Why is it so hard to quit smokeless tobacco?
Maybe you’ve tried to quit smokeless before. Why is quitting and staying that way so hard for so many people? The answer is simple: nicotine.
Nicotine is a drug found naturally in tobacco. It’s as addictive as heroin or cocaine. Over time, a person becomes physically dependent on and emotionally addicted to nicotine. The physical dependence causes unpleasant withdrawal symptoms when you try to quit. The emotional and mental dependence (addiction) make it hard to stay away from nicotine after you quit. Studies have shown that tobacco users must deal with both the physical and mental dependence to quit and stay quit.
Where nicotine goes and how long it stays
Nicotine enters the bloodstream from the mouth or nose and is carried throughout the body. It affects many parts of the body, including your heart and blood vessels, your hormones, the way your body uses food (your metabolism), and your brain. During pregnancy, nicotine freely crosses the placenta and has been found in amniotic fluid and the umbilical cord blood of newborn infants.
Different factors affect how quickly the body gets rid of nicotine and its by-products. Regular oral tobacco users will still have nicotine or its by-products, such as cotinine, in their bodies for about 3 or 4 days after stopping.
How nicotine hooks smokers
Nicotine causes pleasant feelings and distracts the user from unpleasant feelings. This makes the tobacco user want to use more. Nicotine also acts as a kind of depressant by interfering with the flow of information between nerve cells.
As the nervous system adapts to nicotine, tobacco users tend to increase the amount of tobacco they use. This raises the amount of nicotine in their blood, and more tobacco is needed to get the same effect. This is called tolerance. Over time, the tobacco user reaches a certain nicotine level and then will need to keep up the usage to keep the level of nicotine within a comfortable range.
Soon after a person finishes their dip or chew, the nicotine level in the body starts to drop, going lower and lower. The pleasant feelings wear off, and soon the user starts wanting more tobacco. If they delay using it, the person may start to feel irritated and edgy. Usually it doesn’t reach the point of real withdrawal symptoms, but the tobacco user gets more uncomfortable over time. At some point, the person takes in more tobacco, the unpleasant feelings go away, and the cycle continues.
Smokeless tobacco delivers a high dose of nicotine. An average dose from snuff is 3.6 milligrams (mg) and from chewing tobacco is 4.5 mg — compared with 1 to 2 mg from a cigarette. Blood levels of nicotine throughout the day are much the same among smokers and those who use smokeless tobacco.
Nicotine withdrawal can lead quitters back to tobacco
Stopping or cutting back on smokeless tobacco use causes symptoms of nicotine withdrawal much like those smokers get when they quit. Studies have shown that oral snuff users have as much trouble giving up tobacco as cigarette smokers who to quit smoking. Studies also suggest that when regular oral tobacco users can’t use smokeless tobacco, they will often smoke cigarettes or use other forms to satisfy their need for nicotine.
Withdrawal from nicotine is both physical and mental. Physically, the body reacts to the absence of nicotine. Mentally and emotionally, the user is faced with giving up a habit, which calls for a major, long-term change in behavior. Both the physical and mental factors must be dealt with to quit and stay that way.
Those who have used tobacco regularly for a few weeks or longer will have withdrawal symptoms if they suddenly stop or greatly reduce the amount they use. Symptoms usually start within a few hours of the last dip or chew and peak about 2 to 3 days later when most of the nicotine and its by-products are out of the body. Withdrawal symptoms can last a few days to up to several weeks. They will get better every day that you stay tobacco-free.
Withdrawal symptoms can include any of the following:
- Dizziness (which may last only 1 or 2 days after quitting)
- Feelings of frustration, impatience, and anger
- Trouble sleeping, including trouble falling asleep and staying asleep, and having bad dreams or even nightmares
- Trouble concentrating
- Restlessness or boredom
- Increased appetite
- Slower heart rate
These symptoms can lead a person to start using tobacco again to boost blood levels of nicotine and stop symptoms. For information on coping with withdrawal, please see the section called “How to quit.”
Quitting smokeless is a little different
In many ways, quitting smokeless tobacco is a lot like quitting smoking. Both involve tobacco products that contain nicotine, and both involve the physical, mental, and emotional parts of addiction. Many of the ways to handle the mental hurdles of quitting are the same. But there are 2 parts of quitting that are unique to oral tobacco users:
- There is often a stronger need to have something in the mouth (oral substitute) to take the place of the chew, snuff, or pouch.
- Mouth sores often slowly go away and gum problems caused by the smokeless tobacco often stop getting worse. This is a benefit of quitting that everyone can see.
Last Medical Review: 10/18/2012
Last Revised: 10/29/2012