Nicotine in cigarettes (and other forms of tobacco) is addictive, and most regular smokers are addicted to that substance. Over time, the body and brain become so used to the constant presence of nicotine in the body, they have to adjust when the smoker decides to quit and nicotine is no longer present in its usual amount in the body.

These “adjustments” can result in what we call withdrawal symptoms. Some smokers may not experience them, but others do, and there is a possibility that you will experience them too when you attempt to quit.

In this section, we will share with you how you can manage these withdrawal symptoms.

EVEN EX-SMOKERS GET THE BLUES

Withdrawal is different for every smoker‚ but here is a list of the more common symptoms.

Withdrawal symptoms are usually the strongest during the first week after you quit smoking. Be prepared for them, but don’t worry – with the advice of your smoking cessation team, and some determination and willpower, you will be able to “survive” them!

But are withdrawal symptoms dangerous?

We will not lie, there may be times when you are so uncomfortable that you may think that you will expire if you do not light up a cigarette! However, there is no evidence that these symptoms will endanger your health. In fact, quitting the habit is one of the best things you can do for your health!

The 1st week is crucial!

It is worth repeating here that research has shown that if you succeed in abstaining completely – this means not even one cigarette! – within the first week, you are 9 times more likely to remain smoke-free a year later. It is very important, therefore, that you start your quitting efforts on the right track.

Unfortunately, the 1st week is also when the craving and withdrawal symptoms tend to be at their highest, which is why you should seek help from qualified professionals when necessary.

Now, let’s take a look at some ways your healthcare team can help you deal with withdrawal symptoms and other common problems associated with smoking. Let us start with nicotine replacement therapy (NRT), the go-to method used by most smokers with success.

DEVICES TO HELP YOU QUIT

“Nicotine replacement therapy (NRT) is the most common treatment for smoking cessation,” explains family medical physician Dr Rashidi Mohamed. “It employs a range of delivery devices such as gums and patches.”

Let’s take a closer look at some of these devices.

Patch Up Your Life

Nicotine patches: what are they?

These are transdermal patches – they can be placed on your skin to help reduce the symptoms of nicotine withdrawal.

How do they work?

According to psychiatrist and smoking cessation specialist Dr Amer Siddiq, these patches provide a form of nicotine that replaces the stuff you previously supplied your body through smoking.

However, these patches are different from cigarettes. “The nicotine is delivered more slowly and in a more stable manner,” explains Dr Amer. “Compare this to smoking, in which nicotine is delivered in a single dose (bolus) all at once.”

The patch releases a steady stream of nicotine, just enough nicotine to keep away withdrawal symptoms. Over time, your withdrawal symptoms will decrease and your doctor or pharmacist may lower the dosage of the nicotine in your patches. As a result, your body’s craving for nicotine will lessen as well.

How do you use them?

“You can apply them to the bigger muscles of the body, such as the pectoral muscles of the chest, the muscles of your back, or on the biceps (the muscle on your upper arm),” says Dr Amer.

He adds, “Do not put them at areas where the skin is thinner such as between the thighs or on your arms.”

Here are some tips from Dr Amer.

• Stop first. You should stop smoking before you start using a patch.
• Apply once a day. Morning is the best time. However, if the patch falls off during the day, you can re-apply a new one.
• No hair zone. Stick to hairless areas that will not rub constantly against your clothes. If you are particularly hairy and there is no available area to stick the patch, try shaving a spot just for the patch. 
• Rotate your patches. Each time you switch to a new patch, use it on a different part of your body. This helps reduce the chances of skin irritations such as itchiness and redness.

There are different brands of patches available, and they may have more specific instructions for use. Check with your doctor or pharmacist if you have any doubts about proper usage.

Are they safe?

In most cases, yes, although there are minimal reported cases of skin irritations such as itchiness and redness at the site of the patch placement. This is often seen after applying the first few patches and usually goes away after a week. For itchiness, there are over-the-counter treatments which you can apply to the affected area.

According to Dr Amer, some people may experience vivid dreams that can be distressing when the patch is used at night, but these dreams will go away within a week.

Dr Amer adds that the adhesives used in the patches may cause allergy in certain people. For these people, there are other alternative methods (such as nicotine gums) which may suit them better.

I still feel the urge to smoke after applying the patch!

Nicotine patches will not eliminate all craving or withdrawal symptoms – they serve to lessen the intensity over time to make it easier for you to remain smoke-free.

However, there are several reasons why a patch may not be working like it should:

• The dosage of nicotine is too low. Consult your doctor or pharmacist for the appropriate dosage.
• You may be using the patch incorrectly. Check the instructions on the package. If you still have doubts, consult your doctor or pharmacist.

But do they really work?

