Nicotine Addiction

What Is Nicotine?

Nicotine is a highly addictive, naturally occurring stimulant found in tobacco. Nicotine is also what makes tobacco products so addictive.

Products containing nicotine include:

• Cigarettes
• Cigars
• Chewing tobacco
• E-cigarettes (including most vape juice)
• Smoke-free products (i.e., snuff, snus, and dip)
• Tobacco hookah

How Does Nicotine Work?

Nicotine affects the brain’s reward center, causing specific neurotransmitters to release more dopamine.

Dopamine is a “feel good” chemical that the body produces on its own, but nicotine use causes your brain to release additional dopamine into your system. Using nicotine can make users feel calm and relaxed; nicotine can create feelings of stimulation while also decreasing anxiety.

People who use nicotine in any of its forms can quickly fall into a habit to keep getting those nice dopamine hits. In time, the body also becomes used to having regular doses of nicotine, causing “dependence.”

Additionally, once someone becomes dependent on nicotine use, they will likely experience symptoms of nicotine withdrawal (i.e., headaches, irritability, etc.) when trying to cut back or quit, leading to continued use and, very likely, addiction.

While addiction and dependence are technically two separate things, most people tend to use the word “addiction” when talking about chronic nicotine use and how it affects a person.

Nicotine addiction is also sometimes called tobacco addiction or tobacco dependence since nicotine is the active ingredient in tobacco.

How Common Is Nicotine Addiction?

Despite increased awareness and prevention efforts, the prevalence of nicotine use is a significant public health issue throughout the world. It’s estimated that millions of people are impacted by nicotine dependence and addiction.

By understanding the scope of nicotine use, we can continue to develop effective strategies to combat this addiction.

• More than 1.3 billion people worldwide use tobacco products—with more than 80% of tobacco users living in low- and middle-income countries—according to the World Health Organization (WHO).
• The Centers for Disease Control and Prevention (CDC) reports that in 2019, approximately 14% of American adults (34.1 million people) were current smokers.
• The National Institute on Drug Abuse (NIDA) reports that about 70% of adult smokers in the U.S. want to quit smoking, yet only about 7.5% succeed in quitting each year.
• Among adolescents, the CDC notes that about 4.5% of middle school students and 13.7% of high school students reported using electronic cigarettes (i.e., vape products) in 2020.
• Research indicates that first-time smoking is trending toward being more common among young adults than adolescents, according to the National Cancer Institute.

Signs of Nicotine Addiction

Nicotine addiction shows up in many different physical, mental, and even behavioral ways, but recognizing these signs can help you take steps toward quitting before long-term health issues arise.

Physical Symptoms

Someone who has become dependent upon nicotine will notice some physical signs that their body now has developed a physical reliance.

Physical signs of nicotine addiction can include:

• Experiencing cravings for nicotine products (i.e., smoking, using dip, etc.)
• Feelings of anxiety or irritability
• Insomnia or restlessness
• Needing to use higher amounts to get the same effect
• Experiencing withdrawal symptoms appear when trying to cut back or quit
• Wanting to quit but not being able to

Behavioral Symptoms

Beyond the physical tells of addiction, if someone becomes addicted to using tobacco or other nicotine products, they may begin to behave differently as well.

Some typical behavioral symptoms of nicotine addiction include:

• Continuing to use nicotine products despite health issues
• Changing habits, like taking more frequent smoke breaks
• Disregarding hobbies as a result of nicotine use (e.g., struggling at the gym due to smoking)
• Hiding or lying about nicotine product use

Causes and Risk Factors for Nicotine Addiction

Multiple factors can influence a person’s likelihood or risk of becoming addicted to nicotine, from genetics to social influences. People with a family history of substance use disorders or various mental health issues can also be more at risk of developing nicotine dependence.

However, there’s no singular “cause” of developing an addiction to nicotine, and some people can be more susceptible than others.

By understanding the risk factors that can influence nicotine dependence and addiction, we can make better efforts to prevent it from happening and provide better support to those who are addicted.

Environmental Factors

A person’s environment can impact their desire to try smoking or using other nicotine products.

Typical environmental factors that might influence nicotine use, leading to addiction, can include:

• Peer pressure
• Having family members who smoke/use tobacco
• Availability of tobacco products
• Smoking or tobacco use as a cultural norm
• Living in a stressful environment
• Working a stressful job
• Going to social events where smoking is common
• Being exposed to tobacco ads (portraying it positively)

Psychological Factors

A person’s mental and emotional state can significantly impact their likelihood of trying and continuing to use nicotine products.

Some psychological factors that might influence nicotine use can include:

• Stress and anxiety
• Low self-esteem
• Depression or other mental health issues
• Coping with emotional pain or trauma
• Impulsivity or thrill-seeking
• Behavioral disorders (i.e., ADHD)
• Difficulty managing emotions

Genetic Predisposition

In addition to environmental and psychological influences, a person’s genetics can also play a role in their likelihood of developing an addiction to nicotine.

For instance, genetic traits can influence how your body responds to nicotine, from how fast it metabolizes it to how rewarding it feels.

Research also indicates that having a family history of addiction can predispose someone to be more likely to develop addiction themselves, though science still hasn’t determined the exact correlation.

Health Effects of Nicotine Addiction

One of the most concerning health effects of nicotine is its impact on heart health, as it can lead to high blood pressure and an increased risk of heart disease. Long-term use of nicotine is also linked to severe side effects such as lung cancer and other respiratory problems.

