Am I experiencing nicotine withdrawal?

[Dr_Hays]

Nicotine withdrawal can be severe.   For many people withdrawal symptoms peak between 3-5 days, but they can last for many weeks.  Recognizing and alleviating withdrawal from nicotine can be extremely helpful in stopping smoking.

The most common withdrawal symptoms are irritability, anxiety, craving difficulty concentrating, depressed mood, insomnia and restlessness.  Symptoms can also include constipation, dizziness, nausea, sore throat, nightmares, tremors, rapid heart-beat, stomach irritation, anhedonia, and fatigue.  These unpleasant physical sensations, emotions, and cognitions can trigger an intense urge to smoke, however smoking in response to these symptoms is very reinforcing and strengthens the cigarette addiction and builds the ‘habitual’ component of smoking.

Nicotine replacement alleviates withdrawal and is a very safe alternative to smoking.  Nicotine medications don’t deliver the rapid and high doses of nicotine like a cigarette, and are not addictive like the cigarette.  More importantly the nicotine medications don’t contain the 1000’s of chemicals that are in cigarette smoke, and which cause the tremendous toll to health.

These days, there is no reason to suffer from nicotine withdrawal.

[TW517]

I'm curious if anyone can link to any studies that agree with this statement:  "Nicotine medications don’t deliver the rapid and high doses of nicotine like a cigarette, and are not addictive like the cigarette."

Every study I have ever read comes to the exact opposite conclusions.  What I have read says,

• The 21mg patch is not exactly a "low" dose.  It is about the same as a pack of cigarettes.
• Many people end up taking in more nicotine with lozenges and/or gum because they are able to consume them in places where smoking is not allowed.
• The patch is slower releasing than the lozenge or gum, but takes about the same time as a cigarette for the nicotine to get to your brain receptor.
• Lozenges and gum are much faster to your brain than cigarettes.
• The nicotine in all these products is no less addictive than the nicotine in cigarettes.  Nicotine is nicotine.  It is one of the most highly addictive substances around.

[constanceclum]

Mark thanks for this blog. I am using the patch-I think I'm at about 10 days into step 2. This has been a huge struggle for me with this 2nd mo. being harder than the 1st.Craves are not 3-5 minutes for me but come in all day waves. My whole body shakes, irritability through the roof and ongoing fuzzy-headedness. I have had about 4 comfortable days out of the last 19 that I have been in NML. It helps to know that this is not so abnormal. Reading blogs I get the feeling that, yes NML is challenging but I should be much more comfortable by now.

Connie

[bonniebee]

I used the patch and it was very helpful  this time around I am 2 1/2 years quit thanks to God ,the patch and the Ex- community.

 I quit cold turkey once ,I made it to 3 months before I caved but I have to say that the withdrawal without the NRT's was so hard that I never tried to quit again for over 15 years . The first month especially was horrible.

I do believe a person can become addicted to the gum and lozenges because I have seen it happen.  If one follows the directions and uses caution and has  a plan to discontinue there use I think it is very unlikely the one will  become addicted . 

The patch instructions say that the patch has the same amount of nicotine as a pack of cigarettes but it definitely does not feel the same as smoking. I definitely felt the withdrawal quite intensely even using the patch that was why Ex was so important  for me to have a successful quit.

[constanceclum]

The amount the patch delivers depends on the strength and amount smoked. I smoked 2 packs of Pall Malls/day which is among the strongest cigs. So a 21 mg. patch is the equivilant of about 15 of those cigs. I adjusted well to the 21 mg. patch but I've had a horrible time with 15 mg.

Connie

[MikeBurke]

There are a number of articles that show clearly that the cigarette delivers higher doses of nicotine than any method other than intravenous, and delivers the nicotine faster than any method including intravenous injection.  1 article that provides a good summary is       Nicotine Chemistry, Metabolism, Kinetics and Biomarkers by Benowitz et. al. 2009 Hdbk of Exp. Pharm.  In addition tobacco transmits 100's of additional toxic compounds.

It is unfortunate there is so much fear and misunderstanding about the use of nicotine replacement medications.

[MikeBurke]

FDA recommendations now encourage the use of a nicotine patch + a short acting nicotine like the gum or lozenge together.  People who smoke are very good at giving themselves the right amount of nicotine to manage withdrawal and craving, unfortunately the nicotine replacement medicines don't work as well.  But using a long acting patch, + a short acting gum or lozenge, can help better manage the uncomfortable symptoms, while improving the likelihood for success.

[MikeBurke]

It would be helpful if you would provide a reference to this information on nicotine replacement like speed of delivery to the brain.  

[TW517]

Don't get me wrong.  I have nothing against NRT's.  If I had to do it over again, I would use the patch and some gum or lozenges for those tough periods.

