I. The Basics of Nicotine Rehabilitation

This guide was written to provide an overview of the nicotine rehabilitation process as well as to offer helpful resources for persons recovering from nicotine addiction.

Description of the Four Steps of the Rehab Process

What Makes Nicotine Rehabilitation Difficult?

Nicotine isn’t included in the Controlled Substance Act, but new federal minimum age requirements make it illegal to sell any tobacco products to anyone under the age of 21. Despite the rise in popularity of vaping, cigarettes remain the most commonly used tobacco product, with an estimated 1.1 billion smokers ages 15 or older worldwide. Approximately 43 million adolescents ages 13 to 15 worldwide also used tobacco in 2018.

Every year, there are 8 million tobacco-related deaths worldwide, but people continue to use tobacco despite the health risks. Among all adult cigarette smokers in 2015, nearly 7 out of 10 reported they want to stop smoking. The Centers for Disease Control and Prevention suggests it takes 8 to 11 attempts, the American Cancer Society says 8 to 10 attempts, and the Australian Cancer Council believes it takes 12 to 14 attempts to quit smoking before you succeed. However, a University of Toronto study says it’s more likely to take 30 or more attempts for a smoker to quit for a full year.

Nicotine releases dopamine, which makes it pleasurable to use and hard to quit on your own. Physical and mental cravings, sometimes prompted by stress and sensory cues, make it even more difficult to quit and remain nicotine-free. In a 1988 report by the Surgeon General that declared cigarettes were addictive and the primary agent of addiction was nicotine, nicotine addiction was compared to heroin and cocaine addiction. Like these illicit drugs, nicotine activates the brain’s reward center, making it just as hard to kick the habit.

The Unique Struggle of Nicotine Addicts
Nicotine…
  • releases dopamine, which makes you feel good and relaxed
  • must be used again when dopamine levels drop to regain pleasurable, stress-free feelings, often leading to tolerance and dependence
  • causes physical and mental addiction, but addiction is also behavioral
  • addiction can be as difficult to overcome as hardcore drugs like cocaine and heroin
  • withdrawal symptoms, including anxiety, irritability, and depression, further prompt you to crave another cigarette

Nicotine Rehabilitation Statistics

The Substance Abuse and Mental Health Services Administration estimates in 2018:

  • 793,000 people age 12 and older (0.29% of the population) used tobacco products
  • 731,000 people age 12 and older (0.27% of the population) used cigarettes
  • 287,000 people age 12 and older (0.10% of the population) used smokeless tobacco
  • 497,000 people age 12 and older (0.18% of the population) were dependent on nicotine

II. Nicotine Detoxification & Withdrawal Process

When you use tobacco products, you get addicted to the nicotine. Over time, your body gets used to having nicotine in its system, and you need more to feel normal. If your body doesn’t get nicotine, you start feeling uncomfortable and irritable and you crave more nicotine. It takes only two hours after your last cigarette for the nicotine in your body to drop by half and to start experiencing detoxification.

About 4 to 24 hours after you stop using nicotine, withdrawal starts in earnest and generally peaks on the third day. The severity of your withdrawal symptoms largely depends on how you consumed nicotine and how chronic a user you were. Withdrawal symptoms begin tapering off in three to four weeks, but cravings for nicotine can last for years. The first step to quitting smoking or other nicotine products is establishing why you want to quit because having a good reason to quit serves as motivation when detoxification causes uncomfortable withdrawal symptoms.

Visit a doctor or call one of the national nicotine Quitlines for help creating a quit smoking plan. Share your desire to quit with others so they can help support your commitment. Doctors often recommend nicotine replacement therapy or non-nicotine prescription medications, which can help relieve withdrawal symptoms and prevent relapse. There are limited numbers of nicotine addiction treatment centers, but they offer help to tobacco users who simply can’t quit without professional assistance.

Withdrawal Symptoms

Nicotine Withdrawal Symptoms
BodyMind
Short-Term SymptomsDizziness
Insomnia
Headaches
Tiredness
Increased appetite
Slower heart rate
Nausea
Constipation
Cough
Dry mouth
Throat irritation
Nasal drip
Chest tightness
Tremors
Frustration
Impatience
Nervousness
Bad dreams
Trouble concentrating
Long-Term SymptomsCravings
Weight gain
Vision changes
Anxiety
Depression
Irritability

Nicotine Replacement Therapy

Nicotine replacement therapy (NRT) is a very common strategy for managing nicotine withdrawal and recovering from addiction. NRT gives your brain the nicotine it needs while eliminating the numerous other harmful substances found in cigarettes, cigarette smoke, and other tobacco products. NRTs supply a lower dose of nicotine that’s absorbed more slowly to help you wean yourself off nicotine after breaking the physical act of smoking. There are a variety of NRT products approved by the Food and Drug Administration (FDA) — with varying results and side effects — available over-the-counter or by prescription.

