Symptoms of Psychological Withdrawal
Cravings, Urges, Yearnings, Desires and Thoughts
The initial powerful cravings that overlay the normal 72 hours of abstinence that the body needs to purge our blood of all nicotine, are more creatures of habit than actual physical nicotine withdrawal. Our cravings are the minds psychological means of reminding us that it's time to ingest nicotine to avoid experiencing physical withdrawal (nervousness, irritability, grouchiness, tension, anger, rage, frustration, sweating, jitters, shaking, inability to concentrate and mind fog).
Like Pavlov's dogs, who he conditioned to salivate upon the ringing of a bell, the nicotine addict's mind has been conditioned to expect nicotine as soon as it begins to feel any discomfort associated with the onset of physical withdrawal. In response to falling nicotine levels, the habitual mind has been conditioned to intensify "desire" in order to cause us to ingest new nicotine and thereby avoid any discomfort. When we smoked, most of us received a gentle "desire" reminder every 20 to 30 minutes. If not satisfied, the desire would build and escalate in intensity to the point of becoming an influential urge or extremely demanding crave. Our mind has stored the means and manner by which it motivates us to ingest another hit of nicotine. Even after all nicotine has left our body (72 hours), our mind's crave generator remains in tact and fully functional.
Our Time Triggers
- The foundation for our mind's knowledge of how to escalate the intensity of desire, to cause us to bring new nicotine into our body, is "time." Although the subconscious mind is believed to be incapable of independent reasoning or judgment, our conscious mind has conditioned our subconscious to realize that time depletes our blood nicotine level and that the onset of discomfort can be satisfied with nicotine. When we feel a crave begin to escalate in intensity
, it is simply our subconscious turning up the volume control that it has been conditioned to believe will bring the desired result. But in that the subconscious mind is a product of conditioning and not independent reasoning, if nicotine is not ingested after desire's volume or intensity control is increased to maximum, the subconscious simply gives up and quits.
It is extremely important to understand that no single crave lasts for more than a few minutes. While occurring, it may seem like a crave lasts forever. If you think about it, the subconscious mind must make us believe that it will last indefinitely in order to successfully motivate us to ingest new nicotine. But, if you look at a clock and actually time your crave, you will quickly begin to realize that it ends within a couple of minutes - less than three! This psychological mind warfare is the downfall of many as they begin to falsely believe that the only way to end the crave is by means of another fix.
As the body's nicotine level continues to fall during the 72 hours of physical withdrawal, our mind's time trigger will continue to be revisited until all nicotine has left the body. It is then that true and complete reconditioning of our time trigger will occur as our physical symptoms begin subsiding and our mind becomes conditioned to realize that time will no longer produce new nicotine. Withdrawal's peak occurs at the 72-hour mark. The average "starter" will experience approximately six desire attacks or crave episodes on day three. By hour 96 or day four the number of attacks or episodes will diminish to about 3.5. By day ten the average number of daily craves is less than two. In that our time trigger was reconditioned upon depletion of our body's nicotine, we need to explore and understand the reason for our continuing craves.
Overlaying our time trigger atop physical nicotine withdrawal symptoms can, for some, generate a rather intense 72-hour experience, but it's even more complex than that, as habit triggers are being encountered as well. Very few willing to attempt recovery lack the basic core dream and desire needed to carry them far enough (72-96 hours) to to begin feeling their physical symptoms begin to gradually subside or to watch the number of subconscious crave episodes become reduced by almost half.
With a little self-determination, the battle against physical nicotine addition is over in a matter of hours. It is hard to believe that drug manufactures have sold so many smokers on their "Nicotine Replacement Therapy" (NRT) gradual reduction approach, when they've done nothing more than repackage nicotine. They are telling smokers that the nicotine patch, gum, spray, inhaler, candy or pills will make them more comfortable and they are 100% correct. Nicotine addicts need nicotine to maintain comfort. The question should be, does NRT's gradual nicotine reduction approach help smokers achieve permanent long term abstinence from tobacco? Sadly, even their own studies (the results of which they hide from their public web sites and refuse to share with smokers) show that 93%
of over-the-counter NRT users in medical studies - studies designed by pharmaceutical companies to test and prove the merits of their product - relapse
to smoking nicotine within just six months.
Our Habit Triggers
- Although our basic time trigger served as our mind's foundation for conditioning it to generate desire attacks, we have also conditioned it to expect new nicotine during certain events, at specific times each day, upon experiencing certain emotions or when we engage in specific activities. The mind is a "steal trap." You many not consciously remember what you were doing, feeling or where you were when you fed yourself nicotine in the past, but those memories have been locked away deep within your subconscious.
