Nicotine is the primary active chemical found in tobacco smoke. It is a potent psychoactive
drug that induces euphoria, stimulates the endocrine system, and acts on the brain’s reward
mechanisms (Lande, 2011). It is known to cause addiction through its actions in the brain.
Nicotine, like all addictive substances, is both rewarding and reinforcing to the user. Nicotine
enters the brain and facilitates dopamine release in the mesolimbic system, specifically the
nucleus accumbens and corpus striatum. This increase in the flow of dopamine is likely due to
the fact that nicotine increases the firing of dopaminergic neurons in the substantia nigra and
ventral tegmental area. fMRI scans of both human and animal subjects have shown that nicotine
increases activity in the nucleus accumbens (Lande, 2011). As with almost any substance that
interacts with the mesolimbic pathway, nicotine is highly addictive.
Abstinence after periods of extended use produces symptoms of withdrawal. During
withdrawals smokers experience the physical effects of increased heart rate, accelerated
blood pressure, and weight gain (Xu, 2007). Psychological effects include major signs of
depression,irritability, restlessness and poor sleep patterns (Pomerleau, 2004). Many smokers
will also say that they smoke because nicotine has a calming effect on them. However, this
calming effect is not only a characteristic of more tobacco in their system but it is due to the fact
that people have become physically dependent on nicotine. We can see such a dependence on
daily cigarette smokers who experience many symptoms of withdrawals at the time of abstinence
from nicotine use.
Dependence on the drug varies–some become instantly addicted after smoking just one
cigarette while for others it could take weeks (Lande, 2011). As a result habitual smokers depend
on nicotine more and more and become addicts. In fact some experts rank nicotine ahead of alcohol, cocaine and heroin in matters of becoming addicted to the drug (Lande, 2011).
Nicotine addiction affects individuals differently. For the most part, men are more sensitive in
abstinence of daily tobacco use. Several studies have been done examining nicotine dependence
and abstinence in which men seem to show more symptoms of depression while trying to quit
smoking. A 2005 study done by F.Pormerleau, S. Pormerleau, Mehringer, Snedecor, Ninowski,
and Sen characterized phenotypes based on withdrawal discomfort. Men exhibited elevated
cravings and higher levels of depression and dependence during periods of abstinence. Indeed for
men quitting is a hard thing to do since the depression that they experience during the cessation
period is stronger. Some men have difficulty staying motivated and feeling happy. This period of
depression is a period where most cigarettes smokers relapse. However, for those that fight the
cravings, they end up experiencing drastic mood changes.
Nicotine is a substance that makes people feel good (Colrain, 2004). A challenge that smokers
have to face while trying to quit is the withdrawal symptom of irritability. When the body is
deprived of it, most individuals get canky, anxious and irritable. A study done by McRobbie,
Thornley, Bullen, Lin, Senior, Laugesen, Whittaker and Hajek in 2010 shows that nicotine
replacement therapies on tobacco withdrawal, after some hours of abstinence, works. In the
study, participants were deprived of nicotine for about eight hours, but after that time passed,
they were told to use a nicotine mouth spray to control nicotine craving. The spray was a form of
NRT which turned out to be very effective by decreasing smoking cravings and decreasing the
person’s high level of irritability due to smoking abstinence.
Commitment to the challenge of quitting smoking can also improve other withdrawal symptoms
such as restlessness. Nicotine creates a chemical dependency, such that the body develops a need
for a certain level at all times. After quitting smoking a person can start to feel uncomfortable with their new lifestyle change of being nicotine free. This is when feelings of withdrawal
symptoms and restlessness come in. A recent study shows how the restlessness symptoms due
to nicotine withdrawal can be reduced to a much lesser calming effect by simply using one
of the NRT methods available to reduce craving. According to McRobbie et al., tobacco is a
stimulating substance that provokes withdrawal symptoms of restlessness (2010). However,
these symptoms can be counteracted by suppressing the craving with the mouth spray NRT,
which acts quickly to reduce cravings, and may help to prevent relapse. This type of NRT can
also help individuals increase the chances of achieving long-term abstinence. Reducing the
craving of nicotine by using an NRT also helps to reduce the person’s restless feelings. The
reductions of these types of cravings and feelings is something that most people want because
when they have the nicotine the body’s reaction is normal but when the level goes down, the
body reacts with restlessness for the drug.
