Withdrawal symptoms impair the ability to stop tobacco use. The symptoms after absti- nence from tobacco are in large part due to nicotine deprivation. Symptoms are much among those who use nicotine medications. This difference in symptom intensity is likely due to the more rapid onset and higher levels of nicotine with cigarette smoking. Tobacco withdrawal is common among daily tobacco users who stop or reduce but can also occur among nondaily users. Typically, heart rate decreases by 5—12 beats per minute in the first few days after stopping smoking, and weight increases an average of 4—7 1b (2—3 kg) over the first year after stopping smoking. Tobacco withdrawal can produce clinically signifi- cant mood changes and functional impairment.
are associated with tobacco withdrawal. Abstinence can increase constipation, coughing, dizziness, dreaming/nightmares, nausea, and sore throat. Smoking increases the metab— olism of many medications used to treat mental disorders; thus, cessation of smoking can increase the blood levels of these medications, and this can produce clinically significant outcomes. This effect appears to be due not to nicotine but rather to other compounds in tobacco.
Approximately 50% of tobacco users who quit for 2 or more days will have symptoms that meet criteria for tobacco withdrawal. The most commonly endorsed signs and symptoms are anxiety, irritability, and difficulty concentrating. The least commonly endorsed symp- toms are depression and insomnia.
Tobacco withdrawal usually begins within 24 hours of stopping or cutting down on to- bacco use, peaks at 2—3 days after abstinence, and lasts 2—3 weeks. Tobacco withdrawal symptoms can occur among adolescent tobacco users, even prior to daily tobacco use. Pro- longed symptoms beyond 1 month are uncommon.
Temperamental. Smokers with depressive disorders, bipolar disorders, anxiety disor- ders, attention-deficit/hyperactivity disorder, and other substance use disorders have more severe withdrawal.
Genetic and physiological. Genotype can inﬂuence the probability of withdrawal upon abstinence.
Carbon monoxide in the breath, and nicotine and its metabolite cotinine in blood, saliva, or urine, can be used to measure the extent of tobacco or nicotine use but are only weakly re- lated to tobacco withdrawal.
Functional Consequences of Tobacco Withdrawal
Abstinence from cigarettes can cause clinically significant distress. Withdrawal impairs the ability to stop or control tobacco use. Whether tobacco withdrawal can prompt a new mental disorder or recurrence of a mental disorder is debatable, but if this occurs, it would be in a small minority of tobacco users.
The symptoms of tobacco withdrawal overlap with those of other substance withdrawal syndromes (e.g., alcohol withdrawal; sedative, hypnotic, or anxiolytic withdrawal; stim- ulant withdrawal; caffeine withdrawal; opioid withdrawal); caffeine intoxication; anxiety, depressive, bipolar, and sleep disorders; and medication-induced akathisia. Admission to toms that mimic, intensify, or disguise other disorders or adverse effects of medications used to treat mental disorders (e.g., irritability thought to be due to alcohol withdrawal could be due to tobacco withdrawal). Reduction in symptoms with the use of nicotine medications confirms the diagnosis.
Tobacco-induced sleep disorder is discussed in the chapter ”Sleep-Wake Disorders” (see “Substance/ Medication-Induced Sleep Disorder”).
292.9 (F17.209)