Each of these emotions, events, specific times or locations will trigger our mind's crave generator to begin pulsating desire when next encountered. Before total comfort can arrive, each trigger needs to be reconditioned. Again, the beauty is that our subconscious isn't capable of true reasoning and that almost all of our trigger links will be disconnected or reconditioned after just one episode where they fail to produce new nicotine. An additional comforting fact is that over time the power and intensity of our desire or crave generator will diminish to the point of becoming almost insignificant.
Almost like a battery gradually losing its charge, after about twelve weeks or 90 days our once powerful craves start becoming nothing more than ordinary "thoughts." Just like the thought of a "nice juicy steak," you will have total control over when you discard the thought. You'll often hear those in "cold turkey" recovery discuss long term "craves" (four or five months down the road) but when you quiz them about it they quickly admit that it was more like dreaming about a "Hot Fudge Sunday" and it came and went like any other normal desire. What's interesting is trying to learn what triggered the desire "thought," as it is usually some activity that was infrequently engaged in, but during which the ex-smoker had previously smoked (weddings, funerals, graduations, births, etc.).
Aside from our basic time trigger that has already been reconditioned, most of our psychological or habit triggers need to be encountered and reconditioned before total comfort begins arriving. Our psychological triggers may include such things as the habit of smoking while talking on the phone, driving a vehicle, working, upon waking, before going to bed, when leaving a store, when around other smokers, while drinking, surrounding romance, when alone, after meals, during celebrations, when sad, during stressful situations, during other specific emotions, or upon visiting specific locations (garage, porch, garden, in-laws, bathroom). You may notice a small crave spike on day seven of recovery as you celebrate your first full week of freedom. Almost all of us smoked as part celebrating. Unless you've developed an extremely healthy attitude, up until now you've probably been doing very little celebrating. When you do first celebrate, expect a visit from your joy trigger, your pride trigger and/or your party trigger.
The most serious trigger is a period of extremely "high stress" such as tremendous financial strain, serious family illness, injury, or the death of a close friend or loved one. It's a cold hard fact of life that each of us will experience the death of someone we love. We need to prepare our mind now to cope with our "high stress" trigger, as it is certain to occur for each of us. If it occurs while our desire or crave generator still carries a significant charge (the first few weeks), it can be used as your mind's unjustified excuse for relapse.
- Unlike physical withdrawal, psychological withdrawal is 100% mental and greatly within our ability to control. To understand the process can be power in itself. We also need to realize that just one puff of nicotine from one cigarette will revive all memories and conditioning associated with that particular habit trigger and commence the process of re-establishing your full chemical dependency upon nicotine. Whether immediate or gradual, your freedom is over and you're going back to your old level of nicotine intake or higher. Soon, the millions and millions of smoking memories in the recovered addict's mind will make them feel like they've never tasted freedom. Once an addict, even when we do arrest and trade places with our dependency our probation is conditioned on one simple rule - no nicotine, Never Take Another Puff!
Depression & Sadness
Depression can affect our entire being. Sadness, loneliness, disruption of sleep, fatigue, digestion problems, stomach pains, poor memory, an inability to concentrate, a loss of appetite or weight gain, neglect of our appearance, low self esteem, loss of sex drive, irritability, hopelessness, headaches or even a change in bowel habits can and often do accompany depression. Serious chronic depression is often easily treated but does require medical assistance. That being said, giving up years and years of nicotine dependence is a traumatic event, akin to the death of a close loved one, which is often accompanied by the onset of a temporary state of depression.
Although nicotine is not a close friend or loved one, it is now forever leaving our body and our mind knows that a very close bond is forever being broken. Some degree of postpartum nicotine depression is common and heavy long term smokers seem to experience it a bit more frequently. It is a death of sorts. It is like the end of a marriage or other long term relationship. It is normal to mourn the loss and go through the normal phases of grieving. This is an excellent article by Joel on the emotional loss
associated with smoking cessation.
As with the end of any long term relationship, our period of cessation mourning and grieving can be as long or short as we desire. Although it can and often does generate physical symptoms, our underlying conscious thougths are very much within our ability to control. It can become the primary focus symptom once crave trigger re-conditioning diminishes in frequency to the point where you feel somewhat comfortable in managing or coping with craves. This usually happens somewhere between weeks one and three, but may not be noticed until later if any other symptom is receiving higher priority due to continuing discomfort.
The following Freedom message board thread contains an excellent summary of cessation depression issues
, and a bit more on the basic difference between underlying organic depression and the emotional loss associated with cessation. In the Ward "abstinence effects" study - Addictive Behaviors, 26 (2001) Pages 311-327 - 39% of smokers entering the study reported experiencing depression on the day before quitting compared to only 19% of the non-smokers in the control group. On day three the percentage in recovery indicating depression peaked at 53%, and had fallen to 33% (6 points below baseline) by day seven and to just 20% by day twenty-eight - just one point above the non-smokers in the control group.
