Nicotine withdrawal: duration, symptoms and tricks

© Image: Snuzone

After the last cigarette, the craving for the next one becomes noticeable. If unmet, it can lead to unpleasant withdrawal symptoms. Learn here how such a negative cycle can fuel consumption and why nicotine withdrawal is so challenging for many. You’ll also find out what common withdrawal symptoms are, how long they last, and how innovative White Snus products, alongside traditional nicotine replacement products, promise controlled relief during tobacco cessation.

What Nicotine Withdrawal Means and Why It’s So Hard for Many

Nicotine withdrawal often vaguely refers to the occurrence of various physical and psychological symptoms during nicotine abstinence, particularly in the context of tobacco cessation. Withdrawal follows a nicotine abuse that has led to dependence – where the body has adapted to consumption, resulting in typical withdrawal symptoms upon abstinence.

Since "nicotine withdrawal" implies a voluntary or involuntary avoidance of nicotine consumption, it encompasses the entire period in which no nicotine is consumed. Withdrawal begins right after the last cigarette – initially manifesting as a craving, soon a consumption urge, and eventually, specific psychological and physical withdrawal symptoms.

Thus, nicotine withdrawal refers not only to symptom onset but the entire period during which one voluntarily or involuntarily abstains from nicotine and in which the body demands it in the form of mild or severe withdrawal symptoms.

Are Nicotine Withdrawal, Tobacco Withdrawal, and Smoking Withdrawal the Same?

Although other nicotine-containing substances besides tobacco can also lead to addiction, tobacco addiction worldwide is the most common cause of nicotine-specific withdrawal symptoms, especially with smoking tobacco cigarettes. Hence, the terms nicotine and tobacco withdrawal are often used interchangeably, with both mainly referring to smoking withdrawal.

Nicotine Withdrawal in the Vicious Cycle of Addiction

A "circulus vitiosus" – also called a vicious or downward spiral – is seen as a barrier in addiction that makes tobacco cessation difficult for many, fueling ongoing consumption. Nicotine withdrawal (with its craving and nicotine-specific withdrawal symptoms) and consumption (with abusive behavior and addiction) are interwoven in a self-perpetuating cycle that deepens over time. This positive feedback loop strengthens all “stations” of the negative spiral individually.

The infographic shows a downward spiral of tobacco addiction, where positive feedback occurs – abusive consumption attempts to counteract withdrawal symptoms, further intensifying them and making cessation or abstinence increasingly challenging. – © Image: Snuzone

Breaking out of this vicious cycle is difficult because as the cycle repeats, abusive consumption increases, making dependence and its symptoms more intense. As the cycle progresses, all its elements become more pronounced, and abstinence becomes harder.

Nicotine Withdrawal in ICD-10

The WHO provides a clear classification for nicotine withdrawal and its symptoms in the ICD-10 system. Nicotine-specific withdrawal symptoms are categorized under either “F17.3 Mental and behavioral disorders due to tobacco: withdrawal syndrome” or “F17.4 Mental and behavioral disorders due to tobacco: withdrawal syndrome with delirium.”*1

Mild cravings can certainly be distinguished from "tobacco withdrawal syndrome." Verified cessation or reduction of the substance – after repeated use, typically for a prolonged period – is a key diagnostic criterion.*2

Nicotine Withdrawal Symptoms

During nicotine withdrawal, mild to severe withdrawal symptoms can occur. Beyond a simple craving for a cigarette, which may be considered "mild," psychological and physical withdrawal symptoms are clearly distinguishable. Depending on the severity of the addiction, these can vary in intensity, often appearing together but not necessarily all at once.

Nicotine Withdrawal Psychological Symptoms:

• Sleep disturbances (dyssomnias, mainly insomnia) and fatigue
• Restlessness
• Concentration problems
• Nervousness and irritability
• Anxiety or concern
• Dysphoric mood (anxious, depressed, or irritable)
• Depression

Nicotine Withdrawal Physical Symptoms:

• Rapid heartbeat (tachycardia) and palpitations
• Dizziness and nausea
• Headache
• Diarrhea
• Psychomotor agitation
• Tremor
• Shortness of breath (dyspnea)
• Excessive sweating (hyperhidrosis)
• Intense hunger (hyperphagia)

Nicotine Withdrawal Sleep Disturbances

Sleep disturbances during nicotine withdrawal are particularly common, potentially worsening daytime fatigue and dysphoria, making relapse more likely. They can also exacerbate other symptoms – particularly psychological ones. Many smokers use nicotine for its stimulating effects, so they may (re)turn to cigarettes to counteract daytime fatigue, placing themselves back into the vicious cycle.

