You can call a free quit line (from your state, from the National Cancer Institute, or from the American Lung Association). You can receive text messages. You can even chat online with experts. —Dr. Ranard
Withdrawal timeline for quitting smoking
When you stop smoking, you may experience symptoms of nicotine withdrawal. They may be physical or psychological. But it’s important to remind yourself that these effects are temporary and that the first week is the toughest.
It can take days to months for your withdrawal symptoms to disappear, depending on how long you smoked and how many cigarettes you had a day.
Not everyone will experience symptoms in this order:
Immediately: Nicotine cravings start very quickly, sometimes just 30 minutes after your last cigarette. Cravings are short, lasting for about 15 to 20 minutes. Though for some people, they can linger for weeks.
Day 1: You may feel agitated and tense, and experience muscle tightness, particularly around your neck and shoulders. This feeling may increase during the first 3 days and linger for a few weeks. Some people also have feelings of depression and an increase in appetite.
Day 3 to 5: Withdrawal symptoms generally are at their peak. As your respiratory system cleans itself and nicotine is released, you may develop a cough. Some people also have some dizziness, headaches, and insomnia.
First week: Symptoms of anger, frustration, and irritability are at their peak now. You may find yourself losing your temper and getting annoyed more easily, and you may be tempted to give up on tasks more quickly. These symptoms can last for 2 to 4 weeks.
1 to 2 weeks: This is when most relapses occur. If it happens to you, don’t panic. Consider it a setback and schedule a new quit date in a week or so. While relapses can be frustrating, they help identify your triggers so you can prepare new strategies to cope with them.
2 to 4 weeks: You’ll start to experience relief from symptoms such as brain fog, increased appetite, anxiety, and depression.
5 weeks and beyond: The intensity of your cravings starts to decline now. You may notice occasional mild cravings for the next 6 months. If you still have withdrawal symptoms, talk to your doctor about adding a smoking cessation medication or another type of therapy to your plan.
How to deal with nicotine withdrawal
It helps to develop ways of coping with symptoms of withdrawal. While it’s unlikely you’ll experience all of these symptoms, it’s still important to be prepared for them.
Remember, nicotine causes changes to receptors in your brain. When you haven’t had the nicotine you are used to, you may start to become anxious and irritable. Cigarettes seem like they help you relax because they are providing nicotine when your body starts to withdraw.
But smoking can actually make anxiety and mental health worse. Mental health improves once you quit smoking.
Here are some strategies that target specific withdrawal symptoms:
- Body craving nicotine
- Most intense during the first week but can linger for months
Advice: Distract yourself as much as possible. Take a brisk walk. Try chewing on gum or a light snack, or any of these strategies from the National Cancer Institute.
- Body craving nicotine
- Lasts 2 to 4 weeks
Advice: Exercise; take hot baths; use relaxation techniques like deep breathing; avoid caffeine.
- Body’s craving for nicotine temporarily reduces time spent in deep sleep
- Lasts 2 to 4 weeks
Advice: Avoid caffeine, especially after noon. Use relaxation techniques and try to exercise daily. Remove electronics from the bedroom. Use the bedroom for sleeping and sex only.
- Body adjusting to lack of stimulation from nicotine
- Lasts 2 to 4 weeks
Advice: Take naps; do not push yourself.
Lack of concentration
- Body adjusting to lack of stimulation from nicotine
- Lasts a few weeks
Advice: Reduce workload; avoid stress.
- Craving for cigarettes may be confused with hunger pangs
- Lasts up to several weeks
Advice: Drink water or low-calorie drinks; eat low-calorie snacks.
Increased coughing and mouth ulcers
- Can last several weeks and then goes away
Advice: Drink plenty of fluids; try cough drops. Talk with your doctor about whether you need any nasal sprays or other inhalers.
- Intestinal movement decreases from lack of nicotine
- Lasts 1 to 2 weeks
Advice: Drink plenty of fluids; add fiber to diet; exercise.
This prescription medication works by blocking the pleasurable effects you get from smoking while also reducing cravings. You can start taking varenicline a week before your quit date.
