Overview

Nicotine dependence ― also called tobacco dependence ― is an addiction to tobacco products caused by the drug nicotine. Nicotine dependence means you can't stop using the substance, even though it's causing you harm.

Nicotine produces physical and mood-altering effects in your brain that are temporarily pleasing. These effects make you want to use tobacco and lead to dependence. At the same time, stopping tobacco use causes withdrawal symptoms, including irritability and anxiety.

While it's the nicotine in tobacco that causes nicotine dependence, the toxic effects of tobacco result from other substances in tobacco. Smokers have much higher rates of heart disease, stroke and cancer than nonsmokers do.

Regardless of how long you've smoked, stopping smoking can improve your health. Many effective treatments for nicotine dependence are available to help you manage withdrawal and stop smoking for good. Ask your doctor for help.

Symptoms

For some people, using any amount of tobacco can quickly lead to nicotine dependence. Signs that you may be addicted include:

  • You can't stop smoking. You've made one or more serious, but unsuccessful, attempts to stop.
  • You experience withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical and mood-related symptoms, such as strong cravings, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration, anger, increased hunger, insomnia, constipation or diarrhea.
  • You keep smoking despite health problems. Even though you've developed health problems with your lungs or your heart, you haven't been able to stop.
  • You give up social or recreational activities in order to smoke. You may stop going to smoke-free restaurants or stop socializing with certain family members or friends because you can't smoke in these locations or situations.

When to see a doctor

You're not alone if you've tried to stop smoking but haven't been able to stop for good. Most smokers make many attempts to stop smoking before they achieve stable, long-term abstinence from smoking.

You're more likely to stop for good if you follow a treatment plan that addresses both the physical and the behavioral aspects of nicotine dependence. Using medications and working with a counselor specially trained to help people stop smoking (a tobacco treatment specialist) will significantly boost your chances of success.

Ask your doctor, counselor or therapist to help you develop a treatment plan that works for you or to advise you on where to get help to stop smoking.

Causes

Transcript

In many people, nicotine from cigarettes stimulates receptors in the brain to release dopamine, triggering a pleasure response. Over time, the number of nicotine receptors increases and changes your brain's anatomy. When you quit smoking, you cut off the brain's pleasure response because the receptors don't get nicotine, triggering nicotine withdrawal symptoms. If you stick it out and use stop-smoking products to help with withdrawal symptoms and cravings, the number of nicotine receptors returns to normal, helping you quit smoking for good.

Nicotine is the chemical in tobacco that keeps you smoking. Nicotine is very addictive when delivered by inhaling tobacco smoke into the lungs, which quickly releases nicotine into the blood allowing it to get into the brain within seconds of taking a puff. In the brain nicotine increases the release of brain chemicals called neurotransmitters, which help regulate mood and behavior.

Dopamine, one of these neurotransmitters, is released in the "reward center" of the brain and causes improved mood and feelings of pleasure. Experiencing these effects from nicotine is what makes tobacco so addictive.

Nicotine dependence involves behavioral (routines, habits, feelings) as well as physical factors. These behavioral associations with smoking may act as triggers — situations or feelings that activate a craving for tobacco, even if you have not smoked for some time.

Behaviors and cues that you may associate with smoking include:

  • Certain times of the day, such as first thing in the morning, with morning coffee or during breaks at work
  • After a meal
  • Drinking alcohol
  • Certain places or friends
  • Talking on the phone
  • Stressful situations or when you're feeling down
  • Sight or smell of a burning cigarette
  • Driving your car

To overcome your dependence on tobacco, you need to become aware of your triggers and develop a plan to deal with the behaviors and routines that you associate with smoking.

Risk factors

Anyone who smokes or uses other forms of tobacco is at risk of becoming dependent. Factors that influence who will use tobacco include:

  • Genetics. The likelihood that you will start smoking and keep smoking may be partly inherited — genetic factors may influence how receptors on the surface of your brain's nerve cells respond to high doses of nicotine delivered by cigarettes.
  • Home and peer influence. Children who grow up with parents who smoke are more likely to become smokers. Children with friends who smoke also are more likely to try cigarettes. Evidence suggests that smoking shown in movies and on the Internet can encourage young people to smoke.
  • Age. Most people begin smoking during childhood or the teen years. The younger you are when you begin smoking, the greater the chance that you'll become a heavy smoker as an adult.
  • Depression or other mental illness. Many studies show an association between depression and smoking. People who have depression, schizophrenia, post-traumatic stress disorder (PTSD) or other forms of mental illness are more likely to be smokers.
  • Substance use. People who abuse alcohol and illegal drugs are more likely to be smokers.

Complications

Tobacco smoke contains more than 60 known cancer-causing chemicals and thousands of other harmful substances. Even "all natural" or herbal cigarettes have chemicals that are harmful to your health.

Smoking harms almost every organ of your body and impairs your body's immune system. About half of all regular smokers will die of a disease caused by tobacco.

Women smokers are now at equal risk to men smokers of dying from lung cancer, COPD and cardiovascular disease caused by using tobacco.

The negative health effects include:

  • Lung cancer and other lung diseases. Smoking causes nearly 9 out of 10 lung cancer cases. In addition, smoking causes other lung diseases, such as emphysema and chronic bronchitis. Smoking also makes asthma worse.
  • Other cancers. Smoking is a major cause of cancers of the esophagus, larynx, throat (pharynx) and mouth and is related to cancers of the bladder, pancreas, kidney and cervix, and some leukemias. Overall, smoking causes 30 percent of all cancer deaths.
  • Heart and circulatory system problems. Smoking increases your risk of dying of heart and blood vessel (cardiovascular) disease, including heart attack and stroke. Even smoking just one to four cigarettes daily increases your risk of heart disease. If you have heart or blood vessel disease, such as heart failure, smoking worsens your condition. However, stopping smoking reduces your risk of having a heart attack by 50 percent in the first year.
  • Diabetes. Smoking increases insulin resistance, which can set the stage for the development of type 2 diabetes. If you have diabetes, smoking can speed the progress of complications, such as kidney disease and eye problems.
  • Eye problems. Smoking can increase your risk of serious eye problems such as cataracts and loss of eyesight from macular degeneration.
  • Infertility and impotence. Smoking increases the risk of reduced fertility in women and the risk of impotence in men.
  • Pregnancy and newborn complications. Mothers who smoke while pregnant face a higher risk of miscarriage, preterm delivery, lower birth weight and sudden infant death syndrome (SIDS) in their newborns.
  • Cold, flu and other illnesses. Smokers are more prone to respiratory infections, such as colds, flu and bronchitis.
  • Weakened senses. Smoking deadens your senses of taste and smell, so food isn't as appetizing.
  • Teeth and gum disease. Smoking is associated with an increased risk of developing inflammation of the gum (gingivitis) and a serious gum infection that can destroy the support system for teeth (periodontitis).
  • Physical appearance. The chemicals in tobacco smoke can change the structure of your skin, causing premature aging and wrinkles. Smoking also yellows your teeth, fingers and fingernails.
  • Risks to your family. Nonsmoking spouses and partners of smokers have a higher risk of lung cancer and heart disease compared with people who don't live with a smoker. If you smoke, your children will be more prone to SIDS, worsening asthma, ear infections and colds.

Prevention

The best way to prevent tobacco dependence is to not smoke in the first place.

The best way to prevent your children from smoking is to not smoke yourself. Research has shown that children whose parents do not smoke or who successfully quit smoking are much less likely to take up smoking.

Here are steps you can take to prevent future generations from nicotine addiction and the many diseases associated with smoking:

  • Talk to your children about smoking. Tell them about the dangers of tobacco. Encourage them to value good health. You can be a great influence on whether your children smoke, despite what they see in movies and on the web.
  • Stay in touch with your teens. Studies show that smoking is most likely to become a habit during the teen years. Ask whether their friends smoke. Those who have friends who smoke are more likely to start smoking than those who don't. Help them plan ways to handle peer pressure. Let your child know that other forms of tobacco, including cigars and smokeless tobacco, also carry significant health risks.
  • Promote smoke-free environments. Ban smoking in your home. Support legislation to make all workplaces smoke-free. Encourage smoke-free public places, including restaurants. Become active in community and school-based stop-smoking programs.
  • Support legislation to increase taxes on tobacco products. Higher prices discourage teens from starting to smoke. Higher prices on tobacco products, coupled with smoke-free workplace laws, are the most effective public health policies to reduce smoking in adults and prevent young people from ever starting.
Aug. 22, 2017
References
  1. Tobacco-related cancers fact sheet. American Cancer Society. http://www.cancer.org/cancer/cancercauses/tobaccocancer/tobacco-related-cancer-fact-sheet. Accessed March 24, 2016.
  2. Guide to quitting smoking. American Cancer Society. http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/index. Accessed March 24, 2016.
  3. Why people start using tobacco and why it's hard to stop. American Cancer Society. http://www.cancer.org/cancer/cancercauses/tobaccocancer/why-people-start-using-tobacco. Accessed March 24, 2016.
  4. DrugFacts: Cigarettes and other tobacco products. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/drugfacts/cigarettes-other-tobacco-products. Accessed March 24, 2016.
  5. Horn K, et al. Effects of physical activity on teen smoking cessation. Pediatrics. 2011:128:e801.
  6. Rigotti NA. Pharmacotherapy for smoking cessation in adults. http://www.uptodate.com/home. Accessed March 30, 2016.
  7. The truth about kids and smoking. American Cancer Society. http://www.cancer.org/cancer/news/features/the-truth-about-kids-and-smoking. Accessed March 24, 2016.
  8. Rigotti NA, et al. Benefits and risks of smoking cessation. http://www.uptodate.com/home. Accessed March 24, 2016.
  9. Preventing tobacco use among youth and young adults: A report of the Surgeon General ― Executive summary. Centers for Disease Control and Prevention. http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/. Accessed March 24, 2016.
  10. Danovitch I. The clinical assessment and treatment of nicotine dependence. Focus. 2011;9:15.
  11. Get free help: Speak to an expert. Smokefree.gov. http://smokefree.gov/talk-to-an-expert. Accessed March 24, 2016.
  12. Quit guide: Clearing the air. Smokefree.gov. http://smokefree.gov/sites/default/files/pdf/clearing-the-air-accessible.pdf. Accessed March 24, 2016.
  13. Become an EX smoker. https://www.becomeanex.org/about-ex.php#. Accessed March 24, 2016.
  14. A report of the Surgeon General: How tobacco smoking causes disease. http://www.cdc.gov/tobacco/data_statistics/sgr/2010/consumer_booklet/index.htm. Accessed March 24, 2016.
  15. AskMayoExpert. Tobacco use. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
  16. The health consequences of smoking —50 years of progress. A report of the Surgeon General, 2014. Executive Summary. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html. Accessed March 24, 2016.
  17. Barbara Woodward Lips Patient Education Center. My path to a smoke-free future. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.
  18. Rosen JB, et al. Management of smoking cessation in adolescents. http://www.uptodate.com/home. Accessed March 30, 2016.
  19. Rodriguez-Thompson D. Smoking and pregnancy. http://www.uptodate.com/home. Accessed March 30, 2016.
  20. Bupropion. Facts & comparisons eAnswers. http://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed March 31, 2016.
  21. Varenicline. Facts & comparisons eAnswers. http://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed March 31, 2016.
  22. Nortriptyline. Facts & comparisons eAnswers. http://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed March 31, 2016.
  23. Complementary health approaches for smoking cessation: What the science says. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/providers/digest/smoking-science. Accessed April 1, 2016.
  24. Pisinger C, et al. A systematic review of health effects of electronic cigarettes. Preventive Medicine. 2014;69:248.
  25. Ebbert JO, et al. Counseling patients on the use of electronic cigarettes. Mayo Clinic Proceedings. 2015;90:128.
  26. McRobbie H, et al. Electronic cigarettes for smoking cessation and reduction. Cochrane Database of Systematic Reviews.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010216.pub2/full. Accessed April 27, 2016.
  27. Rigotti NA. E-cigarettes. http://www.uptodate.com/home. Accessed March 30, 2016.
  28. Bhatnagar A, et al. Electronic cigarettes: A policy statement from the American Heart Association. Circulation. 2014;130:1418.
  29. Bjartveit K, et al. Health consequences of smoking 1–4 cigarettes per day. Tobacco Control. 2005;14:315.
  30. Sockrider M, et al. Prevention of smoking initiation in children and adolescents. http://www.uptodate.com/home. Accessed April 5, 2016.
  31. Higgins ST, et al. Co-occurring risk factors for current cigarette smoking in a U.S. nationally representative sample. Preventive Medicine. In press. Accessed April 5, 2016.
  32. Smokeless tobacco and cancer. National Cancer Institute. http://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/smokeless-fact-sheet. Accessed April 5, 2016.
  33. What are FDA's regulations for flavored tobacco? U.S. Food and Drug Administration. http://www.fda.gov/AboutFDA/Transparency/Basics/ucm208085.htm. Accessed April 5, 2016.
  34. Hookahs. Centers for Disease Control and Prevention. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/. Accessed April 5, 2016.
  35. Cigars. Centers for Disease Control and Prevention. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/cigars/index.htm. Accessed April 5, 2016.
  36. Bidis and kreteks. Centers for Disease Control and Prevention. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/bidis_kreteks/index.htm. Accessed April 5, 2016.
  37. Kotz D, et al. Prospective cohort study of the effectiveness of smoking cessation treatments used in the 'real world.' Mayo Clinic Proceedings. 2014;89:1360.