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Withdrawal in the First Two Weeks

Because the first two weeks are so critical in determining quitting failure rates, smokers should not be shy about seeking all the help they can during this period. Withdrawal symptoms begin as soon as four hours after the last cigarette, generally peak in intensity at three to five days, and usually disappear after two weeks, although some may persist for several months. They include both physical and mental symptoms. One study found that cheating during the first two weeks of withdrawal, even with the patch, nearly guaranteed smoking again in six months. Further, nearly half of the people who did not cheat during the first two weeks were still not smoking after six months.

Physical Symptoms. During the quitting process people should consider the following physical symptoms of withdrawal as if they were recuperating from a disease and treat them accordingly as they would any physical symptoms:

Tingling in the hands and feet.
Sweating.
Intestinal disorders (cramps, nausea).
Headaches.
Respiratory symptoms as the lungs begin to clear, including sore throats, coughing, and other signs of colds.
Mental and Emotional Symptoms. Tension and craving build up during periods of withdrawal, sometimes to a nearly intolerable point. One European study found that the incidence of workplace accidents increases on No Smoking Day, a day in which up to 2 million smokers either reduce the amount they smoke or abstain altogether.

Nearly every moderate to heavy smoker experiences more than one of the following strong emotional and mental responses to withdrawal:

Infantile emotions: temper tantrums, intense needs, feelings of dependency, a state of near paralysis.
Insomnia.
Mental confusion, vagueness, or difficulty concentrating.
Irritability, restlessness, impatience, or anger.
Anxiety.
Depression, which is common during withdrawal and over the long term [see Long-Term Depression, below]. In the short term it may mimic the feelings of grief felt when a loved one is lost. As foolish as it sounds, a smoker should plan on a period of actual mourning in order to get through the early withdrawal depression.
Long-Term Depression
There is a significant association between cigarette smoking and a susceptibility to depression. People who are prone to depression face a 25% chance of becoming depressed when they quit smoking, and this increased risk persists for at least six months. What's more, depressed smokers have a very low level of success. Only about 6% remain smoke-free after a year. There are strong reasons for this:

Smoking may be masking depression, which can become severe even after the early stages of withdrawal have passed.
For some smokers, the future physical damage incurred by smoking is an abstraction, which fails to motivate quitting when measured up against the very real emotional pain triggered by nicotine withdrawal.
Not only does the smoker suffer, but the negative emotions often harm relationships with friends and family, who might even urge the ex-smoker to take up cigarettes again.
People who suffer from depression while quitting might do better using a combination of emotionally supportive therapy (as opposed to behavioral therapy), nicotine replacements, and antidepressants, such as bupropion (Zyban). If severe depression lasts beyond the withdrawal period, professional help should be sought as soon as possible.

Individual Risk Factors for Failure to Quit Smoking

Researchers have been trying to discover individual risk factors or sets of behaviors that can help predict why specific people fail to quit. Some factors include:

Being female.
Being a heavy smoker.
Inhaling deeply.
Being a long-term smoker.
Having severe withdrawal symptoms.


The many methods of quitting smoking include counseling and support groups, nicotine patches, gums and sprays, and incremental reduction.


Addictive Aspects of Nicotine

Nicotine is a psychoactive drug, and some researchers feel it is as addictive as heroin. In fact, nicotine has actions similar to cocaine and heroin in the same area of the brain.

Depending on the amount taken in, nicotine can act as either a stimulant or a sedative. Cigarette smoking (either the nicotine or the oral process of smoking itself) has definite immediate positive effects:

It relieves minor depression.
It helps suppress little fits of anger.
It enhances concentration and short-term memory.
It produces a modest sense of well being.
The addictive process of smoking has a specific daily cycle:

Most smokers have a special fondness for the first cigarette of the day because of the way brain cells respond to the day's first nicotine rush. Nicotine, particularly taken in the first few cigarettes of the day, increases the activity of dopamine, a chemical in the brain that elicits pleasurable sensations, a feeling similar to achieving a reward.
Over the course of a day, however, the nerve cells become desensitized to nicotine. Smoking becomes less pleasurable, and smokers may be likely to increase their intake to get their "reward." A smoker develops tolerance to these effects very quickly and requires increasingly higher levels of nicotine.

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