Dealing with the Mental Part of Tobacco Addiction

Nicotine is the drug in tobacco that causes pleasant feelings and distracts the user from unpleasant feelings. Over time, a person becomes physically dependent on and emotionally addicted to nicotine. This physical dependence causes unpleasant withdrawal symptoms when you try to quit smoking or other forms of tobacco. There are mental and emotional effects, too. Nicotine actually affects brain chemistry and emotions.

What you might feel when you quit tobacco

  • Depression
  • Sadness or grief
  • A sense of loss
  • Frustration
  • Impatience
  • Anger
  • Anxiety
  • Irritability
  • Trouble concentrating
  • Restlessness or boredom

What you can do

There are many tools to help quit tobacco for good. In most cases, tobacco users are aware of the annoying physical symptoms and think about things like nicotine replacement therapies and medicines to help with them. But they may not be ready for the mental effect, which can be a bigger challenge.

The emotional and mental dependence (addiction) make it hard to stay away from nicotine after you quit. To quit and stay quit, tobacco users must deal with both the physical and mental dependence. Fortunately, there are counseling services, self-help materials, mobile apps for your cell phone or tablet, and support services available to help you get through this time. And just like the physical symptoms, the emotional changes get better over time.

You can prepare yourself for the mental effects of tobacco withdrawal.

Quit-tobacco programs

Telephone-based help to stop using tobacco

All 50 states and the District of Columbia offer some type of free, telephone-based program that links callers with trained counselors. You can call the American Cancer Society at 1-800-227-2345 to help connect you or call 1-800-QUITNOW. The specialists you'll connect with can help plan a quit method that fits each person’s unique pattern of tobacco use. People who use telephone counseling have twice the success rate in quitting smoking as those who don’t get this type of help. Research has shown that telephone counseling also helps people who are trying to quit smokeless tobacco.

Counselors may suggest a combination of methods including medicines, local classes, self-help brochures, mobile reminder apps, and a network of family and friends. Help from a counselor can keep people trying to quit from making many common mistakes.

Telephone counseling is also easier to use than some other support programs. It doesn’t require driving, transportation, or child care, and it’s available nights and weekends. In many instances, callers can receive free vouchers or coupons for NRT, but keep in mind this may vary by state and type of health insurance coverage.

The effectiveness of phone-based services has led to the development of many web-based quit aids and mobile apps. These offer another easy-to-use support resource to people trying to quit.

Support groups for people who are quitting tobacco

Support groups can be helpful, too. One long-standing peer help program is Nicotine Anonymous® (NicA). This group holds regular meetings and applies the 12-step program of Alcoholics Anonymous (AA) to tobacco addiction. This includes attending meetings and following the program. People new to NicA may choose a sponsor to help them through the steps and when they are tempted to use tobacco. The NicA meetings are free, but donations are collected to help cover expenses. NicA also has phone meetings and web meetings, and offers online support.

You can find out if there’s a NicA group near you by visiting www.nicotine-anonymous.org/find-a-meeting or calling 1-877-879-6422.

Some workplaces, hospitals, and wellness centers have quit-tobacco programs, groups, or classes. They may be led by professionals and focus on information and education, or they may be run by volunteers. Some programs may be set up like classes, while others focus on sharing by members of the group. Some groups are set up for just a few weeks, and others go on indefinitely. There are lots of options, and different types of groups work better for different people. Find one that works for you.

For people who can’t go to support group meetings, there are online support systems as well as phone- and web-based support (see above).

Check with your employer, health insurance company, or local hospital to find a support group that fit your needs. Or call your American Cancer Society at 1-800-227-2345 for help finding the support you need.

What to look for in a tobacco cessation program

Tobacco cessation or quit programs are designed to help tobacco users recognize and cope with problems that come up while quitting. The programs should also provide support and encouragement in staying quit. This helps the former tobacco user avoid many of the common pitfalls of quitting.

Studies have shown that the best programs include either one-on-one or group counseling. There’s a strong link between how often and how long counseling lasts (its intensity) and the success rate – overall, the more intense the program, the greater the chance of success.

Intensity may be increased by having more or longer sessions or by increasing the number of weeks over which the sessions are given. So when looking for a program, try to find one that has the following:

  • Each session lasts at least 15 to 30 minutes
  • There are at least 4 sessions
  • The program lasts at least 2 weeks (longer is usually better)

Make sure the leader of the group is trained in smoking cessation.

