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Withdrawal Symptoms and Associated Features

Withdrawal symptoms typically begin within hours of quitting and peak within 2 to 3 days. The worst symptoms usually fade by 2 to 3 weeks, but some symptoms may persist (ACS 2009). Individual experience may vary. The following symptoms are experienced after abrupt cessation of nicotine following a period of prolonged use (weeks):

  • Dysphoric or depressed mood
  • Insomnia
  • Irritability, frustration, or anger
  • Anxiety
  • Restlessness or impatience
  • Decreased heart rate
  • Increased appetite or weight gain
  • Difficulty concentrating

For a diagnosis of nicotine withdrawal, four or more of the above symptoms must be present and must cause clinically significant distress or impairment of social, occupational, or other important area of functioning.

Associated features might include the following:

  • Cravings for cigarettes
  • Desire for sweets
  • Impaired performance on tasks requiring vigilance

(Audrian-McGovern & Benowitz 2011; Kozink et al. 2010)

More on the Effect of Smoking Cessation on Moods

Subjective feelings associated with smoking abstinence after 4 hours include depression, stress, irritability, restlessness (Parrott et al. 1993). Psychological symptoms decrease linearly with increasing number of days in abstinence (Schiffman & Jarvick 1976). Symptoms increase thereafter throughout the day but improve the next morning and increase again. There may be some increase in anxiety immediately following smoking cessation, however, anxiety tends to become lower than pre-cessation levels within one week of quitting (West & Hajeck 1997). Symptoms of anxiety and depression with smoking cessation are more severe in people with histories of major depression or anxiety disorders (Breslau, Kilbey, & Andreski 1992).


Alcoholics are very likely to smoke while drinking. People who feel that their alcohol and tobacco use are strongly linked may be candidates for an attempt at simultaneous recovery (Sobell, Sobell, & Agrawal 2002), although simultaneous dual recoveries are difficult and often lead to failure (Stotts, Schmitz, & Grobowski 2003).

View ReferencesHide References
American Cancer Society. Guide for quitting smoking. American Cancer Society Website. 2009. Available at: https://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-toc Accessed on: 2010-06-23.
Audrain-McGovern J, Benowitz NL. Cigarette Smoking, Nicotine, and Body Weight. Clin Pharmacol Ther. 2011; 90: 164-168. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195407/ Accessed on: 2014-10-23.
Breslau N, Kilbey MM, Andreski P. Nicotine withdrawal symptoms and psychiatric disorders: findings from an epidemiologic study of young adults. Am J Psychiatry. 1992; 149: 464-469. Available at: https://www.ncbi.nlm.nih.gov/pubmed/1554030 Accessed on: 2013-10-28.
Kozink RV, Lutz AM, Rose JE, Froeliger B, McClernon FJ. Smoking withdrawal shifts the spatiotemporal dynamics of neurocognition. Addiction Biology. 2010; 15: 480-490. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1369-1600.2010.00252.x/full Accessed on: 2014-10-23.
Parrott A.C. Nesbitt's Paradox resolved? Stress and arousal modulation during cigarette smoking . Addiction. 1993; 93(1): 27-39. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9624709 Accessed on: 2013-10-28.
Shiffman CH, Jarvick ME. Smoking withdrawal symptoms in two weeks of abstinence. Journal of Psychopharmacology. 1976; 50(1): 35-39. Available at: https://www.ncbi.nlm.nih.gov/pubmed/827760 Accessed on: 2013-10-28.
Sobell LC, Sobell MB, Agrawal S. Self-change and dual recoveries among individuals with alcohol and tobacco problems: current knowledge and future directions. Alcohol Clinical Experimental Research. 2002; (12): 1936-1938. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12500127 Accessed on: 2013-10-28.
Stotts AL, Schmitz JM, Grabowski J. Concurrent treatment for alcohol and tobacco dependence: are patients ready to quit both?. Drug and Alcohol Dependence. 2003; 69: 1-7. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12536060 Accessed on: 2013-10-28.
West R, Hajek P. What happens to anxiety levels on giving up smoking?. American Journal Psychiatry. 1997; 154: 1589-1592. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9356569 Accessed on: 2013-10-28.