But I would genuinely like to see studies backing up claims like, "don't deliver a high dose", or they "are not as addictive".  The study you cite seems to only address absorption rates, not the other issues.

I will look tonight for the study I read about speed of delivery.  I actually got a hard copy from 2 smoking cessation classes I took.  One from Ohio Health Hospital System and one from a large group of MD's, Central Ohio Primary Care.  But even if that study has been disproven, my greater concerns are addiction and abuse of NRT's, not how fast they get into your system.

I agree that there is a lot of misinformation about NRT products.  Unfortunately, I also believe much misinformation (or omitted information) comes from the manufacturers of those products.  Such as risk of replacement addiction, etc.

[MikeBurke]

Not to have too much back and forth, but to answer you question, one of the reasons cigarettes are so addicting is the speed of delivery of the nicotine. This is why the tobacco companies boost that delivery by changing the PH of nicotine in cigarettes using things like ammonia products, in effect 'free-basing' the nicotien.  The available nicotine replacement medications have a very low addiction potential in comparison to tobacco products, in part because of the slower and reduced delivery of nicotine.  Addiction does not seem to happen with the nicotine patch at all, for similar reasons. 

The main thing is to quit tobacco and stay quit.  I wish you all the best in this. 

[Diannnnn]

Thank you Dr. Hays. This is a subject I was thinking a lot about over the last month as I "stepped down" my nicotine patch dosage. I spent 4 weeks at 21mg, then went to 14mg on a Sunday. The following week was really difficult for me. I was depressed for no apparent reason, lethargic, cloudy brain and sleeping quite a bit. It took me a while to realize what was going on, but the nicotine dosage was the only thing that changed. Antidepressant stayed the same, almost non existent alcohol intake and exercise was regular until the Monday following the patch decrease. I stepped down to 7mg on Sunday the 20th. I forgot to change my patch on Monday and by Tuesday I was depressed again with the same symptoms as before. I decided that I wasn't going through this again when I finished the 7mg course, so I simply stopped using the patch. It was tough at first and I am still having a difficult time with tiredness, but by Friday the depression was lifting. Each day is a little better and I do recommend the nicotine patch with the lozenge or gum for those really tough craves. It helped me a lot, I just wasn't prepared for what I call, "mini-withdrawals". I could be way off base, but it's the only thing I can pinpoint that changed. 

[Diannnnn]

Connie,

I am sorry you are having such a rough time! I would think it should be leveling off after 10 days, but it also sounds like these symptoms had been going on before you stepped down the patch.

Hang in there girl, you can do this. Have you tried the lozenge or gum for the really hard craves? I occasionally used the lozenge and it definitely took the edge off. Hated the taste though...lol.

I hope things level out for you soon.

[JonesCarpeDiem]

https://www.tctactics.org/index.php/Pharma

[12Finally34]

I looked up the word Anhedonia.  I felt that way when I was smoking.  

Now with my 41 days and doing some of the 101 activities, I am slowing  not isolating as much.

The comments about the research is interesting and informative.

[RT2016]

I am a recovering alcoholic (sober 3 years).  I have quit before using patches and Did get addicted to them.  I tried to step down and cravings were as bad as going cold turkey. I have tried Wellbutrin but it made me excessively angry, however, I was drinking in those days.  I have the AA support system, but am open to suggestions.  I wonder if I take the Wellbutrin, will it keep me from sleeping and will the anger come back?  I have taken it sober before but sleep did not happen, making three times as fuzzy headed.  Also, now the patches cause nice little itchy squares everywhere I use them.  Can't use them anymore.  Haven't quit.  Just set date today, for 24 October.

[JonesCarpeDiem]

/blogs/jonescarp.aka.dale.Jan_2007-blog/2011/06/26/what-to-expect-in-the-first-four-months 

[JonesCarpeDiem]

https://excommunity.becomeanex.org/message/70402-where-does-it-come-from 

[Dr_Hays]

Hello
I commend your continued efforts to stop smoking and your 3 years sobriety. As you probably know, smoking is the leading cause of preventable death and illness among people who are recovering from alcoholism. And it is likely that the persistent strong cravings for tobacco that occurred to you before were made worse because you were continuing to use alcohol. Regarding the use of bupropion (Wellbutrin and Zyban are common trade names for this drug), it would be best to talk with your prescribing health care provider about this. It is true that the most common adverse effect of bupropion is sleep disturbance. Regardless the treatment approach you decide to take, you should discuss potential adverse drug effects with your health care provider before you start treatment. There are ways to reduce the impact of adverse medication effects if you are alert to the fact that they may occur and report them to your prescribing provider early.

[Dr_Hays]

Withdrawal can be persistent.  Be assured that it will get better, and keep up the good work Diannnnn!

[12Finally34]

Today is my 72nd day of not taking the first puff.  