NRT TypeAvailabilityHow UsedDurationPotential Side Effects
GumOver-the-counterChew slowly until you feel a tingle, and then hold inside your cheek until tingle fades. Repeat for 20 to 30 minutes. Lower the number of pieces chewed per day to wean yourself off nicotine.Recommended for 6 to 12 weeks, with a max of 6 monthsBad taste, hiccups, jaw pain, mouth sores, nausea, racing heartbeat, throat irritation
LozengeOver-the-counterSuck on a single lozenge until fully dissolved, about 20 to 30 minutes, but don’t bite, chew, or swallow it. Taper the number of lozenges used daily to wean yourself off nicotine.3 monthsCoughing, gas, headache, heartburn, hiccups, nausea, racing heart, sleep issues, sore throat, upset stomach
PatchWith or without prescriptionWorn directly on the skin of the upper arm or torso for transdermal delivery of measured doses of nicotine. Different strengths are available, and the dose is lowered to slowly wean you off nicotine.FDA-approved for 3 to 5 monthsDizziness, headache, muscle aches, nausea, racing heartbeat, skin irritations, sleep issues
InhalerPrescription-onlyNot the same as e-cigarettes, nicotine inhalers are a thin plastic tube with nicotine cartridges inside. Inhalers deliver nicotine to the mouth to be absorbed into the bloodstream instead of into the lungs.6 monthsCoughing, headache, mouth irritation, nervousness, racing heart, runny nose, throat irritation, upset stomach
Nasal SprayPrescription-onlyInstructions vary but may include spraying one to two doses in each nostril per hour for quick delivery of nicotine to relieve withdrawal symptoms.FDA recommended for 6 months in 3-month prescription periodsCoughing, headache, nasal irritation, nervousness, racing heart, runny nose, sneezing, throat irritation, watery eyes

NRT products contain nicotine, so they can also be addictive, taking the place of smoking instead of helping you break your nicotine addiction. Work directly with your doctor to ensure you’re using the right product in the appropriate way to stop using tobacco successfully. Your doctor may also prescribe a non-nicotine pill containing bupropion or varenicline, which doesn’t release nicotine into your system but acts on the brain to decrease withdrawal symptoms, cravings, or both.

For more information about withdrawal, read our guide on Nicotine Addiction.

III. Treatment for Nicotine Addiction

Behavioral therapies are similar for nicotine dependence as they are for other drugs, but they’re typically performed on an outpatient basis and may include self-help materials, individual and group counseling, and support groups. While behavioral therapy is effective for treating tobacco dependence, using it together with medication-assisted treatment is more effective than using either treatment option alone.

Nicotine replacement therapies were the first medication-assisted treatments approved by the FDA for smoking cessation therapy. Currently, the FDA approves chewing gum, lozenges, transdermal patches, inhalers, and nasal sprays to deliver low doses of nicotine and relieve withdrawal symptoms while you try to quit. The FDA also approves non-nicotine prescription medications containing bupropion or varenicline to help people quit smoking.

Rehabilitation Settings

Within either an inpatient or outpatient setting, counseling, behavioral therapies, and nicotine and non-nicotine medication-assisted treatments are offered for varying lengths of time. Inpatient treatment involves living full time (including overnight) at a treatment facility for a set time period. Generally, nicotine dependence doesn’t require a long-term inpatient treatment plan, and it’s unusual to find a long-term rehabilitation facility that specifically treats nicotine addiction. There are some short-term residential facilities with programs that typically last four to eight days, and outpatient programs involve scheduled appointments at a clinic or health center.

Many inpatient facilities that treat alcohol and drug addiction can also treat nicotine dependence, but these might not appeal to someone who only wants to quit smoking. However, if you want to quit smoking and you’re seeking treatment for abuse of alcohol, illicit drugs, and/or prescription drugs, an inpatient facility with smoking/tobacco cessation services may be the answer. The 2018 National Survey of Substance Abuse Treatment Services recorded 7,374 (49.8%) substance abuse treatment facilities that offered smoking/tobacco cessation counseling, with 4,153 — or 28% — offering nicotine replacement therapy and 3,302 — or 22.3% — offering non-nicotine medications for smoking cessation.

