When does the urge to smoke go away, and why do cravings come back months later?

There is no day after which the urge to smoke disappears for everyone. Irritability, restlessness, insomnia and difficulty concentrating are strongest in the first week and usually pass within 2-4 weeks (1). The urge to smoke in situations where you used to smoke lasts longer: in one survey, 59% of people who had quit between one and 10 years earlier had felt it in the past year (2). Studies that followed former smokers for months and years do not show a separate peak in relapses at 3 months: the risk of going back to smoking is highest in the first days and falls with every month without a cigarette. After the course of treatment ends, the urge to smoke may still come back when you drink alcohol, at social gatherings and under stress.

In brief

• Nicotine withdrawal symptoms usually ease after 2-4 weeks. The urge to smoke triggered by coffee, alcohol, stress or the company of smokers can keep coming back for months, and in some people for years.
• Studies do not show a separate peak in relapses at 3 months. In a Californian study, 25% of people who had not smoked for 1 to 3 months and 52% of those who had not smoked for 3 to 6 months stayed smoke-free until the next interview.
• Situations associated with smoking can trigger the urge to smoke even after treatment has ended. In a follow-up of US veterans, drinking coffee and alcohol increased the risk of relapse even after several years without a cigarette.
• It is best to agree on a plan for staying smoke-free before treatment ends and to discuss with your doctor whether to extend or repeat treatment.

How long does it take for the urge to smoke to go away?

The general urge to smoke, felt for most of the day, weakens during the first weeks without a cigarette. Sudden, brief cravings in specific situations keep coming back for much longer: according to the US National Cancer Institute, mild urges to smoke may still appear months or even years later (3).

These two kinds of nicotine craving have different sources. The first comes from the nervous system having got used to nicotine. The second comes from associations. If you smoked for years after meals, with coffee, over a beer and with friends, you will feel the urge to smoke in those situations long after the withdrawal symptoms have passed. Even irritation about something that has nothing to do with smoking can trigger the urge, because over the years a smoker learns that a cigarette eases irritation (4). We describe what usually happens during this period in our article on quitting smoking day by day.

Why does the urge to smoke come back in familiar situations?

In a 2011 US study, 86 smokers who were not seeking help to quit were paid for every day without a cigarette, and their abstinence was checked daily. After 7, 14 or 35 days, they looked at 30 pictures associated with smoking, held a lit cigarette and smelled the smoke. Before they saw the pictures, their craving was weaker the longer they had gone without smoking. The urge to smoke that appeared while they looked at the pictures and smelled the smoke, however, did not weaken over time, and in some measurements after 35 days it was even stronger than after a week (5). The authors note that the differences were small and that the study needs to be repeated among people who want to quit of their own accord.

So a few calm weeks do not mean that your first party or your first difficult week at work will pass without a craving. In a 1996 study, people who were quitting carried a small computer with them and recorded in real time when they wanted to smoke and when they first smoked a cigarette again. Smoking the first cigarette after quitting was linked to a bad mood and to situations that were reminders of smoking. Lapses happened more often where smoking was allowed, where cigarettes were easy to get and where other people were smoking (6).

How many former smokers still want to smoke years later?

In an online survey, John Hughes asked 403 former smokers who had quit between one and 10 years earlier whether they had wanted to smoke in the past year. Of these, 59% had, but in only 11% was the urge strong enough for the author to regard it as a significant problem. This smaller group more often included people who had been more strongly dependent before quitting and people with mental health problems. The result comes from a single survey and needs to be confirmed. It is also not known whether a long-lasting urge to smoke increases the risk of relapse.

So wanting a cigarette a few months on does not in itself mean that your attempt to quit is failing. If you smoked very heavily before quitting or are being treated for depression or an anxiety disorder, you should plan from the start for support that lasts longer than the time you take the medicine.

Is month 3 after quitting smoking a high-risk time?

Studies do not show a sudden rise in relapses around month 3 without a cigarette. The risk of relapse falls from the start of abstinence: most people go back to smoking in the first days, and the risk decreases with each month, although even after years it does not drop to zero.

In a review of studies of people who tried to quit without any help, most relapses occurred within the first 8 days. After one such attempt, 3-5% of people did not smoke for 6-12 months (7). The authors note that few studies showed exactly when people went back to smoking, and that their results varied widely.

Does the time already spent smoke-free predict relapse?