Starting 9/27, I experienced some POST TRAUMATIC STRESS  due to the fact I was acknolwedging my son's death (10 anniversary), dealing with the fact another student claimed bullying is the reason why he murdered one student and severely wound another.  That incident triggered my experience three years ago when of one of my students stabbed and killed another student.  

 I had to celebrate my daughter's 47 years the day before my son's anniversary.  

Fighting the city is a nightmare.   I didn't pick up a cigarette but any negative emotions wrecked my nerves.  I usually don't calm down until after October 6, (that is when I buried my son). 

To put the nail in the coffin.  I thought I would be returning to work advocating for my students.  Instead, I am fighting ageism in the work place.  For now, I have to work as if I was a new employee dotting my i(s) and crossing my t(s)  

The nicotine meetings and the blogs have helped me not to take that first puff.  I was able to cry and relieve some tension by attending the nicotine meetings.  

The difference in my quitting this time is that I reeducated my brain and I am not quitting in isolation.  I feel I have support.  I pledge daily how powerless I am over cigarettes and how unmanageable  my life is when I take the first puff.

I am hoping one day instead of pretending I forgive others and myself for my losses (45 years of smoking and lost of a child), it will become a reality.  

Taking Wellbutrin, Chantix, and gum helped to ease the initial irritation and anger.   I am now using natural support such as jumping, screaming, helping newbies, talking to elders/sponsors,  breathing deeply, breaking cheap glasses and plates to deal with irritation and anger.

I owe my freedom to this site.  By blogging and staying in touch, I was able to transition to the nicotine meeting to keep my smobriety.  

Work is hectic and insidious, I am not able to surf the site like I want.  When I do, I am so happy to read when newbies have joined and the elders are still helping.

[Diannnnn]

You are doing amazing!! Keep it up and hold your head high girl!

[bonniebee]

That is what I did and I am now have 973 days of Freedom and truly feel free !

[elvan]

12Finally34  I just saw this comment and my heart is absolutely aching thinking of your loss.  Please accept my condolences and know that I seriously doubt that ANYONE can get over the death of a child...you are doing SO WELL and you are giving so much to all of the members of this site.  YOU, my friend, are as valuable as ANY elder here, our time here is about quality and not quantity.  I am always so happy to hear from you, you are a very, very important part of this site.  Don't forget that...

XOXO,

Ellen

[12Finally34]

Today is my 128 day.

Symptoms are not able to concentrate, restlessness, irritability.

Stressor - death of a sibling 11/20/17.

I allow people in my communities support me (AA/Nicotine, psychodrama group, colleagues, and family).

Removed myself from triggers lit cigarette, group members smoking, reduce sugar intake, do a gratitude check and reach out to a struggling nicotine addicts who is planning to stop smoking.    

[JonesCarpeDiem]

I'm sorry for your loss. Proud of you for staying quit.

The symptoms you listed. Do you still have them at 128 days?

[Giulia]

Symptoms at day 128 - Wow.  Those are tough.  But understandable given the death of your brother.  Personally I don't think you're suffering nicotine withdrawal after all this time.  The nicotine is long gone from your body.  But the "psychological" comfort you got from a cigarette is what's knocking at your craving door.  That behavioral sense memory is still alive and well.  And that's par for the course during the first year of our quits. It just is.  Fact.  No getting around it.  

We can't always remove ourselves from our triggers.  Your brother died.  (And we all grieve with you for that loss.)  But, how can you possible remove yourself from that psychological pain/trigger?  You can't.  

But what you ARE doing is exactly what you're supposed to be doing to protect your beautiful four-month quit.  You've removed yourself from all the triggers you can (I'm assuming "Removed myself from triggers lit cigarette," doesn't mean YOU lit that cigarette, but that you removed yourself from those who had lit cigarettes.)  You're aware of the "symptoms" of cravings, you've reduced your sugar intake, doing a gratitude check, offering support to others..  You're doing everything you can to protect your quit.  Under really awful emotional times.  You have a great Quit Kit!

You are doing it all "right."    YOU will become a member of the Elder's List if you keep this up.  THIS is part of that one-year journey to freedom.  Don't forget to take those long, slow deep breaths.  They really do help.  To concentrate, to slow down restlessness.  As far as irritability is concerned - the only cure I know for that is HUMOR.   Not that this is exactly the right time to bring it up in your world, but - just keep that as a thought in the back burner along with the other tools in your quit kit.  12Finally34‌

[elvan]

I think you are experiencing intense grief and your sibling really JUST died, you are doing a beautiful job holding onto your quit and getting support as well as offering it.  Know that you are in my thoughts and prayers and I am sure those of many, many others.

Ellen

[Dr_Hays]

Hang in there 12Finally34, my thoughts and condolence are with you.  It looks like you are taking all the steps you need to, to get through this one day at a time