Smoking Withdrawal Symptoms and Readiness to Quit

What are nicotine withdrawal symptoms? I have done a survey of the records of the last one hundred patients I treated for smoking cessation in face-to-face sessions. These records contain near-verbatim accounts of what patients say in reply to open-ended questions, since I have found this is the best way to gain an understanding of what is going on in smokers’ minds. It’s in complete contrast to the orthodox, tick-box approach: ‘The following is a list of nicotine withdrawal symptoms – tick all that apply to you: cravings, headaches, stomach pains, depression, nervousness, etc.’

What is remarkable about asking smokers the question ‘What do you actually feel when you feel you want a cigarette?’, is that they usually find it difficult, at first, to say anything at all. Or they might say ‘I don’t know’ or ‘Nothing’. Secondly, when given time for reflection and perhaps after some gentle prompting, their responses are remarkably similar. Thirdly, what is also notable about the replies is the mildness of the symptoms described: they are not that bad in the great majority of cases. Fourthly, they are nearly all mental symptoms.

In descending order of frequency, these are the symptoms mentioned – most patients had more than one:

Anxiety                                               72%
Irritability                                           46%
Distraction                                         20%
Feeling of something missing        16%
Frustration                                        12%
Thinking about smoking a lot          8%
Panic                                                    8%
Light headed                                      3%
Dry mouth/bad taste                        3%
Headache                                           2%
Neck tightness                                   2%
Depression                                         2%
Sleepiness                                          2%
Others                                                1%

Others: sweaty hands, weakness, chest tightness, feeling of lightness in the body, feeling mildly unwell, cough, loss of appetite.

I have paraphrased some symptoms to avoid undue complexity. For example, if patients said they felt short-tempered I have put this under Irritability; difficulty in concentrating and insecurity under Distraction; and nervousness, restlessness and stress under Anxiety.

Some symptoms deserve special mention. Headache occurs frequently in lists of nicotine withdrawal symptoms. As can be seen it was noted only twice among my one hundred subjects: in one case it referred to a feeling of tightness in the muscles at the back of the neck, so this could have been due to associated anxiety; in only one case was it mentioned as a specific symptom. No one mentioned stomach upsets or sleeping difficulties. No one said he or she had ‘cravings’ for a cigarette; all they said, on the relatively rare occasions when such a symptom was noted, was that they were thinking about smoking a lot.

Now let’s do an informal survey of nicotine withdrawal symptoms from the internet. Putting this phrase into Google produced 542,000 hits. Taking a few at random, these are the sorts of dire symptoms you’ll find:

Intense cravings for nicotine, tingling in the hands and feet, sweating, nausea and intestinal cramping, headaches, coughing, sore throat, insomnia, difficulty concentrating, anxiety, irritability

Cravings, restlessness, trouble sleeping, rough mornings, irritability, headaches, anxiety, heightened stress, depression, restlessness/boredom, nausea, heartburn, moodiness

Urges to smoke, depressed mood, difficulty sleeping or sleep disturbances, irritability, frustration or anger, anxiety, difficulty concentrating,  restlessness, decreased heart rate, increased appetite or weight gain

Dizziness, fatigue, insomnia, cough, constipation, hunger, sweet tooth, obsessive desire to smoke, irritability, headaches and pressure behind the eyes

Where do they get these from? Are they just copied from one internet site or textbook to another, endlessly replicated and taken as gospel truths with no one (apart from me) going back to the original sources?

Let me anticipate one objection here. In my own research I list only the immediate symptoms of nicotine withdrawal, maybe those felt one hour after the last cigarette. The other sources to which I refer sometimes list symptoms according to a timeline, perhaps from two hours to twelve weeks or more. Again, I would ask, what is the evidence that recent ex-smokers experience such prolonged misery? I always follow-up my patients and the common story is that most feel very few or no withdrawal symptoms in the longer term.

The myth of the suffering you will likely go through if you try to give up smoking on your own is part of a narrative that you will need help to do it. And the help that’s usually offered consists, bizarrely, of nicotine products or prescription drugs. At best, these are only about 20% effective, so out of one hundred smokers using such methods, eighty will fail and will still be smoking a year later.

Worse, this approach ties in with the mind-set of smokers: they don’t really want to quit. This is hard to admit to oneself, but they feel less foolish about smoking if they believe they’re ‘trying’ to quit. Thus, they unconsciously look for a quit method that will probably fail.

In their heads smokers wish they didn’t have to go through life poisoning themselves every day just to feel normal, but in their hearts, because smoking is drug (nicotine) addiction, they find it more comfortable to carry on, at least for the time being. So they’re always looking for an excuse for smoking, directed to themselves or their loved-ones, even if they don’t admit it: ‘I want to give up – but not now, not yet, it’s too difficult, I’ll be hell to live with if I try, I’m not ready.’

The reality is that smokers will never be ready to quit – that’s why they’re smokers. In any case, what does it mean, being ‘ready’ to quit? Suppose you reach the stage where you’re ready, what then? You find a method of quitting that will likely fail, so you can carry on smoking. Of course, many smokers do quit, but what has readiness got to do with it? How long does the state of readiness need to last to qualify as a valid concept? Presumably the shorter the better. If you were ready to quit smoking for a year but never managed to do it, you would look rather foolish. So those who are ready, quit, and those who aren’t, smoke! In the former case, you smoke your last cigarette, declare that you’re ready to quit and – that’s it  – you’re a non-smoker. The idea of readiness really means the lack of it; it’s not a prerequisite for quitting, but an excuse to continue smoking.

Text © Gabriel Symonds