In a Californian study, interviewers spoke by telephone with 1,449 former smokers twice: in 1990-1991 and again in 1992. The proportion of people who had not gone back to smoking by the second interview depended on how long they had not smoked at the time of the first interview (8):

People who had not smoked for 3 to 6 months stayed smoke-free more than twice as often as those who had not smoked for 1 to 3 months. The authors proposed that research should treat more than 3 months without smoking as a preliminary criterion of success, and at least a year as a stricter one. In these data, month 3 is therefore a stage after which the chances of staying smoke-free improve rather than the point of greatest risk. This is an observational study, so people who had not smoked by month 3 may also have differed from the others in other ways.

Does the risk of relapse disappear after a year without smoking?

The risk of relapse after a year without a cigarette is clearly lower, but it does not disappear. In the US NESARC study, among people who at the first interview had not smoked for between a week and a year, 54-67% went back to smoking within about 3 years (relapse was defined as smoking at least 100 cigarettes). Among people who had not smoked for a year, the rate of return to smoking was 47%; in the group that had not smoked for 2 years it was 36%, in the group that had not smoked for 5 years it was 25%, and in the group that had not smoked for 30 years it was about 10% (9). In a long-term follow-up of 483 men from a US study of veterans, 2 to 4% of them went back to smoking each year in years 2-6 without a cigarette, and this rate fell below 1% a year only after 10 years (10).

What changes around month 3 without a cigarette?

After treatment ends, you may still find yourself in situations associated with smoking, such as social occasions with alcohol or stress. These situations, rather than the number of days itself, may make it harder to resist smoking after a few months. It is not known, however, whether relapses for these reasons happen more often specifically around month 3.

What happens when the course of medication ends?

A course of cytisine (e.g. Desmoxan, Recigar) lasts 25 days, and cigarettes have to be given up by day 5 at the latest (11). By the 3-month mark, a standard course of cytisine will have ended about two months earlier. Treatment with varenicline lasts 12 weeks. In people who have stopped smoking during this time, extending it by another 12 weeks may be considered (12). In a study in which people who were not smoking after 12 weeks of varenicline treatment were randomly assigned to continued treatment or to placebo, 70.5% of those taking the medicine and 49.6% of those taking placebo did not smoke even once over the next 12 weeks, and by the end of the year after the start of treatment, 43.6% of those taking the medicine and 36.9% of those taking placebo had not smoked even once (13).

The risk of relapse does not disappear once you stop the medicine. In a meta-analysis of studies on nicotine replacement therapy, 30% of people who were not smoking after a year had gone back to smoking before the final follow-up, carried out after 2-8 years. The proportion was similar in people who had used nicotine replacement therapy and in those who had received placebo. The authors conclude that tobacco dependence is better treated as a chronic disease in which treatment sometimes needs to be repeated (14).

How do alcohol and situations associated with smoking affect the risk of relapse?

If you are going back to social occasions with alcohol or spending breaks with people who smoke, be prepared for a possible urge to smoke. In the veterans' follow-up, drinking coffee and alcohol and smoking cigars or a pipe increased the risk of relapse in men who had not smoked for at least 2 years (10). Someone who has a drinking problem or is being treated for alcohol dependence needs a plan for quitting smoking that also takes the alcohol problem into account; we write about this in our article on quitting drinking and smoking.

How do weight and mood change after 3 months without a cigarette?

After 3 months without a cigarette, clinical trial participants who did not use medication weighed on average 2.9 kg more than before they quit (15). We describe how to limit weight gain in our article on weight gain after quitting smoking.

On average, mood does not get worse after quitting smoking: in a Cochrane review of 102 studies, people who had stopped smoking had slightly fewer symptoms of anxiety and depression at least 6 weeks later than those who continued to smoke. The authors rated the certainty of these results as very low to moderate (16). We describe low mood in the first weeks, and the signs that symptoms are no longer caused by nicotine withdrawal, in our article on mood after quitting smoking.

How do you prepare a plan for staying smoke-free after 3 months?

A plan for staying smoke-free consists of decisions made in advance: what to do in situations where the urge to smoke may return, and when to consult a doctor about further treatment. It is best prepared before treatment ends, before the first lapse happens.

In a 2019 Cochrane review, programmes that taught people to recognise difficult situations, delivered only after they had quit, did not reduce relapses in people who had quit with the help of treatment. Fewer relapses were recorded in people who took varenicline for longer and, among those who had quit on their own, in people who used nicotine replacement therapy (17). The list below is therefore not a method of proven effectiveness. Its value is that, when a difficult moment comes, you already know what to do.

1. Write down the situations in which you might smoke again. The easiest way is to use your notes from recent weeks: when, where and with whom you most wanted to smoke.
2. For each situation, add one specific action. For example: on my breaks I go outside with a non-smoker, after an argument I go for a 10-minute walk, I keep water in the car.
3. Plan the first social occasion where there will be alcohol. Plan to stay for a shorter time than usual and go with someone who knows you are quitting. Do not go outside with smokers for a cigarette and do not carry a spare pack in your pocket.
4. Do not keep cigarettes at home, at work or in the car. Lapses happened more often where cigarettes were easy to get (6).
5. Book a consultation with your doctor before your supply of medicine runs out.
6. Decide what you will do if you smoke a cigarette again. One cigarette does not cancel out months without smoking, but you then need to act quickly. We describe what to do on the first day in our article I smoked after quitting.

When should you talk to a doctor about extending or repeating treatment?

• if your course of treatment is coming to an end and nicotine cravings are still strong
• if previous attempts to quit ended in relapse in the first weeks after stopping the medicine
• if, before quitting, you lit your first cigarette straight after waking up or smoked more than a pack a day
• if you are being treated for depression, an anxiety disorder or another mental illness
• if you have started smoking again after a few months without cigarettes

The medicine is chosen based on your smoking history, previous attempts to quit and any conditions you are already being treated for. That is why nicotine dependence treatment at Nasz Gabinet starts with a medical interview. Once you have been assessed as eligible, the doctor issues an e-prescription for the chosen medicine. The plan covers 3 months of treatment. The app gives you dose reminders, a smoke-free day counter and a diary. Before treatment ends, you can see from your diary entries when the urge to smoke came back most often. A consultation with a psychologist can be booked separately for an additional fee. This article does not replace a medical consultation.

Is it normal to miss cigarettes after a few months?

Yes. The feeling that something is missing does not have to mean a nicotine craving. Cigarettes marked breaks at work, went with coffee and conversations, and were a way of dealing with tiredness and anger. When they are gone, you miss those moments for a while.

Some people who have quit smoking call this grieving for cigarettes. How long this sense of loss lasts is not known, because studies on quitting smoking usually measure cravings and withdrawal symptoms rather than longing for old rituals. You can fill the old breaks with something else: a short walk, a cup of tea, a conversation. We describe ways of coping with strong, sudden cravings in our article on nicotine cravings.

When is sadness after quitting smoking a reason to see a doctor?

You need to consult a doctor or psychologist if low mood does not go away, nothing gives you pleasure, and work and contact with your loved ones become a struggle. Low mood can be a symptom of nicotine withdrawal, and in rare cases it is accompanied by suicidal thoughts or suicide attempts. Quitting smoking can also make a pre-existing mental illness, such as depression, worse (11). If you have thoughts of taking your own life, you need to see a doctor that same day, even if they seem fleeting.

Frequently asked questions

Does the urge to smoke ever go away completely?

For most former smokers, the urge to smoke stops being a problem over time, but it does not disappear completely for everyone. In a survey of people who had quit between one and 10 years earlier, 59% had felt like smoking in the past year, and in 11% the urge was strong enough for the study's author to regard it as a significant problem. The risk of relapse falls with every year without a cigarette, although according to a large US study it does not drop to zero even after several decades.

Why is the urge to smoke so strong again after 5 months without a cigarette?

A strong urge to smoke after 5 months often appears in a situation associated with smoking: when drinking alcohol, under stress, when tired or in the company of smokers. In a laboratory study, the response to such cues did not weaken in the first weeks without a cigarette, even though the craving felt independently of these cues decreased. If your nicotine cravings are strong for several days in a row, it is better to consult a doctor or psychologist before you reach for a cigarette.

Can I smoke just one cigarette after 3 months without smoking?

Smoking one cigarette after 3 months without smoking cannot be regarded as a safe test. The authors of the NESARC study point out that the nicotine taken in when you smoke again can bring back the urge to smoke. If you have already smoked a cigarette, you need to quickly work out what led up to it and go back to the plan you made for staying smoke-free.

Can a course of cytisine be repeated if cravings come back after a few months?

If treatment with cytisine does not bring the expected results, it should be stopped. The course can be repeated after 2-3 months. If you are still not smoking but nicotine cravings come back after months, the doctor decides whether to repeat treatment after discussing your smoking history and current difficulties. You should not start another course on your own or combine medicines without a doctor's advice.

How long does a single nicotine craving last?

A single nicotine craving usually lasts a few minutes (18). According to the National Cancer Institute, cravings become less frequent over time, and months or years after quitting, the urge to smoke appears only occasionally and is mild. We describe ways of getting through those minutes in our article on nicotine cravings.

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