TOBACCO WITHDRAWAL
● Insomnia (APA, 2013)
Withdrawal symptoms are often a barrier to stopping tobacco use, often due to nicotine deprivation (APA, 2013). Withdrawal symptoms begin within 24 hours of abruptly quitting tobacco and include ● Irritability, frustration, or anger ● Anxiety ● Difficulty concentrating
Symptom intensity is higher in individuals who smoke cigarettes or use smokeless tobacco but peaks 2-3 days after abstinence but lasts approximately 2-3 weeks (APA, 2013). However, nicotine replacement therapies (NRT) and other medications are available to augment quitting (CDC, 2022a). The following represents NRTs but is not meant to be an inclusive list or offer individual medical advice.
● Increased appetite ● Depressed mood
NRT
Advantages
Disadvantages
Side Effects
Precautions
Nicotine patches
It can be used with other modalities, steady dosing; OTC
Unable to change doses; may need augmented therapy
Headache; sleep disturbances; skin sensitivity
MI within 2 weeks of starting; Arrhythmia; angina; pregnant or breastfeeding; age < 18 years MI within 2 weeks of starting; Arrhythmia, angina; pregnant or breastfeeding; age < 18 years
Nicotine lozenges
It can be used regularly with withdrawal symptoms or urges; can control the amount of nicotine delivered; may help substitute for a cigarette in the mouth; OTC It can be used regularly with withdrawal symptoms or urges; can control the amount of nicotine delivered; may help substitute for a cigarette in the mouth; OTC Can be used regularly with withdrawal symptoms or urges with patches; can control the amount of nicotine delivered; may help substitute for a cigarette in the mouth Can be used regularly; delivers nicotine most rapidly of all NRTs
Use it regularly; do not eat/drink for 15 minutes before using or when the mouth; it can cause dyspepsia.
Nausea; hiccups; insomnia; headache; cough
Nicotine gum
Use it regularly; do not eat/drink for 15 minutes before using or when the mouth; it can cause dyspepsia; it may be hard to use with dentures/dental work. Use it regularly; do not eat/drink for 15 minutes before using or when the mouth More addictive than other forms of NRT; some do not prefer nasal spray; require a prescription More possible side effects than other medicines; cannot be used if the history of bulimia/anorexia; or recently took MAO inhibitor; requires a prescription
Mouth/jaw soreness; stomach; hiccups; nausea/vomiting
MI within 2 weeks of starting; Arrhythmia, angina; pregnant or breastfeeding; age < 18 years; TMJ disease
Nicotine oral inhaler
Mouth and throat irritation; runny nose; cough, headache, hiccups
MI within 2 weeks of starting; asthma and chronic lung
disease; Arrhythmia, angina; pregnant or breastfeeding; age < 18 years; TMJ disease MI within 2 weeks of starting; sinus issues; asthma Arrhythmia, angina; pregnant or breastfeeding; age < 18 years; TMJ disease History of seizures; do not taking bulimia/ anorexia; taking MAO inhibitor; liver disease, pregnant or breastfeeding; < age 18 years
Nicotine nasal spray
Nasal irritation; tearing; runny nose, sneezing or cough headache
Bupropion SR
Simple to use; may help with depression; combined with patches
Nausea, dizziness; insomnia; constipation, dry mouth, rash, seizures, changes in mood or behavior; anxiety
E-CIGARETTES/VAPING
Vaping was introduced to the U.S. market in 2007, containing both nicotine and tetrahydrocannabinol (TCH), which are poorly regulated (Werner et al., 2020). Unfortunately, there is insufficient data to determine short-term or long-term effects or the type of components to blame (Broderick, 2023). Vaping is a delivery system similar to a nebulizer; however, the vaping system coats the lungs in harmful chemicals masked in various flavorings and aromatic additives. Vitamin E is often used as part of the delivery system and a thickening agent in the e-liquid, an irritant to the lungs. Other common substances found in the e-liquid include
(1) diacetyl, which is a food additive (buttery taste in microwave popcorn) known to damage small passages in the lungs, (2) formaldehyde which contributes to lung and heart disease; and (3) acrolein, which is used as a weed killer and can also damage lungs (Broderick, 2023). Several lung diseases are associated with vaping. Bronchiolitis obliterans (popcorn lung) is a rare condition resulting from diacetyl damage to the small airways. Inhaling this additive causes coughing, wheezing, chest pain, and shortness
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