Withdrawal

If you’re still here, it means you’re working very hard to quit smoking. We really appreciate that effort. If you keep trying, you’ll make it.

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

However, psychological processes—and quitting smoking is one—can be discontinuous, so some people skip phases, experience some simultaneously, go backward, 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 a mark on the brain, such as in memory, the reward circuit, and nicotinic receptors.

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

• Nervousness, anxiety, difficulty concentrating. We recommend:

  • Walking, taking a stroll.
  • Taking a warm or hot bath. Cold showers are helpful because they provide well-being and relaxation afterward, but they can increase the sensation of shortness of breath. So, if anxiety is very intense and includes difficulty breathing or chest tightness, 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 inhaling gives you the perception of gaining inner space, the brief intermediate apnea creates a feeling of inner silence, and exhaling promotes the impression of release. As you follow the breath, notice which of the 3 intervals you feel most in tune with your body and most consistent 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 the body gains space and, with exhalation, releases. Close your eyes. Your breathing will become slower and slower. Now imagine a pleasant scene, in a relaxing and trusting 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’re in. We are often tense without knowing 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, and then relaxing it. So, you can start by tensing the facial muscles 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 entire arm from the shoulder to the fingertips for 5 seconds, and then relax both limbs, paying special attention to how you have moved from a state of tension to a state of muscular relaxation in that part of the body. In this way, you can go through all the muscle groups of the body (neck, shoulders, chest, legs, and feet), tensing them briefly and then relaxing them, and becoming aware of the state of muscular relaxation in each part.
  • Treat yourself to a massage!
  • Distraction techniques: coloring mandalas, making up stories about the lives of unknown passersby, etc.
  • Put the feeling into words with people close to you and talk about everyday or trivial topics.
  • Accept and normalize that it is an unpleasant inner state, but temporary.

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

  • Intensive physical exercise.
  • Anger releases: hitting a pillow, screaming with your mouth covered by a pillow or inside a closed car, hitting the mattress with a pool noodle, stepping on single-use plastic cups, etc. Ideally, there should be no other people nearby and, if there are, let them know that you are going to do an exercise that may be loud, but without any intention to intimidate, threaten, or break anything valuable. After physical releases, it is usually easier to verbalize the emotion in an assertive and less aggressive way.
  • Put your anger into words with other people, preferably when its intensity has decreased, or when you have done the release.
  • Write a new letter to tobacco, emphasizing the anger you feel.
  • Avoid alcohol.

• Intense cravings to smoke. There are resources for these cravings:

  • The passage of time reduces impulsivity. You can set a 3-minute alarm and reassess your sensations after that time. Remember that the urge passes; it’s not forever. Each time it will be less intense and less frequent.
  • Look for an activating distraction: a conversation about anything other than tobacco, playing sports, going for a walk, exploring sexuality.
  • Brush your teeth immediately or take a shower.
  • Return to the relaxation techniques already mentioned.
  • Avoid alcohol.
  • In module 3 we provide you with an extensive list of resources for intense cravings 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 at a pharmacy.
  • Exercise more, preferably in the morning rather than 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 dim the lighting 1 hour before going to sleep.
    • Eat dinner at least 2 hours before going to bed.

• Discouragement. 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. Take care of yourself.
  • Increase rest time without falling into inactivity or isolation.

• Constipation. We suggest:

  • A diet rich in fiber.
  • Drink water.
  • Eat fruit.

• Hunger. We recommend:

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

• Cough. It may be that in the first 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 recommended:

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

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

Even if withdrawal syndrome decreases, the consequences of psychological dependence can last longer, for example, the association of certain moments or activities with cigarettes, and cravings 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. Here’s an example: If you’ve ever realized that you only have two cigarettes left in the pack, and due to schedule or location you don’t have the option to buy tobacco until the next day, it may be that in the very moment you inhale the smoke from one of the two cigarettes you have left, you start to feel nervous or anxious because you anticipate that you’ll run out of tobacco. This feeling is not the result of a physical lack of nicotine, since you are in fact smoking at that very moment. It is a result of psychological dependence and the anticipation that you will have a hard time when you run out of tobacco.

However, sometimes the opposite can happen: if you know it’s impossible to smoke—for example, on a transoceanic flight—you feel calm without doing it. The cravings arrive when being able to smoke gets closer, 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 that they could do something to get more tobacco, and that makes them uneasy. If they were on a plane, perhaps they would not feel that uneasiness. In this case, the urge to smoke is driven by the opportunity to do so and, therefore, is a psychological construction, not a physical symptom of a lack of nicotine in the body. Could smoke: there are cravings. It’s impossible to smoke: the person relaxes.

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

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

A phenomenon we call the pink cloud can also appear. It is a euphoric feeling and sense of control after the first days or weeks of abstinence. It is that experience of success, of victory, that 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 you have made progress, the addiction probably still hasn’t been overcome.

It is advisable to sustain the satisfaction without turning it into a euphoria that is too intense to be maintained. You deserve to feel victorious, but you have to remember that the process may be longer and that the pink cloud and its euphoria can generate a sense of false control, of having won too early, which can relax you and bring you closer to a relapse.

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