Nicotine Rehabilitation and Treatment Programs
SettingType of TreatmentDescriptionDurationTime Commitment
InpatientShort-Term ResidentialIntensive treatment that includes individual and group counseling with a trained nicotine addiction specialist. Programs also include medications to alleviate withdrawal symptoms, educational sessions to help with stress management, tobacco-related health education, and long-term follow-up to prevent relapse.4 to 8 daysHours Per Day:

24

Days Per Week:

4

OutpatientSmoking/Tobacco Cessation CounselingIndividual and group counseling that focuses on helping you stop smoking/using tobacco. Topics may include the health, financial, social, and emotional impacts of tobacco use.As long as desiredHours Per Day:

1-2

Days Per Week:

1-3

QuitlinesSmoking/Tobacco Cessation CounselingTelephone support lines offering smoking cessation counseling, support, and tips. Many also help you create a quit-smoking plan that works for you and provide information about nicotine replacement therapy and medications that may help in your efforts to stop smoking. Quitlines are toll-free and available in every state.As long as desired 

Hours Per Day:

Varies

Days Per Week:

Varies

Support GroupsSmoking/Tobacco Cessation CounselingSelf-help groups center on maintaining a smoke-free lifestyle. Some are structured as 12-step programs, but others aren’t.As long as desiredHours Per Day:

1-2

Days Per Week:

1

Behavioral and Medication-Assisted Therapies

Behavioral therapy for substance addiction seeks to identify and manage addictive behaviors that lead to tobacco use and helps prevent relapse. Behavioral therapy is based on the concept that all behavior is learned, and thus, unhealthy behavior can be changed through learning coping skills and increasing awareness of negative thoughts and beliefs that contribute to substance abuse.

There are two types of medication-assisted treatment for smoking cessation. One includes products that contain nicotine and works by giving you small doses of nicotine while eliminating other dangerous chemicals found in cigarettes. The purpose of these products is to help you wean yourself off nicotine and help ease withdrawal symptoms. The second type includes prescription medications that don’t contain nicotine and are used to ease withdrawal symptoms and block the effects of nicotine should you relapse.

Behavioral Therapies for Nicotine Addiction
Type of TherapyDefinition
Cognitive Behavioral Therapy

Further reading:

Cognitive behavioral therapy (CBT) is structured psychotherapy that helps you develop cognitive and behavioral skills to resist the urge to smoke while equipping you with therapeutic tools and coping strategies to stop smoking and prevent relapse. CBT also helps you identify triggers, including people, places, and situations, that increase your desire to smoke and teach you how to deal with these triggers.
Motivational Interviewing

Further reading:

Motivational interviewing helps you explore and resolve your ambivalence about quitting smoking, enhances your motivations to quit and make healthy changes in your life, and supports self-efficacy and optimism.
Individual or Group Counseling

Further reading:

This therapy includes counseling for individuals and groups, as well as support groups such as Nicotine Anonymous. Counseling teaches you techniques to stop smoking and provides support throughout the process.
Mindfulness

Further reading:

Mindfulness in smoking cessation treatment teaches you to increase your awareness of thoughts, sensations, and cravings that might make you relapse. You also learn techniques that help you tolerate negative emotions, such as stress that can trigger cravings, so you don’t return to tobacco use.
Medication-Assisted Treatment for Nicotine Addiction
Type of Medication for TreatmentDefinition
Nicotine Replacement Therapy

Further reading:

NRT includes various products that replace the nicotine from cigarettes and other tobacco products to slowly wean yourself off nicotine. NRT products include chewing gum, lozenges, transdermal patches, inhalers, and nasal sprays. Each may be equally effective for quitting smoking and are often used together with counseling or behavioral therapies.
Varenicline (Chantix)

Further reading:

Chantix is the brand name of varenicline, a prescription drug that works by mimicking and partially blocking the effects of nicotine to ease withdrawal symptoms and cravings and to make smoking less enjoyable if you relapse.
Bupropion (Wellbutrin, Zyban)

Further reading:

Wellbutrin and Zyban are the brand names for bupropion, a prescription antidepressant that triggers some of the same receptors as nicotine to ease withdrawal symptoms and help reduce your desire to smoke.

IV. How to Find Help

Finding a Treatment Program for Nicotine Addiction

It’s difficult to find long-term inpatient rehabilitation centers just for nicotine addiction, but you can find short-term residential facilities or seek treatment at a long-term substance abuse rehabilitation center that also offers smoking cessation services. However, nicotine dependence doesn’t generally require a long-term inpatient treatment plan. An outpatient program that offers counseling and behavior therapies combined with nicotine replacement therapy and/or non-nicotine medication-assisted treatment is one of the best ways to enhance your success in kicking the tobacco habit for good.

Our Directory

Our directory of rehab programs includes a comprehensive list of available treatment centers and programs as provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). In the directory, you will find tools to filter the programs by setting, price, and location.