Well, a few years ago, there was a large study in Europe called the Collaborative European Anti-Smoking Evaluation (CEASE). CEASE involved 3,575 smokers and its purpose was to find out whether NRT success rate is affected by the dosage and duration of use of nicotine patches. This is what they found:

• Smokers are 9 times more likely to remain smoke-free one year later if they succeed in abstaining within the first week.
• Smokers using the 25mg patch have a generally higher success rate in staying smoke-free compared to smokers using the 15mg patch. They conclude that “a higher than standard dose of nicotine patch was associated with an increase in the long-term success in smoking cessation.”

Therefore, it may be worth discussing with your doctor or pharmacist about whether the 25mg nicotine patch is suitable for you.

Gum is the Word!

Nicotine gums: what are they?

These are somewhat similar to chewing gums, only they contain nicotine. Just like chewing gums, they come in several different flavours.

How do they work?
“They are somewhat similar to nicotine patches in that they release nicotine into the body to reduce withdrawal symptoms. The difference is that nicotine gums are shorter acting and, hence, probably safer for high-risk groups such as pregnant women or heart attack patients,” explains Dr Amer.

Nicotine gums can also be used as a way to keep your mouth busy and reduce your craving for cigarettes.

How do you use them?

Why, simple – just pop one into the mouth and chew! Dr Amer explains that chewing nicotine gum would release a spicy flavour – that is the medication present in the gum.

Getting the most out of your gum in 3 steps

1. Chew the gum slowly until you feel a slight tingling or taste the spicy medication.
2. Then, you should stop chewing and park the gum between your cheek and gum.
3. After a while, the tingling or spicy taste would reduce in intensity. When it is almost gone, chew again.
4. Repeat the above 3 steps until the gum is completely “flavourless”.

Your doctor or pharmacist would prescribe the number of gums you would need each day. The amount depends on how many cigarettes you smoke daily.

Here are some additional tips from Dr Amer:

• Usually, you would be advised to use one on the hour for every hour, but check with your doctor or the package for specific instructions as they may vary from brand to brand.
• Do not eat and drink for 15 minutes before and during chewing of nicotine gum.
• You may find it enjoyable to chew on the gum – especially when it comes in your favourite flavour! – but do not to take more than the prescribed number of gums a day.
• Don’t let them fall into the hands of children, who may mistake them for candies!

Are they safe?

Generally, yes. However, Dr Amer points out that people with recent dental work or chewing problems may have difficulties using nicotine gums.

And the Rest

While patches and gums are two commonly used smoking cessation aid in NRT, there are other options available in case neither patch nor gum is suitable for you, such as:

Nicotine lozenges

Works similarly to lozenges, these “hard candies” dissolve slowly in your mouth to release nicotine.

Some options (such as microtab and mouthspray) are not yet available in Malaysia but according to Dr Amer, they are being researched by the University Malaya Centre of Addiction Sciences (UMCAS). In the future, a few of these may make their way to our shores.

PRESCRIPTION MEDICATIONS

Depending on the case, a doctor may sometimes prescribe medications to help the smoker cope with withdrawal symptoms. These medications include:

BUT WHAT ABOUT…?

There are other new or recent methods that are purported to be useful in helping you quit the habit, but are they really effective or are just hype?

E-cigarettes. Debate – and controversy – arises over the possible use of e-cigarettes as an aid in smoking cessation therapy. Dr Amer explains, “So far, there were only 2 trials looking at its use for smoking cessation and both were small studies. We just don’t have the data to make any conclusion at this time.”

He points out that the World Health Organization (WHO) and the US Food and Drug Administration (FDA) at this point in time do not approve of the use of e-cigarettes for smoking cessation. Our Ministry of Health Malaysia holds the same stance.

Therefore, it looks like we should wait until we have more evidence to prove, or disprove, the effectiveness of e-cigarettes. In the meantime, there are already tried-and-tested reliable ways to quit the habit that you can fall back on.

Acupuncture and hypnosis. “The use of acupuncture and hypnosis has not been shown to be effective as a method of treatment in large clinical trials,” Dr Amer says. “However, they may be good options for a very limited group of patients.”

References:

Cochrane.  Can electronic cigarettes help people stop smoking or reduce the amount they smoke, and are they safe to use for this purpose? Retrieved on July 9, 2015 from http://www.cochrane.org/CD010216/TOBACCO_can-electronic-cigarettes-help-people-stop-smoking-or-reduce-the-amount-they-smoke-and-are-they-safe-to-use-for-this-purpose

Tønnesen, P, et al. (1999). Higher dosage nicotine patches increase one-year smoking cessation rates; results from the European CEASE trial. Eur Resp J; 13:238-246.

Smokefree.gov. Available at http://smokefree.gov/

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