Insomnia (lack of sleep) is one of the most common symptoms during nicotine withdrawal. It can be very distressing and exacerbate other symptoms - © Image: AdobeStock

A scientific study from the University of Göttingen examines the “effects of several days of nicotine withdrawal” on sleep. Although no definitive results were found, at least two independent research groups - named in the study - observed what is called “sleep fragmentation,” which one group considers a significant criterion for assessing sleep quality.*3

Many former smokers know that sleep quality can remain impaired for a long time after quitting, which can heighten the risk of relapse. Here, another finding from the aforementioned study stands out: Nicotine replacement products seem to improve sleep quality*4 and may reduce the risk of relapse.

Nicotine Pouches are not yet recognized as a cessation method but offer potential, and there are specific snus products that seem especially suitable. Before going into this potential, let’s briefly discuss the duration of nicotine withdrawal and the concept of "cold turkey."

Nicotine Withdrawal Duration

As mentioned, withdrawal begins after the last use. Depending on one's usual stimulus-response interval (the lapse in effect) and previous consumption levels, the desire for another cigarette may arise within minutes. This craving intensifies by the minute, eventually leading to strong cravings or addiction pressure (= craving in common sense).

After a few hours of abstinence, the first psychological and physical symptoms appear, peaking within 1-2 days. They gradually diminish after about three days. While these symptoms, especially the psychological ones, can persist in a milder form for weeks, they generally improve over time, often disappearing entirely after about a month. While many report increased appetite and resulting weight gain at this point, this is not necessarily symptomatic hyperphagia as seen during the acute phase.

A widely-cited 2004 publication on tobacco cessation states that symptoms like restlessness, concentration difficulties, irritability, or anxiety usually disappear after 30 days.*5

This persistent increased appetite can be explained as oral satisfaction, a behavior ingrained during smoking. The so-called addiction memory is at work, with "eating" providing substitute satisfaction.

Analogously, it’s worth noting that a mild craving for cigarettes, especially in "trigger situations," may continue for a long time. The addiction memory retains (and recalls) situations with "rewarding" positive feelings associated with consumption. The more the habit dominated one's daily life, the more potent this "memory material" can be in evoking cravings. In such moments, it’s essential to stay strong and focus on the benefits of tobacco abstinence. Falling back into smoking can result in a rapid return to cigarette addiction.

Nicotine Withdrawal Phases

The duration of nicotine withdrawal can be broken down into phases, assuming abstinence is maintained:

1. Prodromal Phase: After the last use, initial cravings or addiction pressure (craving) appear without specific withdrawal symptoms.
2. Initial Phase of Withdrawal Symptoms: After a few hours, specific withdrawal symptoms begin to appear.
3. Acute Phase of Withdrawal Symptoms: Symptoms peak after 24-48 hours.
4. Symptom Decline Phase: Within 3-30 days, withdrawal symptoms gradually subside and disappear.
5. Residual Phase: Throughout the previous phases, the addiction memory was active, but after 30 days, it remains as an isolated residual effect. This phase can last a lifetime.

>> Referring to the previous infographic, it can be summarized that the key to successful cessation is to strengthen resistance to cravings, alleviate withdrawal symptoms, and prevent abusive tobacco use from resuming. Learn about available treatment options in: Nicotine Abuse – Causes, Effects, and Treatment Options

Nicotine Addiction Curve

The so-called "Nicotine Addiction Curve" refers to the (temporal) progression of withdrawal symptoms after the last use. The curve illustrates how cravings, withdrawal symptoms, and subjective well-being develop through the different phases of nicotine withdrawal.

This model can provide quitters with a reference point to prepare for withdrawal. It also demonstrates that perseverance is worth it.

Cold Nicotine Withdrawal

Cold nicotine withdrawal refers to abruptly quitting without using any aids such as nicotine replacement products, psychotropic medications, or other tobacco-free alternatives. The withdrawal phases are thus faced without gradually reducing use or relying on nicotine patches, lozenges, medications, or less harmful tobacco-free alternatives.

Is Cold Nicotine Withdrawal Dangerous?

In any case, this method is the most unpleasant – as withdrawal symptoms must be endured at full strength without mitigation. Without preparation, this can be overwhelming, and the intensity of the symptoms can lead to relapse due to the overwhelming urge to resume consumption (cf. vicious circle).

But, is it dangerous?