Additionally, secondhand tobacco smoke can create health risks for non-smokers who are exposed to another person’s nicotine use.

Short-term effects of nicotine addiction can include:

• Increased heart rate
• Nausea
• Dizziness
• Insomnia or difficulty sleeping
• Irritability, mood swings
• Headaches
• Shortness of breath

The long-term effects of nicotine addiction are much more severe and can even lead to life-threatening health problems.

Common long-term side effects can include:

• Heart disease
• Lung cancer
• Chronic cough
• Lower lung capacity
• Infertility/impotence
• Stained teeth
• Gum disease
• Chronic obstructive pulmonary disease (COPD)
• Stroke
• Respiratory infections
• Pregnancy complications
• Tooth loss
• Increased risk for diabetes

Additional Impact on Mental Health

Over time, some nicotine side effects can pile up and exacerbate existing mental health difficulties, or they can erode a person’s overall sense of well-being.

Here are some of the potential effects nicotine can have on your mental health:

• Trouble concentrating
• Impact on memory and learning
• Depression
• Increased anxiety
• Trouble falling asleep
• Poor sleep quality
• Mood swings (often connected to the dependence/withdrawal cycle)

Nicotine Withdrawal

Once your body becomes used to nicotine, stopping it can cause withdrawal symptoms to appear. Withdrawal symptoms can vary from person to person and can vary based on several factors, including your level of nicotine use and how long you used it.

Nicotine withdrawal isn’t dangerous, but it can be uncomfortable, which is why there are so many options available to help with quitting (i.e., smoking cessation tools).

Nicotine withdrawal symptoms can begin as early as a few hours after your last use and usually reach peak intensity 2 to 3 days after quitting.

Typical nicotine withdrawal symptoms include:

• Irritability
• Headaches
• Anxiety or restlessness
• Insomnia
• Intense cravings
• Weight gain, increased hunger
• Tightness in the chest
• Depression
• Fatigue or feelings of apathy

Treatment for Nicotine Addiction

Nicotine addiction is especially prevalent, and the health risks outweigh any short-term positives. According to the CDC, cigarette smoking alone is still “the leading cause of disease, disability, and death in the United States.”

If you’re ready to quit smoking, vaping, or using a smoke-free form of nicotine, you actually have several different treatment and support options to choose from.

If you aren’t sure where to begin or which would be right for you, you can also talk to your primary healthcare provider for an assessment and recommendation.

Nicotine Replacement Therapies (NRTs)

Nicotine replacement therapy is a type of treatment where a person uses regulated products with decreasing doses of nicotine to slowly taper off their nicotine use. Using NRT can significantly decrease cravings and other withdrawal symptoms.

Some commonly used forms of NRT include:

• Nicotine patches
• Nicotine inhaler
• Nicotine lozenges
• Nicotine gum
• Nicotine nasal spray

Smoking Cessation Medication

The FDA has approved certain pill medications to assist with quitting smoking (or other nicotine usage). These medications work by reducing cravings and blocking the pleasant effects of nicotine in your brain.

Often, these medications are used along with some form of therapy or support group to give the user a better chance of quitting for good.

These pill medications include:

• Varenicline (Chantix®*, Champix®), specifically designed for smoking cessation
• Buprproion (Welbutrin®), an antidepressant that helps quit nicotine use by reducing cravings

*Note: As of 2021, Pfizer discontinued Chantix®, and the name-brand product is no longer available. However, other generic brands of varenicline are still available via prescription.

Behavioral Therapies

Behavioral therapy can also be especially helpful when quitting nicotine use.

In particular, cognitive-behavioral therapy (CBT) can help you identify things you associate with your nicotine addiction (i.e., feelings, behaviors, habits, reactions, etc.) With your therapist, you can work to rewire your brain and develop positive associations with activities outside of smoking/nicotine use.

Similarly, motivational interviewing (MI) is another type of therapy that can be helpful in quitting a nicotine addiction. MI focuses more on your reasons for quitting and helps you build a strong commitment to a tobacco-free lifestyle.

Support Groups and Alternative Counseling

There are SO many types of support groups out there for people who want to quit nicotine. 

Among them are programs like:  

• Nicotine Anonymous, a 12-step support group similar to the structure of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)
• The National Cancer Institute Quitline at 877-448-7848. They offer free counseling and information regarding quitting nicotine.
• Internet forums like Reddit threads focused on quitting vaping or smoking cessation.
• Smartphone apps, such as the quitSTART app.

Whatever you choose, having a group of supportive, like-minded people can hold you accountable and celebrate your successes in your life outside of nicotine addiction.

Start Your Nicotine-Free Journey Today

If you’re struggling with nicotine addiction, finding help is a critical step toward a healthier, tobacco-free life.

Here are a few resources that can help:

• Smokefree.gov: Offers several different resources like quit plans, text message support, and a quitline to help you stop smoking. You can also call them at 1-800-QUIT-NOW (1-800-784-8669).
• American Lung Association: Offers programs like “Freedom From Smoking” and a quitline to help you quit smoking. Their phone number is 1-800-LUNGUSA (1-800-586-4872).
• National Cancer Institute: Not only do they have a comprehensive guide to quitting smoking, (i.e., tips, strategies, and support), they also have a list of tools and support options for quitting.

Whether you need help managing cravings, advice about nicotine replacement therapy, counseling, or just a group of people who understand what you’re going through, there are so many types of support available.