Learnings from California - Part 2

Arjun Kumar

August 20, 2020

The time spent with the founders of the California Smokers Helpline (the United States first state wide quit-line) was hugely impactful, not just in program structure (length of time of consultations, call flows, when a quit date should be set etc.) but also in aspects such as pharmacotherapy, physical and mental health, cultural diversity of clients and managing withdrawal symptoms – which is the focus of this article, and naturally, one of the primary focuses for people on the quit journey.

Anybody who has smoked can tell you of the nicotine withdrawal symptoms that arise when you try to quit, or even if you’ve not smoked for a few hours. Nicotine is a powerful and addictive substance that affects the body chemically – think of that buzz feeling you get when smoking, that’s the brain releasing dopamine (the reward chemical, the feeling we eventually get addicted to). So when we’re not activating that chemical release when we quit, there is an unbalance within, think irritability, mood swings, inability to concentrate –but to really understand the withdrawal symptoms, a good place to start would be to identify the type of symptoms, are they:


·             Physiological – The body’s need for nicotine (physical urges) ​

·             Psychological – The mind’s desire, oral craving (thoughts about smoking, hand to mouth action​)

·             Habitual – Learned behaviour associated with smoking​(cigarette with coffee, cigarette post meals etc.)

 They can also be a combination of 2 or all 3.

Below are some of the most common nicotine withdrawal symptoms:

·         Anxiety​

·         Irritability,frustration or anger

·         Difficulty concentrating​

·         Depressed mood​

·         Sleep disturbance

·        Restlessness​

·        Insomnia​

·        Impaired performance​

·        Increased appetite or weight gain​

·        Cravings

Usually there are some tried and tested methods which can help overcome the intensity of these withdrawal symptoms, of course everybody is different and will deal differently with their own symptoms, but here are some strategies to get you thinking about how to prepare and approach withdrawal.

Short-term Strategies:

 The Four D’s

1.                 Delay – Urges come & go; cravings last 5-10 min and decrease in length& intensity as time goes on​

2.                 Distract – Get busy and divert the energy elsewhere (hobbies, chores,books)​

3.                 Deep Breathing – Release tension / anxiety that we hold in our body and mind

4.                 Drink water – Satisfy oral fixation and hand to mouth action, helps flush chemicals out

The 3 R’s ​

1.                Remind – Review your reasons to quit​(re-establish them by writing them down)

2.               Refuse – Thoughts and rationalisations about smoking (there is no such thing as “just the one won't hurt”)​

3.               Rehearse – Review your plan for handling difficult situations, preparation is key

Long-term Strategies:

·            Alter Routines: Do something new or out of the ordinary pattern. Create a NEW routine to replace the OLD​

·            Review reasons for quitting: Reasons maintain motivation (health, finance, kids etc.), a key ingredient in quitting​

·            Adopt a nonsmoker self-image: Smoking is no longer an option,look at examples from the past. What did it feel like when you were a non-smoker?


Research from the European Respiratory Review shows that if you can quit for 28 days,you are 5 times more likely to quit for good. So if you want to learn more about the above strategies, information on pharmacotherapy and talk with one of the 28 Days Quit Coaches, get in touch here: hello@28days.org.uk | www.28days.org.uk