• Withdrawal symptoms can certainly be risky if one is unaware of them before attempting cessation. The symptoms can also intensify in a feedback loop.
• Additionally, a high level of prior abuse can lead to "withdrawal syndrome with delirium" – recall ICD-10 coding F17.4. Then it can indeed be dangerous.

Given the availability of aids that ease cessation – nicotine replacement products, psychotropic medications, and tobacco-free alternatives – it is advisable to use these to reduce the risk of relapse.

Recently, a tobacco-free, less harmful White Snus variant has been introduced that can aid in withdrawal, with its specific ingredient making abuse unlikely.

White Snus for Tobacco Withdrawal

Experts increasingly emphasize that White Snus can indeed help individuals leave "cigarettes" behind, marking at least an initial step toward tobacco cessation.

>> Read more here: Nicotine Pouches as a Cigarette Alternative – Education Could Promote Smoking Cessation

However, White Snus has also recently faced widespread criticism. Many view them as potentially highly addictive and even believe they could lead to abusive use. However, most people are unaware that some tobacco-free nicotine pouches contain a nicotine form also found in nicotine gum. Called Nicotine Polacrilex in White Snus, this ingredient allows for controlled, consistent nicotine release, preventing rapid absorption and enabling sustained relief from withdrawal symptoms without heightened "addiction potential."

This specific White Snus variant is therefore as suitable as traditional nicotine gum for nicotine replacement therapy. In fact, it uses the same form of nicotine, and chewing gum can be inconvenient or inappropriate in some situations – nicotine pouches are much more discreet.

But why are they not taken seriously? Simply due to a lack of awareness and, as noted, fear of potential misuse.

Those who assume this must likewise scrutinize nicotine gum – they contain the same form of nicotine and are used similarly. Some may argue that their nicotine levels are lower and thus "safer," but it’s the specific nicotine form rather than the nicotine content that limits addiction potential and abuse. Some former heavy smokers report needing multiple gums or a combination with nicotine patches to manage withdrawal adequately.

By the way, gum is available over-the-counter, so anyone of legal age can purchase it – though it tends to be slightly more expensive.

Returning to the previously mentioned vicious cycle, these specific White Snus variants may not only slow the progression of the negative spiral of tobacco addiction but also help control and potentially prevent abusive consumption.

© Image: Snuzone

They can help in two ways: by acting preemptively before withdrawal symptoms arise, offering support for abstinence and resistance against cravings, or by mitigating symptoms when they do occur. Strong motivations for consumption can thus be weakened or even neutralized preventively or counteractively.

Why White Snus is Always Better Than Tobacco Products

For tobacco-free White Snus, the so-called “harm reduction strategy” can certainly apply. The EU-wide cancer rates associated with smoking could be significantly reduced with these – as Sweden impressively demonstrates.

>> Read more on how nicotine pouches could lower cancer rates in: EU Tobacco Directive: The Future of Snus and Nicotine Pouches

Home Remedies and Tips for Nicotine Withdrawal

Finally, here are some "home remedies" and proven strategies to help maintain perseverance during nicotine withdrawal:

• Regularly remind yourself of the reasons for quitting and the progress you’ve made.
• If possible, avoid places where consumption occurs – especially during the acute phase of withdrawal symptoms.
• Allow yourself the rest you need, and avoid stress as much as possible.
• Pursue your hobbies – especially sports, which can work wonders. Not only does it distract, but you’ll feel better afterward.
• Common home remedies for sleep disturbances include milk with honey or CBD. Generally, create a relaxing atmosphere before bed, and don’t pressure yourself to fall asleep. Sleep difficulties during nicotine withdrawal are normal and will improve.
• Keep healthy snacks for cravings ready. Fruits and nuts are natural appetite suppressants.
• Drinking plenty of water can help satisfy/dampen learned oral cravings.
• Avoid alcohol – it won’t alleviate sleep issues and may even exacerbate them. While your body adjusts to withdrawal, alcohol can be counterproductive, harmful, and detrimental to addiction memory.

------------------------------------------------------
*1 See: https://www.icd-code.de/icd/code/F17.-.html
*2 Also see: https://www.medizin.uni-tuebingen.de/de/das-klinikum/einrichtungen/kliniken/psychiatrie-und-psychotherapie/allgemeine-psychiatrie/sucht-und-praevention/tabak
*3,4 See: https://ediss.uni-goettingen.de/handle/11858/00-1735-0000-0018-00A8-C
*5 See: Cornuz J, Humair JP, and Zellweger JP (2004): Tobacco Cessation. Schweiz Med Forum 4, 764–770