Nicotine dependence

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 28, 2016
StartDiseasesNicotine dependence

Over 480,000 people in the United States die each year from smoking cigarettes. Nicotine is the main ingredient in tobacco, offering a pleasurable feeling or “rush” when inhaled or absorbed. It can also be found in chewing tobacco which is placed inside the cheek or lip. Nicotine is extremely addictive and can cause nicotine dependence among its users. Nicotine withdrawal can cause a range of unpleasant symptoms.


Definition & Facts

Nicotine dependence refers to the increased reliance on the nicotine drug found in tobacco cigarettes or smokeless tobacco. Being dependent means a person may realize they need to stop using the harmful drug but are unable to do so easily. Nicotine is inhaled thorough cigarette smoke or can be chewed or sucked out of the tobacco. When nicotine enters the body, the brain releases the pleasure-causing chemical called dopamine.

As with most drugs, nicotine triggers neurotransmitters in the brain to create mood-altering and physical effects such as increased heart rate and weight loss that many people find desirable. A person will continue to use nicotine to generate a high or rush and can very quickly become addicted.

Symptoms & Complaints

Symptoms of nicotine dependence include tolerance, which is the need to consume increasing amounts of nicotine to attain the same desired effect that was achieved initially. Other symptoms include:

  • Decrease in appetite or significant weight loss over time
  • Cravings for nicotine become intense and much more time is spent on seeking out the “rush”

If a person is nicotine dependent they will experience withdrawal symptoms when attempting to discontinue using that may include:


While dependence on nicotine is caused by a chemical addiction to the effects of the drug, there are several environmental causes that play a role as well. Whether alone or in a group, people tend to smoke or use smokeless products more when engaging in certain activities. These may include:

  • Driving long distances in the car or while speaking on the phone
  • Feeling anxious or stressed in situations out of their control
  • Smoking with a cup of coffee or during work breaks when several co-workers gather together
  • After eating a meal
  • Hanging out at specific places or with certain friends where smoking is prevalent

Diagnosis & Tests

Recently, the Diagnostic and Statistical Manual of Mental Disorders has changed how they refer to nicotine addiction. The newest manual uses the term tobacco use disorder. If a person feels they are addicted to nicotine and has become dependent to the point that they cannot stop using, they should consult with their doctor for help. Their doctor will want to know their medical history, detailing how long and how much nicotine is used.

A questionnaire may be filled out describing symptoms that the patient has experienced. A physical examination will be performed, recording the common effects of nicotine dependence. For there to be a diagnosis of nicotine dependence, at least two of the following criteria need to have occurred within the past 12 months:

  • Physical or recreational activities that limit or stop the ability to use are given up and replaced with functions where smoking or smokeless tobacco is permitted or readily accepted
  • Efforts to discontinue or cut back are continuously attempted and failed at
  • Cravings for nicotine become intense and much more time is spent on seeking out the “rush”
  • Gradual increased use of nicotine in situations that could be physically harmful or deadly, such as smoking in bed or falling asleep while smoking
  • A tolerance is built up requiring more nicotine to get the pleasing effects and experiencing withdrawal symptoms when tobacco products are not available
  • Continuing smoking even when health issues, such as heart problems or lung problems arise

Treatment & Therapy

While it may take many attempts to quit the use of nicotine, it can be done. Almost instantly upon quitting, the user will enhance their health and wellbeing. They will significantly decrease their chances for a heart attack, lung disease, and cancer. One form of treatment is called nicotine replacement therapy. Small doses of nicotine are administered to decrease cravings and ease the effects of withdrawal. Non-prescription nicotine replacement therapy can be found in the form of:

  • A skin patch –that is replaced daily can take up to eight weeks or longer to fully work
  • Throat lozenges - come in 2-4 mg doses, releasing nicotine through the lining of the mouth
  • Chewing gum – dispenses small doses of nicotine into the bloodstream and can take about three months to be fully effective
  • Inhalers or nasal sprays – are the only treatments that require a doctor’s prescription. These can both cause irritation to the nose and mouth and should be monitored by a doctor

Another alternative includes medications that do not contain nicotine but will increase the brain’s neurotransmitters to bolster happy feelings and will reduce the need for nicotine as well as reduce the symptoms of withdrawal. Such drugs include bupropion and varenicline tartrate, and they can have serious side effects, such as dry mouth, sleep problems, and psychiatric symptoms. It is important for those who use these prescription drugs to work closely with a doctor.

Prevention & Prophylaxis

People often discover that trying to quit a nicotine addiction is a long, hard road. The best way to prevent nicotine dependence is to never start smoking cigarettes or try smokeless tobacco products in the first place.

It is important to insist on an environment that is tobacco free. Research suggests that teens begin using nicotine to emulate the adults around them. If the adult lives in a nicotine-free environment, chances are that the adolescent will not have the desire to begin either.