Note to instructor(s): Refer students to the Withdrawal Symptoms Information Sheet handout. This handout describes several symptoms, when they occur postcessation, and how to cope with withdrawal. In addition to being an educational aid for students, it can be copied and distributed to patients who are quitting.
When nicotine is discontinued abruptly, the following withdrawal symptoms develop (American Psychiatric Association, 1994; Hughes et al., 1991; Hughes & Hatsukami, 1998):
-Depression
-Insomnia
-Irritability/frustration/anger
-Anxiety
-Difficulty concentrating
-Restlessness
-Increased appetite/weight gain
-Decreased heart rate (not measurable through self-report)
-Cravings*
*Cravings is a symptom of tobacco withdrawal that was included in the third edition and revised third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders; however, this symptom was omitted from the fourth edition (DSM-IV) classifications. Other symptoms of quitting have been described in the literature, and many of these are addressed in the Withdrawal Symptoms Information Sheet.

Tobacco users usually experience a strong desire or craving for tobacco. In general, withdrawal symptoms peak 24–48 hours after cessation and gradually dissipate over the next 2–4 weeks. Strong cravings for tobacco may persist for months to years after cessation (Benowitz, 1992; Hughes et al., 1991).

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association.
Benowitz NL. (1992). Cigarette smoking and nicotine addiction. Med Clin N Am 76:415–437.
Hughes JR, Gust SW, Skoog K, Keenan RM, Fenwick JW. (1991). Symptoms of tobacco withdrawal: A replication and extension. Arch Gen Psychiatry 48:52–59.
Hughes JR, Hatsukami D. (1998). Errors in using tobacco withdrawal scale (letter to the editor). Tob Control 7:92–93.

Slide is used with permission, Rx for Change: Clinician-Assisted Tobacco Cessation. Copyright © 1999-2007 The Regents of the University of California, University of Southern California, and Western University of Health Sciences. All rights reserved.