Nicotine dependence



What is nicotine dependence?

Nicotine dependence is an addiction to tobacco products caused by one of its ingredients – the drug nicotine. Nicotine is an addictive drug which causes mood-altering changes in the brain which are temporarily pleasing, making people want to use it more and more.

When a person is addicted to nicotine they have unpleasant withdrawal symptoms, which temporarily go away when they receive the nicotine through smoking tobacco. Experts say that nicotine is one of the hardest of all addictions to break.

Put simply – nicotine dependence means the individual cannot stop using the substance.

How common is nicotine dependence?

Nicotine dependence is common. Please discuss with your doctor for further information.


What are the symptoms of nicotine dependence?

The common symptoms of nicotine dependence are:

  • 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.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes nicotine dependence?

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

What increases my risk for nicotine dependence?

There are many risk factors for nicotine dependence, such as:

  • 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.
  • 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.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is nicotine dependence diagnosed?

There is no current diagnostic test, such as a blood test or imaging scan which can determine whether somebody is addicted to nicotine, and to what degree.

A GP (general practitioner, primary care physician) can help the patient determine their degree of dependence by asking pertinent questions, or using a specific questionnaire. The following questions may help determine how dependent a patient is:

  • How soon after you wake up do you light up?
  • How many cigarettes do you smoke per day?
  • Do you find it hard not to smoke in places where it is not allowed, such as in a church, school, movie theatre, library, public transport, hospital, etc.?
  • If you had to give up, which cigarette would you miss the most (e.g. the first one in the morning)?
  • Do you smoke more cigarettes during the first few hours after waking up, than during the rest of the day?
  • If you are ill, with a bad cold or the flu, do you still smoke?
  • Have you ever smoked more than you intended to?
  • Have you ever neglected a duty because you were smoking, or so that you could have a cigarette?
  • Have you ever concluded that you needed to control how many cigarettes you smoked each day, but found it very difficult to do?
  • Have you ever tried to quit? If so, how many times and for how long?
  • Did you experience withdrawal symptoms when you spent an extended period without smoking? Did those symptoms go away when you lit up?
  • How long have you been aware of the health dangers of smoking?
  • How long do you think you will live if you continue smoking?
  • If you gave up now for good, how long do you think you will probably live?

How is nicotine dependence treated?

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 stop if you use medications and counseling, which have both been proved effective, especially in combination.


Many treatments, including nicotine replacement therapy and non-nicotine medications, have been approved as safe and effective in treating nicotine dependence. Using more than one medication may help you get better results.

For example, combining a longer acting medication with a short-acting nicotine replacement product may be beneficial. Talk to your health care provider about the right treatment for you.

If you’re pregnant or breast-feeding, you smoke fewer than 10 cigarettes a day, or you’re under age 18, talk to your doctor before taking any over-the-counter nicotine replacement products.

Nicotine replacement therapy

Nicotine replacement therapy gives you nicotine without tobacco and the harmful chemicals in tobacco smoke. Nicotine replacement products help relieve withdrawal symptoms and cravings.

The best time to start using nicotine replacement medication is on the date you’ve set to stop smoking. Some smokers start earlier in order to reduce smoking on their way to stopping altogether.

The following nicotine replacement products are available over-the-counter:

  • Nicotine patch (NicoDerm CQ, Habitrol, others). The patch delivers nicotine through your skin and into your bloodstream. You wear a new patch each day. You typically use the patch for eight weeks or longer. If you haven’t been able to stop smoking completely after two weeks of wearing the patch, ask your doctor about adjusting the dose or adding another nicotine replacement product. Common side effects include skin irritation, insomnia and vivid dreams.
  • Nicotine gum (Nicorette, others). This gum delivers nicotine to your blood through the lining of your mouth. Nicotine gum is often recommended to curb cravings. Chew the gum for a few times until you feel a mild tingling or peppery taste, then park the gum between your cheek and gumline for several minutes. This chewing and parking allows nicotine to be gradually absorbed in your bloodstream. Mouth irritation is a common side effect. Other side effects are often a result of overly vigorous chewing that releases nicotine too quickly. These include heartburn, nausea and hiccups.
  • Nicotine lozenge (Commit, Nicorette mini lozenge, others). This lozenge dissolves in your mouth and, like nicotine gum, delivers nicotine through the lining of your mouth. Place the lozenge in your mouth between your gumline and cheek or under your tongue and allow it to dissolve. You’ll start with one lozenge every one to two hours and gradually increase the time between lozenges. Avoid drinking anything right before, while using or right after the lozenge. Side effects include mouth irritation as well as nicotine-related effects such as heartburn, nausea and hiccups.

