Withdrawal

If you’re still here, it means you’re working very hard to stop smoking. We really appreciate that effort. If you keep trying, you will achieve it.

Withdrawal processes don’t have to be linear. Linear improvements are those in which, gradually, cumulatively and at a steady pace, improvements are achieved without setbacks.

However, psychological processes — and smoking cessation is one — can be discontinuous, so some people skip stages, or experience some simultaneously, go backwards, or take 2 steps at once.

Detoxification is the process by which nicotine leaves the body. It usually lasts between 1 and 3 days. After that, you’ll be free of the drug. However, addiction doesn’t disappear that quickly, because it leaves its mark on the brain, such as in memory, the reward circuit and nicotinic receptors.

Withdrawal syndrome doesn’t usually last more than 28 days, but it may last less, depending on the person. This syndrome refers to the clinical picture that arises in response to deprivation of the substance, that is, the lack of the drug. Symptoms may include:

• Nervousness, anxiety, difficulty concentrating. We recommend:

  • Walking, going for a stroll.
  • Having a bath with warm or hot water. Cold showers are useful because they provide wellbeing and relaxation afterwards, but they can increase the feeling of shortness of breath; therefore, if anxiety is very intense and includes breathing difficulties or tightness in the chest, we do not recommend them.
  • Guided breathing exercises with QuitNow. First, find a quiet place with dim lighting. When you start breathing, you’ll notice that inhalation gives you the perception of gaining internal space, the brief intermediate apnoea generates a sense of inner silence, and exhalation promotes the impression of release. As you follow the breathing, notice which of the 3 intervals you feel most attuned to your body and most aligned with your purpose. Connect with that feeling. If you want to go deeper into this exercise, lie down and place one hand on your abdomen and observe how, during inhalation, this part of your body gains space and, with exhalation, it releases. Close your eyes. Your breathing will become slower and slower. Now imagine a pleasant scene, in a relaxing and safe environment. Enjoy that image. When you finish, stay lying down for a little longer before getting up. You can also try alternatives, for example the 4-7-8 sequence, which consists of inhaling while counting internally to 4, holding your breath while counting internally to 7, and exhaling while counting to 8. Breathing combats anxiety and the hyperventilation associated with it, because it helps you relax, but also because focusing on breathing is a distraction.
  • Progressive relaxation. Anxiety also manifests as muscle tension. And you can’t be tense and relaxed at the same time. To relax all the muscles in the body, you first need to become aware of the state they are in. We are often tense without realising it. Progressive relaxation consists of sitting or lying down comfortably, taking deep breaths with your eyes closed, and briefly tensing a part of the body, then relaxing it. Thus, you can start by tensing the muscles in your face for 5 seconds, noticing that state of tension and contraction, and then relaxing that area for 10 seconds and keeping it relaxed. Then you can stretch your arms, clench your fists and tense the whole arm from the shoulder to the fingertips for 5 seconds, and then relax both limbs, paying special attention to the fact that you have moved from a state of tension to a state of muscle relaxation in that part of the body. In this way, you can move through all the muscle groups in the body (neck, shoulders, chest, legs and feet), briefly tensing them and then relaxing them, and being aware of the state of muscle relaxation in each part.
  • Treat yourself to a massage!
  • Distraction techniques: colouring mandalas, inventing the life stories of unknown passers-by, etc.
  • Putting the feeling into words with people close to you and talking about everyday or trivial topics.
  • Accepting and normalising that this is an unpleasant internal state, but a temporary one.

• Irritability, bad mood, anger. Anger is a highly energetic emotion that predisposes you to action, and sometimes to defence or aggression. It’s an emotion that needs to be expressed. We advise:

  • Intensive physical exercise.
  • Anger releases: hitting a cushion, screaming into a cushion or inside a closed car, hitting the mattress with a pool noodle, stamping on single-use plastic cups, etc. Ideally, there should be no other people nearby and, if there are, let them know you’re going to do an exercise that may be noisy, but without any intention to intimidate, threaten or break anything of value. After physical releases, it is usually easier to put the emotion into words assertively and less aggressively.
  • Putting the anger into words with other people, preferably when its intensity has decreased, or once you’ve done the release.
  • Writing a new letter to tobacco, emphasising the anger you feel.
  • Avoid alcohol.

