Prolonging nicotine withdrawal
Video explains how the 72 hour withdrawal symptoms that I discuss in many of my videos and articles is only applicable to true cold turkey quitters.
Pharmacological Aids: Prolonging Withdrawal Syndromes
"I could ring your neck! What is this 72 hour garbage you are preaching about? It is not getting any better! You lied to me from day one!" This warm greeting was thrust upon me on a Sunday night by an irate clinic participant. Sure, she had reason to be mad. After all, being in constant withdrawal for five days is enough to make any person lose her composure.
While she had every right to be angry, it was aimed at the wrong person. She had only herself to blame for this prolonged agony. For unlike the majority of people in her group, she did not throw out her cigarettes during the clinic session Tuesday night. Instead, she had a couple of cigarettes that evening. Then on Wednesday she took a couple of sticks of Nicorette chewing gum. I then told her that due to the administration of nicotine from the cigarettes and then the gum, she was back at square one. She was angry at me then, too. She wanted to know what right I had to tell her she was failing. But she said she would throw out the cigarettes and get rid of the gum.
Unfortunately for her, she did not dispose of the gum and continued to chew a couple of sticks a day. The next three days were horrendous. Every night she came back to the meeting and complained bitterly. But this is nothing out of the ordinary, many people are suffering in the initial three days. On Saturday, she still complained of bitter symptoms. But she knew that she quit a day late, so this too could have been expected. But by Sunday, it should have been getting better. It was not though, and she was fuming.
I told her the gum was prolonging the withdrawal process. "But it's only a couple of sticks, and it's not like I am smoking." It was her failure to recognize this point that was causing all of her problems. Chewing the gum was exactly like taking a couple of puffs. She was administering a small amount of nicotine – not enough to reach the peak nicotine level she desired, but just enough to reinforce her addiction and cause chronic withdrawal symptoms.
After the explanation she was still defiant. She would not accept that the nicotine gum was causing her problem. The next day, though, she came back to the clinic. All of the other participants had successfully overcome the first weekend. They all talked about how they still occasionally desired a cigarette but no longer were suffering the powerful cravings they had encountered the first few days. As usual, they were visibly calmer and enthusiastic about the progress they had made.
Almost everyone in the group expressed similar sentiment. Everyone except our friend with the gum, who still complained bitterly. And she still insisted she needed a cigarette or the gum to make quitting possible and bearable. In the beginning of the meeting she tried to monopolize the discussion. But soon she realized the group had no desire to sit and listen to her complain of the horrors of quitting. It was history to them, and they had more pertinent issues to address.
Finally, after sitting and listening to all the positive feeling expressed by her other classmates, she started to realize that she was the only one suffering. Our predictions of easing of withdrawal after 72 hours were true. And the only difference between her and the other group members was her first few cigarettes and her subsequent nicotine gum use.
Quitting smoking should be done in a manner which is as easy and effective as possible. Cease all administration of nicotine in any form. In a few days withdrawal symptoms will ease up, and in two weeks will stop all together. Then, to avoid ever having to quit again – NEVER TAKE ANOTHER PUFF!
NOTE: This was originally published in 1986. Since then, a number of similar products, (e.g., patches, gums, lozenges, nasal sprays and inhalers), have been or will be introduced as over the counter cessation aids. The same principal applies to them too: they are transferring the delivery system of the drug nicotine. If the smoker simply stops, withdrawal will peak and start to subside within 72 hours. Use of these agents will unnecessarily prolong the cessation process as well as add to the expense.
"You know smoking two or three cigarettes is
better than having smoked two or three packs!"
This statement was angrily snapped at me by an irate clinic participant on her third successive day of cheating during her stop smoking clinic. She was mad because I kept telling her that she was blowing her chance at quitting smoking. I told her that as long as she smoked three or two cigarettes or even a single puff, she should just smoke the other two packs she would normally consume in a typical 24 hour period. She was suffering horribly and was convinced that all this misery had to serve a useful purpose. I was belittling her valiant attempt, and she was mad as hell at my arrogance.
She had been in other professional programs before. The other programs considered an 80% reduction in smoking a great accomplishment. Sure, they thought 100% would be better, but not all people could do 100%. Her physician would probably agree as well, that, if she couldn't quit, at least she drastically reduced her smoking. Her family and friends were most likely equally impressed by her major victory. Then she would come in to our meeting and I would say she was back to square one and should either smoke everything or stop all together. What made her so mad was her conviction that I really thought she was doing a great job but wouldn't admit it to her.
Contrary to her beliefs, I did not consider her attempt at reducing smoking a praiseworthy effort. Cigarette smoking is an addiction. Because of this, smoking is an all or nothing proposition. While her other programs, family, friends and other professionals may have viewed her drastic reduction as impressive, they all failed to understand that reduction was a temporary state. Reducing smoking by 50, 80, 90, or even 99.99% is worthless. It will result in a complete failure in the attempt. This failure will most often result in an eventual return to the old level of consumption and may even lead to a substantial increase over the level smoked prior to the attempt at quitting. It does not pay to cut down for a day or week or even a month just to become a heavier smoker for years afterward because of it. The end result of such a pattern is often the loss of one's health and eventually one's life. No one has ever lost his or her life from following our clinic's cold turkey and total abstinence approach, but many have already died and many more will die from disregarding it.
Eventual loss of health and life is not the only problem with cutting down in our program. There is the more immediate problem of intensified withdrawal lasting over a longer duration of time. It's not that the quitter is treating herself to one or two a day. In fact, she is prolonging the period during which she feels that she is depriving herself of 30 or 40 per day. This period will last until she either totally quits and survives through the initial quitting phase or until she reaches her old level. Unfortunately, the latter is the outcome in the vast majority of similar situations.
For a person truly dependent on nicotine, cutting down on tobacco consumption is guaranteed suffering and failure. It doesn't pay to suffer just for the sake of suffering. Quitting cold may cause some discomfort, but it is short term, and the end result can be freedom from cigarettes. Sure, quitting cold turkey can be difficult. But–for an addict–quitting by any other means is virtually impossible. Given the choice between difficult and impossible, go for the difficult. At least there is a chance of success. With that success comes improved health, self-esteem, societal acceptance, more money and an overall improvement in the quality of life. Once quitting is accomplished, all that needs to be done to maintain a life free from nicotine addiction is to – NEVER TAKE ANOTHER PUFF!
- Quitting by gradual withdrawal
- My first encounter with NRT
- The first Monday morning after having quit smoking
- Comparing quits with others
- "How long before I don't want a cigarette?"
- Nicotine addiction
- Is cold turkey the only way to quit?