Withdrawal & Relapse

Withdrawal Symptoms

Tobacco use can lead to an addiction to nicotine – similar to cocaine, heroin or alcohol. When an individual stops using tobacco, withdrawal symptoms begin within a couple of hours.

When a person smokes a cigarette, the body and brain have to make changes to be able to tolerate the substance. Once this happens, the body begins to act like having this substance is normal. When a person quits smoking, the body feels abnormal because it has gotten used to the chemical. This stage of adjustment, learning to live without nicotine, can be challenging due to withdrawal symptoms. On average, these symptoms last about 2 – 4 weeks, but the first week can be the toughest.

 

Common withdrawal symptoms:

1. Anxiety
2. Decreased heart rate
3. Depression
4. Impaired concentration
5. Increased appetite/weight gain
6. Insomnia
7. Irritability, anger, frustration
8. Restlessness
9. Mouth Sores

 

Relapse

It is not unusual for patients to relapse after quitting tobacco, especially after their first attempt. Chances of relapse are high for new mothers, and women in general are more likely to relapse. Also, many patients relapse due to discontinuing treatment medications too soon (i.e., medications that are approved by the FDA to help smokers quit).

It is important for clinicians to impress upon patients that they should not be discouraged when a relapse occurs. Each time they try to quit, their chances of eventually quitting improve. This is a step in the process of quitting.

Trigger and Solution: Tips for Patients to Prevent Relapse

Trigger: After quitting, thinking that I can have just one. This usually leads to another one after that, and then another.
A Solution: Remind yourself that cravings to smoke are like an itch: the more you scratch it the itchier it gets. It might help to take this a step at a time. You don't have to worry about quitting for a lifetime: the only cigarette you need to worry about picking back up is the first one.

Trigger: Stress (or celebrations). For years you have used tobacco as a way of dealing with stressful (including happy) situations
A Solution: Begin thinking about ways to cope with stress - and ways to reward yourself - without tobacco use. Fun activities, talking with a trusted friend, saving up money for special rewards, exercise - these are some of the ways to cope that others have discovered. Having trouble thinking of ideas on your own? Speak with your health care provider or call The Maine Tobacco HelpLine at 1-800-207-1230.

Trigger: Consuming alcohol. Many people have found that drinking even small amounts of alcohol can trigger a return to smoking.
A Solution: Unless alcohol is also a problem for you, most people don't need to give it up for good but many find that they need to stay away from drinking for the first couple of weeks.

Trigger: Too much caffeine. When people quit smoking, caffeine can begin to affect the person more strongly than when still smoking. This can add to feelings of anxiety, restlessness and difficulty sleeping.
A Solution: Cut back on the amount of coffee, tea or soft drinks containing caffeine that you consume. With coffee, an easy way to do this is to mix in some decaf with every cup that you drink.

Trigger: Smelling others' tobacco smoke. For some people the smell of tobacco – or even just being around others when they are smoking - can be too tempting.
A Solution: Try to avoid smoking situations for the first few weeks. It may be hard to avoid it entirely but the more you can minimize your contact the easier it will be. In situations where it is completely unavoidable, try to think in advance about who else might be present that doesn't smoke. Try hanging out with him or her.

Trigger: Not enough medication or coming off of it too soon. For people using the nicotine gum, lozenge, inhaler or nasal spray it is not uncommon for people to not use enough of the medicine. With almost all tobacco treatment medication, people often come off it too soon.
A Solution: Don't wait for a craving to hit. It may be too late. With the gum, lozenge, inhaler and nasal spray try taking it as directed periodically throughout the day. This will keep a steady supply of medicine in your body to help with any cravings. For all tobacco treatment medicines, take the medication for at least 8 weeks.

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Coping Skills

Managing Cravings. Preparing patients for coping with cravings associated with tobacco use can help them achieve success.

1. Know why you are quitting. Commitment to the reasons for quitting can build long term success. Commit your reasons to paper, and use the list as a tool to help overcome urges to smoke.
2. Know when you're rationalizing. Once you quit smoking, it's easy for a smoker to find reasons to smoke again. Be prepared for dialogue that urges "just one more" cigarette. Realizing that this is part of the process of recovery can help patients overcome the desire to fall into their own mental traps.
3. Know your triggers. Breaking down old habits and creating new ones that are much healthier is something that can be done with practice. Having healthy snacks around and avoiding traps like alcohol can help create new, healthier patterns.
4. Use a system of support. Smokers heighten their success when they have a system of social support. Friends and family can serve as support, and cessation groups and "buddies" can sometimes work better for those seeking understanding and encouragement. Support also leads to self-efficacy - if a patient feels like quitting is possible, it's more likely they'll succeed.

Redirection. Redirecting patients' urges can help them through their most vulnerable times. Patients can be armed with ways to redirect urges with actions such as:

1. Eating a popsicle
2. Flossing teeth
3. Playing with Silly Putty
4. Looking at pictures of the negative effects of smoking
5. Going to the gym
6. Counting the money saved from not smoking

Have patients create their own list, or use Terry Martin's 101 Things to Do Instead of Smoking.

Creating positive actions. Quitting tobacco dependence is a process. Turning negative actions and thoughts into positive solutions can help patients build a quit program that works over the long term. It can also provide them with knowledge about what leads to relapse so they can avoid those in the future.

The following is adapted from Terry Martin's "Things to Avoid When You Quit Smoking" to share with patients.

1. Be patient. The natural tendency is to quit smoking and expect to be done with it within a month. Smoking cessation doesn't work that way. Have patience with yourself, and with the process.
2. Focus on today. It can be overwhelming to think you'll never smoke another cigarette, so don't. Don't focus on forever, focus on the day you have in front of you. This is where your power is.
3. Be positive. Successful long-term cessation starts in the mind. Don't beat yourself up for things you can't change, such as the years you spent smoking. And don't look at past quit attempts as failures. Learn from the experiences you've had and move on. Think about all of the positive changes you're creating in your life by quitting tobacco.
4. Take care of yourself. This is a time when you should be taking extra care to make sure all of your needs are being met. You'll weather withdrawal more comfortably if you do things like eat a well-balanced diet, get more rest, drink water, exercise daily, and take a daily multi-vitamin..
5. Avoid alcohol triggers. Alcohol and tobacco go hand-in-hand, and new quitters are vulnerable. Putting yourself into a social setting where you're tempted to drink too soon after quitting can be dangerous. Don't rush it. The time will come when you can have a drink without it triggering the urge to smoke, but don't expect that to be within the first month, or perhaps even the first few months.
6. Take it easy. Early cessation creates its own tension, let alone all of the other stresses that come and go in our busy daily lives. Fatigue and stress are big triggers to smoke, and it can be a quick jump to feeling that you need a cigarette to cope. Plan ahead of time how you'll keep yourself out of those danger zones.
7. Laugh it off. You will have bad days. Expect and accept that. When you have a bad day, use it as an excuse to pamper yourself excessively. Be good to yourself and put your negative thoughts on hold.
8. Ask for help. Statistics show that people who quit with a healthy support system in place have a much higher rate of success over time. If you don't have people around you who are supportive, and even if you do, add some online support to your quit program.
9. Know when you're rationalizing. A relapse always begins in the mind. If you recognize unhealthy thoughts of smoking cropping up, it's time to renew your resolve.
10. Remember why you quit. You quit smoking for a reason. Don't let time and distance from the habit cloud your thinking. Tap into why you quit and remind yourself of the benefits to you and your family of being smoke free.

Find more resources for quitting, helping others quit and quitting success stories at Quit Tobacco.

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