It was once thought that those with depression smoked in order to self medicate but new research is beginning to seriously ask, "which came first, nicotine addiction or depresssion." This thread contains two recent articles
and this one discusses the need for possible medication adjustments
Education and honesty are the fastest ways to put the postpartum nicotine blues behind us. In reality you've given up nothing of value by stopping the smoking of nicotine. If each reason for feeling a sense of loss is fully explored, we quickly realize that it was only another drug addict's excuse for justifying in our mind why it was ok to continue with our addiction. For example, many nicotine addicts have convinced themselves that tobacco makes their coffee taste better when in truth their coffee's taste won't change at all. In fact, our healed taste buds and increased sense of smell will allow us to enjoy our coffee or tea even more. The science behind why we feel that smoking helps relieve stress, when in truth is doesn't, along with numerous other false beliefs, if learned and understood will help bring an end to any sense of loss. "The truth
will set us free."
It should also be mentioned that there are two non-nicotine approved anti-depression medications that, although unnecessary for success, are available by prescription and appear to aid 13% of quitters, after factoring out those within the studies who quit while wearing placebos. Wellbutrin and Zyban are both manufactured by the same company (Glaxowellcome) and contain the same active ingredient (bupropion). It is very important in using either of these drugs that you consult with your physician regarding risks, potential side effects and proper use. You may want to note that although they are identical, Zyban is being marketed to smokers while Wellbutrin is being marketed to people with depression. I mention this as almost all health insurance policies cover medications associated with the treatment of depression, while few cover products marketed for smoking cessation.
Loneliness or Feeling Cooped Up
Akin to postpartum nicotine depression, loneliness is natural anytime we leave behind a life long companion (who in this case was extremely unhealthy and killing us ever so slowly). It's time to recognize a new healing and healthy companion - YOU!
We need to climb out of the deep, deep smoker's rut that we've lived in for years. For far too long we've severely limited many of the activities that as smokers we were willing to engage in either because they might have interfered with our need to obtain a nicotine fix every 20 minutes or because our lungs and body did not have the capacity to enjoy them. Start your new life now! Don't wait to gradually learn that you've been missing so much. Alter your outlook, climb from the ditch and open your eyes. One of the interesting parts of recovery is in learning to live life as an ex-smoker. If we want to stay in our rut and keep waiting for something to happen, instead of climbing and learning to enjoy all that we've been missing, we'll continue to feel lonely. If we don't replace our loneliness with the glory of our wonderful new and healthy life, we may eventually talk ourselves into returning to the world we know, our world of fix and fix after fix after fix - until death do we part.
Increased Appetite or Hunger
It's easy to attribute a new found desire to consume large quantities of food to our rapidly healing taste buds and our revived sense of smell. Truth is that many reach for extra calories almost immediately and probably for a combination of reasons. Whether using it as a hand-to-mouth oral crutch
or as a replacement feeding for those now absent nicotine induced adrenaline releases
that once pumped stored fats and sugars into the blood with each new puff, the net effect is the same - extra body weight. How can the weight gained during quitting be minimized?
Attempting to satisfy an urge for more nicotine with a mouth full of food may serve as a brief coping tool but be extremely careful not to allow eating to become a new habit or serious weight problem which saps your motivation to the point that a 50% chance of a very early grave looks more appealing than the extra weight. If you do find yourself using food as a temporarily early oral substitute (which is NOT recommended) reach for healthy foods
like fresh vegetables.
Even if we leave extra food alone it's very common to see some initial weight gain in the first couple of days. Unless you're piling it on, it's usually extra water retention primarily associated with physiological changes. You should see water retention return to normal within two weeks. Minor metabolism changes can account for a few extra unburned calories each day but they can be more than offset by enhanced cardiovascular abilities due to an almost one-third increase in overall lung function within just 90 days and general enhanced performance of the entire body. Not smoking nicotine does not cause weight gain - eating food does!
We often smoked at the end of meals which was a signal to the brain that our meal was complete and eating over. This cue no longer exists. Its absence can lead to continued eating after our normal meal would have ended. If the left-overs keep vanishing you may need to find a new cue that your meal has ended. A toothpic, walk, immediate brushing of your teeth, a stick of sugarless gum, or even a nice big deep breath may be all it takes.
But accept early-on that should they occur, a few extra pounds are acceptable and be patient
with yourself. It would take an extra 100 pounds to equal the health risks associated with a single pack of cigarettes. Is your life worth a few temporary pounds?
There will be plenty of time to shed them later!
The next few minutes are all that matter and each is entirely doable. There is only one rule - no nicotine today, Never Take Another Puff!
Breathe deep, hug hard, live long,
John R. Polito Nicotine Cessation Counselor