Nicotine Gum and Mental Health Therapy: Treating Both at 28

I am 28 years old. I live in Denver, Colorado. I started smoking when I was 20, during my junior year of college, and I smoked for six years before I quit. Six years is not an eternity, but it was my entire adult life up to that point, and I want to tell you the real story of how it started and why it took what it took to stop.

The real story involves anxiety that I spent years treating with cigarettes without understanding that is what I was doing.

How It Started

I have had anxiety my whole life. I did not have a name for it growing up. I just knew that I was the kid who triple-checked her backpack the night before school, who lay awake working out worst-case scenarios, who needed a long time to come down from anything stressful.

College made it worse. The unstructured time, the new social landscape, the pressure of grades that felt like a verdict on my entire future. By my junior year I was managing it through over-scheduling, perfectionism, and a habit of quietly leaving parties when my nervous system hit its limit.

I started smoking at a party in October of my junior year. A friend handed me a cigarette and I took it because refusing felt like one more social calculation and I was already exhausted. I stood outside with three other people, nobody saying much, and for about ten minutes I felt genuinely calm.

I know now, sitting here at 28, that this was not a coincidence. Nicotine activates the release of dopamine and reduces anxiety signals in the brain in the short term. I had accidentally found a chemical that addressed the exact thing I was struggling with. Of course I went back for it.

Within a month I was bumming cigarettes at parties. Within two months I was buying my own. Marlboro Lights at first, then eventually American Spirit Blues when I moved to Colorado, where the slower burn suited the altitude and the general vibe of my life there.

The Six Years I Told Myself I Could Stop Whenever I Wanted

The lie I told myself most consistently during those six years was that I was not really a smoker. I smoked maybe ten cigarettes a day, which is not heavy by some people’s standards. I did not smoke first thing in the morning. I held the rule that I did not smoke inside. I took smoke breaks from studying and told myself it was stress management, which it was, just not in any sustainable or healthy sense.

I tried to quit twice on my own. The first time lasted about a week. The second time, maybe nine days. Both times the anxiety came back so hard and so fast that smoking felt less like a choice and more like necessary stabilization. I had no other tool that worked as quickly. That is the honest truth of it.

By the time I was finishing my bachelor’s degree and applying to graduate programs, I was smoking through every high-anxiety period with the efficiency of someone who has refined a coping strategy over years. Application deadlines, GRE prep, waiting for acceptances, moving to a new city for my master’s program in environmental policy. Each transition was navigated partially with cigarettes.

The Therapist Who Said the Uncomfortable Thing

I started seeing a therapist in Denver during my first year of grad school. Her name is Dr. Renata Vasquez and I went to her specifically for anxiety management, because by my second year I was waking up at 3 a.m. with racing thoughts and could not get back to sleep.

About three months into our work together, she said something direct: she told me that we could work on anxiety management skills, but that the smoking was functioning as a crutch that was actively preventing me from developing them. Not in a judgmental way. More like a mechanic telling you that the duct tape holding something together needs to come off before they can look at what is underneath.

She explained the feedback loop: anxiety spikes, I smoke to relieve it, relief comes quickly, brain registers that smoking is the solution to anxiety, next time anxiety spikes the pull toward smoking is stronger. Six years of that loop had made the connection between anxiety and smoking very deeply grooved.

What she said next was the part I had never heard before. She told me that quitting smoking without addressing the anxiety was likely to fail, and that managing the anxiety without removing the smoking was likely to be incomplete. They needed to happen together, or at least in coordination.

This was inconvenient to hear. I wanted her to teach me breathing exercises and call it a day.

How We Did It Together

Dr. Vasquez and I spent about a month on groundwork before I set a quit date. We mapped my specific anxiety triggers. We identified the situations where I was most likely to smoke, which corresponded almost exactly with high-anxiety situations: deadlines, difficult conversations, social events where I did not know many people, long stretches of solitary work where my brain started spiraling.

For each category, we built a substitute response. Not generic advice like “take a walk.” Specific: when a deadline is three days out and the spiral starts, I write down every individual task that needs to happen and assign it to a specific time block. When I am at a social event feeling overwhelmed, I allow myself to step outside for five minutes and call one specific person from my contact list. When solitary work spirals, I set a ten-minute timer and write down every anxious thought without editing them, then close the notebook.

For the physical withdrawal, we decided to use Nicorette gum. I chose the 4mg, because I was a consistent daily smoker and the 2mg is really meant for lighter use. The park-and-chew method that Nicorette recommends, where you chew until you get a tingle and then park it against your cheek, takes some practice but once you get it right it delivers nicotine steadily rather than in a spike. It is nothing like smoking. But it keeps the physical withdrawal from being the loudest thing in the room while you are also trying to rebuild your anxiety toolkit.

I set my quit date for a Monday in March, about three weeks before a major paper was due.

The Hardest Moment

Exam week during the first semester I was quit.

My master’s program in environmental policy involves a research methods class in the first year that builds toward a comprehensive final exam and a paper that together constitute a substantial portion of your grade. I had known this was coming. Dr. Vasquez and I had specifically planned for it. I had extra Nicorette on hand. I had reviewed all my coping strategies.

None of that made it easy.

The two days before the exam were the closest I came to buying a pack. I was studying in a coffee shop near campus and a man at the next table came back in from outside smelling like cigarette smoke, and the smell hit my brain in a way that felt almost physical. Not nostalgic exactly. More like a switch that someone flipped.

I took a 4mg piece of Nicorette and chewed it. I texted Dr. Vasquez. She responded quickly, which was not standard outside of our scheduled sessions, but she had told me I could reach out during exam week and meant it. She sent me back to the task list I had made three nights before. She asked me which item I was on and what was next.

That was enough. Not comfortable. Just enough.

I took the exam. I finished the paper. I did not smoke.

What Changed About My Anxiety

This part surprised me. Quitting smoking did not fix my anxiety. I want to be clear about that because I think there is a version of this story that implies removing the substance removes the problem, and that was not my experience.

What happened was more complicated and also more useful. Without cigarettes, my anxiety had nothing to immediately hide behind. Every anxious spike became something I had to actually process rather than temporarily suppress. That was uncomfortable for a long time. Dr. Vasquez describes it as the anxiety coming into full resolution rather than being paused.

The tools we had built got more use. They also got better, because I was practicing them under real conditions rather than as a backup plan.

About four months after I quit, I noticed something different. The anxiety was still there, but it was no longer in charge of my decisions. I could feel it and keep moving. The automatic link between anxiety and the need for relief had loosened, because I had been practicing, over and over, that a spike did not require immediate chemical intervention.

This is not something I could have told you I wanted when I started. I wanted to feel less anxious. What I got instead was a more honest relationship with anxiety, which is actually better but is a much harder sell.

Where I Am Now

I finished my master’s degree in May of last year. Smoke-free. I walked across the stage and afterward went to dinner with my parents, who flew out from Ohio for it, and at no point did I step outside to smoke. My mom cried, which she claimed was about the degree.

I still see Dr. Vasquez, though less frequently. Monthly now, sometimes less. I still use the tools we built together. I still carry a piece of Nicorette occasionally, not because I need it the way I did in the early months but because having it available removes the scarcity anxiety that can itself become a trigger.

I run now. I started running during grad school partly as a craving management tool and partly because Denver is an excellent city for it if you actually have lungs. My times are not impressive. I do not care about my times. I care that I can run three miles without stopping, which I absolutely could not have done a year into smoking American Spirits at altitude.

For You, If You Are Still Smoking

If you started smoking young and anxious, if you have noticed that the cigarette is not really about enjoyment but about relief, if you have tried to quit and found that the anxiety that comes back is harder to sit with than the physical withdrawal, I want you to know that you are not making it up and you are not weak.

You have been self-medicating. Efficiently and with something widely available. The fact that it worked in the short term is not a moral failing. The fact that it became a problem is also not a moral failing.

What helped me was not treating the smoking in isolation. It was treating the anxiety and the smoking as connected problems that needed connected solutions. A therapist who understood addiction, a nicotine replacement that handled the physical side while I rebuilt psychological skills, and the willingness to go through a period of uncomfortable clarity before things got better.

If money is a barrier to therapy, look into community mental health centers, university training clinics where supervised graduate students see clients at low or no cost, or the SAMHSA National Helpline at 1-800-662-4357, which can connect you to low-cost resources in your area.

You do not have to white-knuckle it alone. You especially do not have to pretend the anxiety does not exist while you are trying to quit. Address both. It is harder up front and much easier after.

You will get there.