Current guidelines recommend lung cancer screening when the number of years you have smoked multiplied by the number of packs per day you smoked equals 20 or higher. —Dr. Ranard
Treatments for quitting
There are prescription and over-the-counter medications and therapies that can make quitting smoking easier. Some help wean you off of nicotine gradually, while others help you deal with cravings and other issues. Talk to your doctor about which one is best for you.
Nicotine replacement therapy
Nicotine replacements, like patches, gum, lozenges, nasal spray, and inhalers, can help people quit smoking. They give you some nicotine to blunt cravings while helping to break the habit of smoking.
Long-acting nicotine replacements like patches release nicotine into your bloodstream in steady amounts to avoid ups and downs. Short-acting nicotine replacements like gum and lozenges can be used when nicotine cravings strike. Most people do best with a combination of long- and short-acting replacements.
Studies find that using a nicotine replacement doubles your chances of quitting successfully. Patches, gum, and lozenges are available over the counter. Sprays and inhalers require a prescription.
Abrupt “cold turkey” quitting while on varenicline is most effective, but an alternative is to gradually decrease your smoking. Discuss with your doctor to come up with a plan.
Side effects include nausea, trouble falling asleep or staying asleep, abnormal or vivid dreams, and headaches.
Bupropion is a prescription antidepressant that can decrease the symptoms of nicotine withdrawal, such as irritability and anxiety, and curb the urge to smoke. You should start taking bupropion at least 1 week before your quit date.
Common side effects include weight loss, constipation, nausea, headache, and dry mouth. Bupropion increases risk of seizures in those already at risk. It also has an increased risk of glaucoma and mania in those who are already at risk for those conditions.
Cognitive behavioral therapy
This form of therapy helps you replace negative thoughts with healthier ones. Working with a therapist can help you feel more confident in your ability to stop smoking, help identify your smoking triggers and how to avoid them or respond in a different way. It can also teach you how to manage stress and cravings.
Some people find hypnosis helpful in quitting smoking, but studies show mixed results. A hypnotherapist guides you into a meditative yet very focused state. Then, the therapist gives you messages such as “Smoking is poisonous” and “You don’t feel well when you smoke.” These messages may pop into your head later when you feel the urge to smoke.
To find a qualified hypnotherapist, ask your doctor for a referral or search for one online at the American Hypnosis Association, the American Society of Clinical Hypnosis, and the National Board of Certified Hypnotherapists. Your insurance may not cover the sessions, so be sure to check your policy first before trying hypnotherapy.
Acupuncture may be helpful for quitting smoking, particularly when it’s combined with other methods such as therapy. During treatment, the acupuncturist inserts very thin needles (or other forms of stimulation) into certain parts of your body. Most acupuncture is based on Eastern medicine and has the goal of rebalancing energy flow.
Acupuncture is not always covered by insurance, so be sure to check your policy before you make an appointment.
Communities most affected by tobacco use
- Black smokers are more likely to die from smoking-related diseases than white smokers. They report, on average, more quit attempts compared to other groups, and yet have less success quitting. This is likely because of less access to smoking cessation treatments such as counseling and medication. Tobacco marketers have long targeted the Black community, in particular when advertising menthol cigarettes. [Source: CDC]
- Menthol cigarettes make it harder to quit. This is a major concern for Black smokers, who are much more likely to smoke menthols (77% of smokers) than white smokers (25%). The FDA is now moving to ban menthol cigarettes, in part to increase people’s chances of quitting smoking. [Source: CDC]
- Native American/Alaska natives have the highest prevalence of smoking than any other racial/ethnic group and quitting rates are lower. Tobacco companies target this group through extensive promotions, sponsorships, and advertising campaigns. [Source: CDC]
- The LGBTQ+ community is more likely to smoke, more likely to smoke menthol cigarettes, and less likely to have access to health care resources. [Source: CDC]
- People with low levels of income or education are more likely to smoke. Tobacco companies have been known to target their advertising campaigns towards low-income neighborhoods and communities. [Source: CDC]
- People who have behavioral or mental health conditions are also more likely to smoke. [Source: CDC]