Nicotine dependence: withdrawal, treatments and quitting

Nicotine is the drug in tobacco that keeps people smoking. The NHS describes it as highly addictive. Dependence has two parts: a physical need for nicotine, which produces cravings and withdrawal symptoms when levels fall, and the routines and rituals of smoking, which the NHS says can be hard to stop.

The NHS stresses that it is not nicotine itself that causes most of the harm of smoking. Nicotine on its own does not cause cancer, lung disease, heart disease or stroke. Cigarettes release thousands of chemicals when they burn, many of them poisonous, and up to 70 cause cancer, as well as lung disease, heart disease and stroke.

When someone dependent on nicotine stops, they commonly feel the symptoms the NHS lists: feeling irritable, headaches and feeling restless. The NHS’s vaping guidance adds that nicotine strengths can be adjusted to help with cravings and other withdrawal symptoms such as feeling irritable and having low mood.

Quitting products work by handling the cravings and physical symptoms, which lets you focus more on managing the thoughts and feelings that make quitting harder. The NHS says many people do not use stop-smoking products for long enough, which can cause cravings to return, and that the general advice is to use nicotine replacement and other products for at least 12 weeks, or longer if needed.

The NHS says there are more proven products to help you quit smoking than ever before, and that using a combination of products gives the best chance of success. The options it describes are summarised below.

The NHS says switching to vaping is less harmful than continuing to smoke, and that you are roughly twice as likely to quit smoking if you use a nicotine vape compared with other nicotine replacement products such as patches or gum. It adds that almost two-thirds of people who use a vape along with support from a local Stop Smoking Service successfully quit.

It also says that vaping is not completely harmless, that long-term effects are not yet known, that children and non-smokers should never vape, and that if you are vaping to quit you should aim to eventually stop vaping too. Disposable vapes are now illegal to sell or supply in the UK, while reusable and refillable vapes can still be bought. No vaping products have been licensed as stop-smoking medicines in the UK, so they are not available on prescription.

The NHS says you will begin to see almost immediate improvements. After 20 minutes your pulse rate begins to return to normal, after 8 hours the harmful carbon monoxide level in your blood has reduced by half, and after 48 hours carbon monoxide has dropped to that of a non-smoker, with taste and smell improving.

It lists further benefits: after 72 hours breathing feels easier, after 2 to 12 weeks circulation improves, after 3 to 9 months coughs and wheezing improve as lung function increases by up to 10%, after 1 year the risk of heart attack has halved compared with a smoker, and after 10 years the risk of death from lung cancer has halved compared with a smoker.

The NHS says your local Stop Smoking Service is completely free and offers expert, professional support in person, online or even on the phone. Research shows that talking to a professional can help you choose the right product, which increases your chances of quitting. Your GP can also help, and the NHS Quit Smoking app offers personalised support, progress tracking and daily encouragement.

The NHS notes that quitting is a process rather than a race, and that finding the right way to quit can take time. If you slip up, it advises getting back on track rather than treating it as failure. If you are unsure about staying quit, do not stop using your support products.

On the NHS, free support is available through local Stop Smoking Services and GPs, who can also give access to nicotine-free medicines. NRT can be bought from pharmacies, supermarkets and other shops, and vapes from specialist shops and other retailers, but the NHS notes that you should buy vaping products from reputable retailers that meet UK safety and quality regulations.

Some private clinics and apps offer quitting programmes for a fee. The NHS says professional support plus the right products improve your chances, and its local Stop Smoking Service is free, so compare any paid option with that.