• Intense urges to smoke. There are resources for those urges:

  • The passage of time reduces impulsivity. You can set a 3-minute alarm and reassess your sensations after that time. Remember that the craving passes; it’s not forever. Each time it will be less intense and less frequent.
  • Find an activating distraction: a conversation about anything other than tobacco, doing sport, going for a walk, exploring sexuality.
  • Brush your teeth immediately or take a shower.
  • Return to the relaxation techniques mentioned above.
  • Avoid alcohol.
  • In module 3 we provide you with an extensive list of resources for intense urges to smoke.

• Insomnia. We recommend:

  • Avoid stimulants (caffeine, theine, sugar, nicotine) and alcohol.
  • Relaxation techniques (as in the previous section).
  • Add relaxing drinks or supplements to your diet: consult the options in a pharmacy.
  • Do more exercise, preferably in the morning rather than in the afternoon or evening.
  • Maintain good sleep hygiene:
    • Go to bed and get up at the same time every day.
    • Don’t do activities in bed other than sleeping.
    • Don’t stay in bed for a long time if you can’t sleep.
    • Don’t use screens and lower the lighting 1 hour before going to bed.
    • Eat dinner at least 2 hours before going to bed.

• Low mood. In response to this feeling you can:

  • Avoid being alone.
  • Share your sensations, feelings and emotions with someone. If you prefer, write them down. If you prefer, send yourself a voice note explaining how you feel.
  • Read the goodbye letter to tobacco out loud, if you wrote it. Or take this opportunity to do so.
  • Stay active.
  • Try to do things you feel like doing. Look after yourself.
  • Increase rest time without falling into inactivity or isolation.

• Constipation. We suggest:

  • A fibre-rich diet.
  • Drink water.
  • Eat fruit.

• Hunger. We advise:

  • Drink water.
  • Chew sugar-free gum.
  • Eat fruit or nuts.

• Cough. It may be that in the first few weeks you have more coughing and expectoration (expulsion of secretions from the bronchi), due to the regeneration of the respiratory mucosa. This symptom is normal and decreases over time. It is advisable to:

  • Drink plenty of water or herbal teas.
  • Consult a healthcare professional if the cough is very intense or does not lessen.

These symptoms will gradually reduce, their intensity will decrease, and they will become more spaced out over time. Urges to smoke are not eternal — they pass!

Even if the withdrawal syndrome decreases, the consequences of psychological dependence can last longer, for example, the association of certain moments or activities with a cigarette, and the urges to smoke, longing, etc.

Many of the symptoms are the result of the internal mental struggle you experience when you quit, and of psychological dependence, and not necessarily a physical effect of the lack of the substance. We’ll give an example: If you’ve ever noticed that you only have two cigarettes left in the pack, and due to your schedule or location you don’t have the possibility of buying tobacco until the next day, it may be that at the very moment of inhaling the smoke from one of the two cigarettes you have left, you start to feel nervous or anxious because you anticipate you’ll run out of tobacco. This sensation is not the result of the physical lack of nicotine, since you are in fact smoking at that very moment. It is a result of psychological dependence and of your anticipation that you are going to have a hard time when you run out of tobacco.

However, sometimes the opposite can happen: if you know it is impossible to smoke, for example, on a transoceanic flight, you feel calm without doing it. The cravings come when smoking becomes possible again, but while it’s impossible, not smoking may not feel so bad. In the case of the person who is running out of tobacco and is smoking their last cigarettes, they may feel they could do something to get more tobacco, and that unsettles them. If they were on a plane, they might not feel that unease. In this case, the urges to smoke are driven by the opportunity to do so and, therefore, are a psychological construction, not a physical symptom of the lack of nicotine in the body. Could smoke: you want to. Impossible to smoke: the person relaxes.

In the first days of withdrawal we suggest that you talk to yourself: remember the benefits you are achieving for your health.

“I’m doing it”, “Another day”. Acknowledge how difficult what you’re doing is, avoid judging yourself for wanting to smoke, and don’t treat yourself as weak: “This is so hard…”.

A phenomenon we call the pink cloud may also appear. This is a euphoric feeling and sense of control after the first days or weeks of abstinence. It is that experience of success, of victory, which brings vitality, joy and pride when you feel you have achieved an important challenge. It is the emotional experience that follows achieving a goal or overcoming a difficulty. The risk is that, even though progress has been made, the addiction has probably not yet been overcome.

It is advisable to sustain satisfaction without it turning into a euphoria that is too intense to maintain. You deserve to feel victorious, but it’s important to remember that the process may be longer and that the pink cloud and its euphoria can generate a false sense of control — of having won too soon — that relaxes you and brings you closer to a relapse.

Start noticing differences: What is changing in your life? In what ways do you notice that you’ve stopped smoking? Bring those changes into your awareness and write them down.