Nicotine dependence

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Nicotine dependence occurs when you cannot stop using nicotine, the chemical in tobacco that makes it hard to quit. Smoking tobacco produces temporary pleasing effects in the brain, leading to a cycle of reaching for another cigarette to maintain those effects.

Over time, as you smoke more, you need increasing amounts of nicotine to feel good. Attempts to quit smoking result in unpleasant mental and physical changes known as nicotine withdrawal symptoms.

Stopping smoking, regardless of how long you’ve smoked, can significantly improve your health. While it may not be easy, breaking your dependence on nicotine is possible with the help of effective treatments and support. Consult your doctor for assistance in quitting smoking.

Symptoms of Nicotine Dependence

Signs that you may be addicted to nicotine include:

  • Inability to stop smoking despite serious attempts to quit.
  • Experiencing withdrawal symptoms when trying to stop, such as strong cravings, anxiety, irritability, restlessness, difficulty concentrating, and more.
  • Continuing to smoke despite having health problems related to smoking.
  • Giving up social activities to smoke in certain situations.

When to See a Doctor

If you’ve tried to stop smoking without success, know that you’re not alone. Most smokers make multiple attempts to quit before achieving long-term abstinence. To increase your chances of success, follow a treatment plan that addresses both the physical and behavioral aspects of nicotine dependence. Consider using medications and seeking help from a tobacco treatment specialist to quit smoking effectively.

Causes of Nicotine Dependence

Nicotine is the addictive chemical in tobacco that keeps you smoking. When you smoke, nicotine reaches your brain quickly and increases the release of neurotransmitters like dopamine, which cause feelings of pleasure and improved mood. As you smoke more, nicotine becomes ingrained in your daily routine and habits, making it difficult to quit.

Common situations that trigger the urge to smoke include drinking coffee, taking breaks at work, talking on the phone, drinking alcohol, driving, and spending time with friends. To overcome nicotine dependence, it’s essential to become aware of your triggers and develop a plan to deal with them.

Complications of Nicotine Dependence

Smoking tobacco exposes you to more than 60 known cancer-causing chemicals and thousands of other harmful substances. It can lead to a wide range of health problems, including:

  • Lung cancer and lung diseases such as emphysema and chronic bronchitis.
  • Other cancers, including cancer of the mouth, throat, esophagus, bladder, pancreas, and more.
  • Heart and circulatory system problems, increasing the risk of heart attacks and strokes.
  • Diabetes, by increasing insulin resistance and worsening diabetes complications.
  • Eye problems like cataracts and macular degeneration.
  • Infertility and impotence.
  • Complications during pregnancy, such as preterm delivery and low birth weight babies.
  • Increased risk of respiratory infections, tooth, and gum disease.
  • Health risks to those around you, including higher risk of lung cancer and heart disease for nonsmoking spouses and children.

Prevention of Nicotine Dependence

The best way to prevent nicotine dependence is to not use tobacco in the first place. For parents, not smoking yourself and successfully quitting smoking can significantly reduce the likelihood of your children taking up smoking. Providing a smoke-free environment can help prevent nicotine dependence in others as well.

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Your doctor may ask you questions or have you fill out a questionnaire to see how dependent you are on nicotine. Knowing your degree of dependence will help your doctor determine the right treatment plan for you. The more cigarettes you smoke each day and the sooner you smoke after awakening, the more dependent you are.


Like most smokers, you’ve probably made at least one serious attempt to stop. But it’s rare to stop smoking on your first attempt — especially if you try to do it without help. You’re much more likely to be able to stop smoking if you use medications and counseling, which have both been proved effective, especially in combination.


Some quit-smoking products are known as nicotine replacement therapy because they contain varying amounts of nicotine. Some of these nicotine replacement therapies require a prescription, but others don’t. There are two approved quit-smoking medications that don’t contain nicotine, and both are available only by prescription.

Any of these products can help reduce nicotine cravings and withdrawal symptoms — making it more likely that you’ll stop smoking for good. Using more than one may help you get better results.

Although you can buy some quit-smoking products without a prescription, it’s a good idea to talk to your doctor first. Together you can explore which products might be right for you, when to start taking them and possible side effects.


Medications help you cope by reducing withdrawal symptoms and cravings, while behavioral treatments help you develop the skills you need to give up tobacco for good. The more time you spend with a counselor, the better your treatment results will be.

During individual or group counseling, you learn techniques you can use to help you stop smoking. Many hospitals, health care plans, health care providers and employers offer treatment programs. Some medical centers provide residential treatment programs — the most intensive treatment available.

Methods to Avoid

Electronic cigarettes (e-cigarettes) have not proved to be safe nor are they more effective in helping people stop smoking than nicotine replacement medications. In fact, many people who use e-cigarettes to stop smoking find themselves using both products rather than quitting.

It’s not a good idea to substitute another type of tobacco use for smoking. Tobacco in any form is not safe. Steer clear of these products:

  • Dissolvable tobacco products
  • Smokeless tobacco
  • Nicotine lollipops and balms
  • Cigars and pipes
  • Hookahs

Coping and Support

Social support is key to achieving a stable and solid, smoke-free life. Ask your family, friends and co-workers for support and encouragement. Be direct and let them know what would help you most.

Also consider trying these resources:

  • Support groups. Often available at little or no cost, support groups offer coaching and mutual support from others attempting to quit. Nicotine Anonymous groups are available in many locations.
  • Telephone counseling. Quit lines offer convenient access to trained counselors. In the U.S., call 800-QUIT-NOW (800-784-8669) to connect directly to your state’s quit line.
  • Text messaging and mobile apps. A number of services are available to get reminders and tips delivered to your mobile phone.
  • Web-based programs. Sites such as BecomeAnEX provide free personalized support, interactive guides and tools, and discussion groups to help you quit.

Preparing for Your Appointment

You’re likely to start by seeing your primary care doctor. Here’s some information to help you get ready, and what to expect from your doctor.

What You Can Do

  • Consider your smoking triggers. List the circumstances when you’re most likely to reach for a cigarette. In what situations has smoking become a ritual?
  • Make note of any symptoms that may be related to smoking. Include the length of time you’ve had each one.
  • Make a list of your medications. Include any vitamins, herbs or other supplements.
  • Invite a family member or friend along. Sometimes it can be difficult to soak up all the information provided during an appointment.

What to Expect from Your Doctor

Being ready to answer questions your doctor may ask reserves time to go over any points you want to spend more time on. Some questions your doctor may ask include:

  • How many cigarettes do you smoke each day? How soon after waking do you smoke?
  • Have you previously tried to stop smoking? If so, what happened? What worked? What didn’t work?
  • What is motivating you to stop smoking now?
  • Do you have any physical health problems, such as heart disease or diabetes, which you suspect are related to smoking?
  • Has smoking caused any problems at work or in your relationships?

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