Found this very interesting (cannot vouch for the authenticity): Whomever AlGiordino is, he seems quite knowledgeable: https://www.reddit.com/r/stopsmoking/comments/1wvcft/how_long_after_quitting_until_neurotransmitters/
With no tobacco use, it takes about 3-4 months for the billions of nicotinic acetylcholine receptors that have grown in our brains to return to normal levels. Some research has suggested that the unique spike of nicotine from tobacco leaves an "indelible memory" on the receptors that remain permanently. Exposure to high levels of "free-based nicotine", which only tobacco provides, can cause the billions of receptors to quickly up-regulate again. This idea explains why someone trying to quit can find themselves right back were they started after the addiction tells them, "you can have just one".
I make sure to use the term "free-based nicotine" because addiction in tobacco develops due primarily to three things: genetic disposition (two nicotine genes have been ID'd in human genome), delivery mechanism of a cigarette (faster than IV administration), and the thousands of chemicals added to tobacco (cigs, dip, pipe tobacco, etc). These chemicals essentially make nicotine more volatile when it hits the bloodstream, allowing for almost instantaneous absorption. This is a similar process to how crack is created from cocaine.
Interestingly, nicotine replacement therapy does not have the speed or power (not free-based) to sustain the billions of up-regulated receptors. Research shows that people on cessation medication are losing these receptors at the same rate as if they quit cold turkey. This is why doctors and counselors recommend medications in tobacco treatment -they helps manage withdrawal while allowing the addiction to continue dying away uninterrupted. The only thing that can cause these billions of nicotine receptors to return is tobacco use.
tl;dr: With or without cessation medications, nicotine receptors return to non-smoker levels after 3-4 months of no tobacco use.
EDIT: Cleaned up sentence structure
Thanks for this. Great response.
But why do you think that people who quit cold turkey tend to have better success rates if the receptors are being lost at the same rates for those who take medication and have lesser withdrawal symptoms to deal with?
I appreciate the question, it's one I get often from folks with whom I meet.
To answer this, we can view quitting at the population level and the individual level. On a larger scale, quitting cold turkey is the most popular approach and a high number of people in survey's report that this is how they quit smoking. On an individual level, quitting cold turkey is statistically the least effective method for quitting. Studies find that 3-5% of people that quit this way are still smoke-free after 6 months compared to those who use counseling and treatment medications (between 25-36%).
But since cold turkey is so frequently tried, the following situation takes place every year: if you have 100,000 people quitting cold turkey and 1,000 quitting with treatment meds/counseling, the group that quit cold turkey will have an overall higher number of total ex-smokers (3000-5000) than the treatment group (250-360), even though the cold turkey group had an abysmal success rate. Despite the poor success rate, people who are considering quitting are led to believe that "just putting them down" is the best way to go.
This is why tobacco professionals (on the treatment side, anyway) push for better coverage of counseling and medications. If you gave those 100,000 people who were quitting cold turkey access to effective treatments, we could see 25,000-36,000 of that group quitting, instead of a tenth of that number.
As a former tobacco user, one of the hardest parts of quitting was building up the motivation to make another attempt. As a counselor working to help others now, I know the time, mental energy, and motivation it takes for someone to come into my office and express a readiness to quit. Everyone has to find a plan that they are most comfortable with so I never tell them what the need to do. Rather, my goal is simply to share the most effective, up-to-date strategies available that will give them the best chance to quit.
This was harder to put into written words than I thought so let me know if any part needs further clarification.
Thank you for the reply, I think you explained it perfectly.
So essentially, the misconception that quitting cold turkey is the most effective is simply because the sample size is much bigger?
From a statistical point of view, yes. I certainly do not want to take away from the level of motivation, preparation, and commitment people put into their quit attempts when they stop cold turkey. However, I've personally found that using treatment medications and counseling can be stigmatized - "you should be strong enough to do this on your own". I fear this mentality can keep some folks from seeking helpful treatment.
The fact is, tobacco addiction while having common characteristics, is a very individualized. Some people need more intensive approaches, such as inpatient treatment: