Nicotine dependence occurs when you need nicotine and can't stop using it. Nicotine is the chemical in tobacco that makes it hard to quit. Nicotine produces pleasing effects in your brain, but these effects are temporary. So you reach for another cigarette.

The more you smoke, the more nicotine you need to feel good. When you try to stop, you experience unpleasant mental and physical changes. These are symptoms of nicotine withdrawal.

Regardless of how long you've smoked, stopping can improve your health. It isn't easy but you can break your dependence on nicotine. Many effective treatments are available. Ask your doctor for help.


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 have 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 activities. You may stop going to smoke-free restaurants or stop socializing with family or friends because you can't smoke in these 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 health care team to help you develop a treatment plan that works for you or to advise you on where to get help to stop smoking.


Video: Smoking — Anatomy of nicotine addiction

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 reaches 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 feelings of pleasure and improved mood.

The more you smoke, the more nicotine you need to feel good. Nicotine quickly becomes part of your daily routine and intertwined with your habits and feelings.

Common situations that trigger the urge to smoke include:

  • Drinking coffee or taking breaks at work
  • Talking on the phone
  • Drinking alcohol
  • Driving your car
  • Spending time with friends

To overcome your nicotine dependence, you need to become aware of your triggers and make a plan for dealing with them.

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:

  • 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 addicted.
  • 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.
  • Parents and peers. Children who grow up with parents who smoke are more likely to become smokers. Children with friends who smoke are also more likely to try it.
  • Depression or other mental illness. Many studies show an association between depression and smoking. People who have depression, schizophrenia, post-traumatic stress disorder 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.


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

You already know that people who smoke cigarettes are much more likely to develop and die of certain diseases than people who don't smoke. But you may not realize just how many different health problems smoking causes:

  • Lung cancer and lung disease. Smoking is the leading cause of lung cancer deaths. In addition, smoking causes lung diseases, such as emphysema and chronic bronchitis. Smoking also makes asthma worse.
  • Other cancers. Smoking increases the risk of many types of cancer, including cancer of the mouth, throat (pharynx), esophagus, larynx, bladder, pancreas, kidney, cervix and some types of leukemia. Overall, smoking causes 30% of all cancer deaths.
  • Heart and circulatory system problems. Smoking increases your risk of dying of heart and blood vessel (cardiovascular) disease, including heart attacks and strokes. If you have heart or blood vessel disease, such as heart failure, smoking worsens your condition.
  • Diabetes. Smoking increases insulin resistance, which can set the stage for 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.
  • Complications during pregnancy. Mothers who smoke while pregnant face a higher risk of preterm delivery and giving birth to lower birth weight babies.
  • Cold, flu and other illnesses. Smokers are more prone to respiratory infections, such as colds, the flu and bronchitis.
  • Tooth and gum disease. Smoking is associated with an increased risk of developing inflammation of the gum and a serious gum infection that can destroy the support system for teeth (periodontitis).

Smoking also poses health risks to those around you. 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. Children whose parents smoke are more prone to worsening asthma, ear infections and colds.


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

The best way to keep 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.

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April 19, 2022
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