Another study done by McRobbie et al. in 2010 shows that nicotine replacement therapies
on tobacco withdrawal, after some hours of abstinence, works. In the study, participants were
deprived of nicotine for about eight hours, but after that time passed, they were told to use a
nicotine mouth spray to control nicotine craving. The spray was a form of NRT which turned out
to be very effective by decreasing smoking cravings and decreasing the person’s high level of
irritability due to smoking abstinence.
Quitting smoking is not easy. In fact, quitting smoking is a very hard thing to do and users
trying to quit will experience irritable symptoms and cravings that are unpleasant and stressful
but with the right form of therapy these symptoms can easily be settled. Another form of NRT
is the Nicorette gum, which also helps the individual to relieve the nicotine craving during the
quitting process. It also well known, the first two weeks after quitting smoking are usually the most critical in determining the individual level of commitment to the challenge of creating a
new lifestyle–nicotine free. This is also a period where most people become discouraged for
not succeeding if they have failed in the past. However, if the individual remains strong and
committed to accomplish the challenge, he or she is more likely to stay on track and succeed.
Another symptom particularly seen in the withdrawal of nicotine is poor sleep patterns.
When the individual is very dependent on nicotine, the withdrawal effects become greater in
severity. This is when people begin to show a reduction in how much sleep they are getting on a
particular night due to abstinence from nicotine. According to a study done by Colrain, Trinder,
and Swan June in 2004, smoking cessation has a negative effect on sleep quality. Evidence also
indicates that sleep deprivation at nighttime is fragmented, sometimes showing the effects during
the daytime. Unfortunately, this type of sleep disturbance plays a big part in why some of the
people that are trying to quit smoking relapse. Smokers also relapse because nicotine is addictive
and the brain can become so used to having it that it craves it. If anyone is really serious about
quitting, then it is a good idea for that individual to surround themselves with friends, family,
and fellow quitters that can help to get through the struggle.
Regardless of a participant’s race, gender or age, the findings of each study show that anxiety,
depression, restlessness and difficulty sleeping are some of the withdrawal symptoms that people
have to deal with during the abstinence phase. These findings also provide additional support,
under laboratory supervision, for studies in which differences in craving during early abstinence
signaled differential abilities or methods that can be used to help the individual control craving
during smoking-cessation trials.
Currently tobacco addiction is the second-leading cause of death in the world. Approximately
1.1 billion people smoke worldwide, and in North America 28% of men and 24% of women smoke, (Lande, 2011). Unfortunately those who become addicted to the drug will eventually
experience nicotine withdrawal symptoms. These symptoms peak in the very first few days of
smoking cessation but eventually disappear within a month of nicotine absence. Interestingly
studies have found that nicotine withdrawals affect men and women differently during the
cessation period. The early phases of withdrawals are very similar between males and females
they include irritability, anxiety and agitation. During this phase smokers experience weight
gain due to increase in appetite, decreased heart rate, difficulty concentrating, nervousness,
headaches, insomnia and depression. However results indicate that there are gender differences
in smoking behavior and smoking cessation among males and females in particular in mood
and performance. According to a recent study conducted by Torchalla, Okoli, Hemsing, Graves
in 2011, women use cigarettes to cope with negative emotions and are more likely to develop
depressive disorders during the cessation period. Researchers of this study concluded that when
women experience negative emotions they are less likely to refrain from smoking. Therefore
women with a history of major depression were less likely to quit smoking than women with no
history of depression. Researchers of this study also found that women face greater concerns
for weight gain and received less social support than men when attempting to quit smoking.
The study concluded that women tend to gain more weight than men while abstaining from
cigarette smoking. However with Nicotine replacement therapy the women were able to control
their weight gain throughout the treatment. The findings of the researchers suggested that nonpharmacological
interventions designed just for women, such as cognitive and behavioral
approaches have a higher rate of effectiveness during the cessation period.
Furthermore, the roles of smoking for social relations and relationship behaviors may be
stronger for women than for men. In the same study done by Torchalla et al., it was suggested that nonsmoking wives were more likely to initiate smoking when they were married to smokers
(2011). The findings of the researchers concluded that women find less support from family
members and their spouses, whereas men find support from their spouse or partner during the
cessation period.
Another study done by Xu, Azizian, Monterosso, Domier, Brody, London, and Fong, in
2008 revealed that women more likely to relapse while trying to quit smoking. The women also
exhibited the most severe symptoms of nicotine withdrawal such as depression, anxiety, anger
and cravings for cigarettes only after a few hours of not smoking. Researchers in this study
indicated that female smokers enjoyed a greater relief of nicotine withdrawals after resuming
cigarette smoking; by smoking just one cigarette the female smokers exhibited a greater
reduction in cravings and nicotine withdrawals symptoms unlike the male smokers, who after
more than three days of smoking abstinence had a greater joy when smoking.
Essentially men and women experience the same withdrawal symptoms upon the cessation
of smoking. However female smokers may be less sensitive than male smokers to nicotine when
administered by other routes than smoking (Xu et al., 2008). The women smokers were more
sensitive to other smoking-related stimuli which included visual, motor, and somatosensory
components, such as smoking a cigarette of their preferred brand. Immediately female smokers
experienced substantial relief from mood swings and felt less anxious when they faced difficult
situations or other forms of stressors around them. The findings of the researchers suggested
that by adding therapeutic manipulations to mimic the rewarding effects of the actual cigarette
smoking such as de-nicotinized cigarettes, or other pharmacological therapies may aide women
initiating smoking cessation. Evidence gathered suggested that women achieve lower abstinence
rates than men after attempting to quit cigarette smoking with nicotine replacement therapies (NRT), thus supporting the evidence that tobacco cessation affects men and women in different
ways.
In a study done by Hughes in 2005, it was determined that abstinence from smoking produces
an increase of psychological distress particularly in females. The women also faced a greater
challenge when trying to quit smoking. The deprivation of nicotine in women caused symptoms
of depression, mood disorder, dysphoria, difficulty concentrating, and trouble sleeping. The
results of this study concluded that by undergoing nicotine replacement therapy in combination
with counseling therapies, the women have a greater chance of success.
Other nicotine withdrawal includes psychological and physiological aspects of the teen.
The physiological effects are a direct result of the teen’s body trying to cleanse itself from the
nicotine. These symptoms can be very intense and stressful, since the teen is usually going
through physical cycle with the onset of puberty. The psychological effects are equally different
since the hormonal changes that usually occur during the teen years can only be exasperated
by the teen abstaining from nicotine which has been a part of his life or her either through peer
pressure, a coping mechanism, or a as a learned behavior. Nicotine withdrawal symptoms have
profound negative effects on teens.
Symptoms of nicotine withdrawals generally start two to three hours after the last tobacco
use. The symptoms will usually peak about two to three days. The first two weeks are the
most critical when cessation begins with the teen (Huggins, 1990). Cessation of nicotine use
is characterized by tolerance, cravings, and feeling a dependency upon tobacco. Some of the
physical symptoms include headaches, which may be attributed to the simple stress of abstaining
from the act of smoking. The other contributing factor to these symptoms is the brain is receiving
more oxygen and less carbon monoxide than it has become accustomed to (DiFranze et al, 2000). Another expected symptom of nicotine withdrawals is insomnia. Insomnia can be very
challenging for teens, as their bodies need approximately nine-and-a-half hours worth of sleep.
Insomnia may occur because the body’s metabolism is trying to adjust itself from abstaining
from the stimulation that comes with nicotine use. Sleeping troubles can become an added
ailment to teens suffering from nicotine withdrawals, as hormones critical to the growth and
sexual maturation of the teens are released during slumber (Panday et al, 2003).
Lesser symptoms of nicotine withdrawal include harsh bouts of coughing and moodiness.
Once a teen abstains from smoking, it is not uncommon for the teen to develop a cough; these
bouts may last up to several weeks. The cilia that protect the lungs are simply getting rid of the
toxins that have built up within the lungs and throat due to cigarette smoking. The moodiness
can be expected as well, due to the body withdrawing from the antidepressants within the
nicotine. According to the results of more than one study, a link has been discovered between
depressions and smoking; however, there is no consensus on why this link exists since smoking
has been found to have relaxing effect upon the body. Depression can also be replaced by anger
and irritability, as the struggle within to ignore cravings to smoke often result in one becoming
cranky and unpleasant (Carpenter, 2001).
According to a survey conducted by the American Lung Association in 2008, 68% of current
smokers began smoking before the age of 18. It is very important to the teen who is attempting to
quit smoking to be made aware of all of the withdrawal symptoms associated with nicotine, as a
single cigarette is capable of providing enough nicotine to initiate the addiction process.
While conducting research at the Center for Tobacco Research and Intervention, Timothy
Baker discovered that the individual who is given a purpose for quitting would be successful in
accomplishing the task. According to the results of Baker’s study, the individual’s mindset plays a very key role in resisting the body’s nicotine cravings.
One theory about nicotine addiction involves self-medication. Nicotine has been shown to
have antidepressant qualities when used by depressed patients. Similarly, stopping the use of
nicotine has been shown to exacerbate symptoms of depression in users. Use of antidepressants
in the treatment of nicotine withdrawal is becoming more and more common (VazquezPalacios,
Jaime-Bonilla, Velazquez-Moctezuma, 2004). Additionally, the same study showed
that cessation of nicotine use also exacerbates the symptoms of psychiatric disorders–it may be
used for self-medication by sufferers of disorders other than depression. With the symptoms of
nicotine withdrawal being similar to the symptoms of many psychiatric disorders, this notion
should not be surprising.
Pharmacological treatments for the cessation of tobacco smoking are all but necessary in
weaning oneself off of the drug. 70% of all smokers in the United States and Europe have tried
to quit smoking, but only 6% of those who quit actually maintain abstinence (Anderson, Jorenby,
Scott, & Fiore, 2002). There are five main factors involved in quitting smoking, as described by
Cryan, Gasparini, van Heeke, and Marku in a 2003 study. They are to first stop smoking, reduce
nicotine’s reinforcing effects, mitigate withdrawal symptoms, reduce cravings, and reduce the
risk of relapse. Two types of treatments have been approved by the FDA in the United States.
The first is nicotine replacement therapy, in which users replace cigarettes as their source of
nicotine with another product, often a gum or patch that delivers a dose of the drug. The second
approved therapy is the use of the atypical antidepressant bupropion.
Nicotine replacement therapy (NRT) simply substitutes one product for another, though all
approved nicotine replacement products are much safer than tobacco. This type of therapy does
not work to address all five of the factors involved in quitting smoking. NRT products do not mitigate nicotine’s reinforcing effects; they simply administer the substance by an alternative
method. Additionally, they do not greatly reduce the risk of relapse, as 80% of those undergoing
NRT relapse within the first year (Murray, Voelker, Rakos, Nides, McCutcheon & Bjornson,
1997). NRT only works to mitigate withdrawal symptoms and reduce cravings by introducing
nicotine into the system. NRT relieves cravings for cigarettes, insomnia, anxiety, depressed
mood, and inability to concentrate. Cessation of the treatment will see the withdrawal symptoms
and cravings return almost immediately. Due to the many shortcomings of NRT, the use of
bupropion in treating nicotine withdrawal is steadily increasing.
Bupropion, an atypical antidepressant, is the only approved non-nicotinic treatment
for the cessation of smoking. Bupropion’s mechanism of action is not entirely clear, but
it is hypothesized that it is due to the drug’s ability to block reuptake of dopamine and
norepinephrine. Additionally, it has an antagonistic effect on nicotinic acetylcholine receptors
(Slemmer, Martin & Damaj, 2000). Bupropion also decreases the firing rate of dopaminergic
neurons in the substantia nigra and ventral tegmental area–the exact opposite effect of nicotine.
Bupropion is not the only antidepressant used in the treatment of smoking cessation and
nicotine withdrawal. Tricyclic antidepressants have been shown to be effective in combination
with behavioral therapy, though their significant side effects have led to the use of a safer
class of antidepressants–selective serotonin reuptake inhibitors, or SSRIs. A study with the
SSRI fluoxetine showed that it alleviated several symptoms of nicotine withdrawal, including
tension, anger, and depression (Dalack, Glassman, Rivelli, Covey & Stetner, 1995). Other
antidepressants, like the MAOI moclobemide, have been tested but have not yielded significant
results. In conclusion evidence gathered from all the studies support the findings that nicotine is
highly addictive and causes withdrawal symptoms at the time abstinence from the drug. Nicotine
addiction occurs when smokers rely on the effects of smoking to improve mood and arousal to
relieve withdrawal effects, (Rosental, Weitzman, and Benowitz, 2011).