Not all programs are honest, so be careful. Think twice about any programs that:

  • Promise instant, easy success with little to no effort on your part
  • Use injections or pills, especially “secret” ingredients
  • Advertise 100% success rate with no ill effects
  • Charge a very high fee (check with the Better Business Bureau if you have doubts)
  • Won’t give you references and phone numbers of people who have used the program

Support of family and friends

Many former tobacco users say a support network of family and friends was very important during their quit attempt. Other people, such as your co-workers and your family doctor, may offer support and encouragement. Tell your friends about your plans to quit. Try to spend time with non-tobacco users and former tobacco users who support your efforts to quit. Talk with them about what you need – for instance, patience as you go through cravings, taking your late-night or early-morning phone calls, and plans for doing things in places where it’s harder to use tobacco.

Some people who smoke or are trying to quit are also struggling with a mental illness or substance abuse. Peers who have had similar experiences can be helpful in assisting quit attempts. Find out what you can count on each friend or family member to do. You can also suggest that they read Helping a Smoker Quit: Do’s and Don’ts.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Boccio M et al. Telephone-based coaching. American Journal of Health Promotion. 2017;31(12):136-142. 

Centers for Disease Control and Prevention. Quit smoking. Available at https://www.cdc.gov/tobacco/quit_smoking/index.htm. Accessed October 10., 2020. 

Malone V, Harrison R, Daker-White G. Mental health service user and staff perspectives on tobacco addiction and smoking cessation: A meta-synthesis of published qualitative studies. J Psychiatr Ment Health Nurs. 2018;25(4):270-282.

Nash CM, Vickerman KA, Kellogg ES, Zbikowski SM. Utilization of a Web-based vs integrated phone/Web cessation program among 140,000 tobacco users: an evaluation across 10 free state quitlines. J Med Internet Res. 2015;17(2):e36.

Nicotine Anonymous. Find a meeting. Available at https://www.nicotine-anonymous.org/find-a-meeting. Accessed October 10, 2020.

Shaik SS, Doshi D, Bandari SR, Madupu PR, Kulkarni S. Tobacco use cessation and prevention: A review. J Clin Diagn Res. 2016;10(5):ZE13-17.

Smoking Cessation Leadership Center. Behavioral health: Fact sheets and reports. Available at https://smokingcessationleadership.ucsf.edu/behavioral-health/resources/factsheets. Accessed October 10, 2020. 

US Preventive Services Task Force. Tobacco smoking cessation in adults, including pregnant women: Behavioral and pharmacotherapy interventions. 2015. Available at https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions. Accessed October 10, 2020.

References

Boccio M et al. Telephone-based coaching. American Journal of Health Promotion. 2017;31(12):136-142. 

Centers for Disease Control and Prevention. Quit smoking. Available at https://www.cdc.gov/tobacco/quit_smoking/index.htm. Accessed October 10., 2020. 

Malone V, Harrison R, Daker-White G. Mental health service user and staff perspectives on tobacco addiction and smoking cessation: A meta-synthesis of published qualitative studies. J Psychiatr Ment Health Nurs. 2018;25(4):270-282.

Nash CM, Vickerman KA, Kellogg ES, Zbikowski SM. Utilization of a Web-based vs integrated phone/Web cessation program among 140,000 tobacco users: an evaluation across 10 free state quitlines. J Med Internet Res. 2015;17(2):e36.

Nicotine Anonymous. Find a meeting. Available at https://www.nicotine-anonymous.org/find-a-meeting. Accessed October 10, 2020.

Shaik SS, Doshi D, Bandari SR, Madupu PR, Kulkarni S. Tobacco use cessation and prevention: A review. J Clin Diagn Res. 2016;10(5):ZE13-17.

Smoking Cessation Leadership Center. Behavioral health: Fact sheets and reports. Available at https://smokingcessationleadership.ucsf.edu/behavioral-health/resources/factsheets. Accessed October 10, 2020. 

US Preventive Services Task Force. Tobacco smoking cessation in adults, including pregnant women: Behavioral and pharmacotherapy interventions. 2015. Available at https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions. Accessed October 10, 2020.

Last Revised: October 10, 2020

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.