These nicotine replacement products are available by prescription:

  • Nicotine nasal spray (Nicotrol NS). The nicotine in this product, sprayed directly into each nostril, is absorbed through your nasal membranes into your blood vessels. The nasal spray delivers nicotine a bit quicker than gum, lozenges or the patch, but not as rapidly as smoking a cigarette. It’s usually prescribed for three-month periods for up to six months. Nasal and throat irritation, runny nose, sneezing and coughing are common side effects.
  • Nicotine inhaler (Nicotrol). This device is shaped something like a cigarette holder. You puff on it, and it delivers nicotine vapor into your mouth. You absorb the nicotine through the lining in your mouth, where it then enters your bloodstream. Common side effects are mouth and throat irritation and occasional coughing.

Non-nicotine medications

Medications that don’t contain nicotine and are available by prescription include:

  • Bupropion (Zyban). The antidepressant drug bupropion increases levels of dopamine and norepinephrine, brain chemicals that are also boosted by nicotine. Typically your doctor will advise you to start bupropion one week before you stop smoking. Bupropion has the advantage of helping to minimize weight gain after you quit smoking. Common side effects include insomnia, agitation, headache and dry mouth. If you have a history of seizures or serious head trauma, such as a skull fracture, you shouldn’t take this drug.
  • Varenicline (Chantix). This medication acts on the brain’s nicotine receptors, decreasing withdrawal symptoms and reducing the feelings of pleasure you get from smoking. Typically your doctor will advise you to start varenicline one week before you stop smoking. Common side effects include nausea, headache, insomnia and vivid dreams. Rarely, varenicline has been associated with serious psychiatric symptoms, such as depressed mood and suicidal thoughts.
  • Nortriptyline (Pamelor). This medication may be prescribed if other medications haven’t helped. This tricyclic antidepressant acts by increasing the levels of the brain neurotransmitter norepinephrine. Common side effects may include dry mouth, drowsiness, dizziness and constipation.

Counseling, support groups and other programs

Combining medications with behavioral counseling provides the best chance for establishing long-term smoking abstinence.

Medications help you cope by reducing withdrawal symptoms including tobacco craving, while behavioral treatments help you develop the skills you need to avoid tobacco over the long run. The more time you spend with a counselor, the better your treatment results will be.

Methods to avoid

It’s not a good idea to substitute another type of tobacco use for cigarette smoking. Tobacco in any form is not safe. Even products that deliver nicotine without tobacco are risky.

Stick with proven stop-smoking aids and steer clear of the following products:

  • Dissolvable tobacco products. Tobacco pouches, lozenges, strips or other products contain small amounts of tobacco and nicotine you hold or dissolve in your mouth. There is no evidence they will help you stop smoking and little is known about their health effects.
  • E-cigarettes. Electronic cigarettes, or e-cigarettes, are battery-powered devices that heat liquid containing nicotine into a vapor to be inhaled. Because these products are new, there isn’t much data about possible safety risks. Studies of e-cigarettes for smoking cessation have shown mixed results. For these reasons, e-cigarettes aren’t recommended for people trying to quit smoking.
  • Flavored cigarettes. Clove cigarettes (kreteks) and flavored cigarettes (bidis) carry the same health risks as smoking regular cigarettes and can cause additional health problems. Although they’re banned in the United States, flavored cigarettes are available in other countries.
  • Hookahs (narghiles). These are water pipes that burn tobacco, and the smoke is inhaled through a hose. They are not safer than cigarettes. The water does not filter out toxins in the smoke, and the water and pipe have a risk of transmitting infections.
  • Nicotine lollipops and balms. Products containing nicotine salicylate are not approved by the Food and Drug Administration, and they pose a risk for accidental use by children.
  • Pipes and cigars. These products have similar, though less frequent, health risks as cigarettes, and they are not a safe alternative.
  • Smokeless tobacco and snuff (snus). These products contain nicotine in amounts similar to cigarettes and increase your risk of mouth and throat cancer, tooth and gum diseases, and other health problems.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage nicotine dependence?

The following lifestyles and home remedies might help you cope with nicotine dependence:

  • Exercise regularly. Regular physical activity has been found to reduce withdrawal symptoms and help people stop smoking. Exercise also helps avoid potential weight gain often associated with stopping.
  • Wait out cravings. Cravings or urges usually last less than five minutes. Wash the dishes, go for a walk or have a healthy snack, such as carrots, an apple or sunflower seeds, which will keep your mouth busy. Do something that keeps your hands busy, and before you know it, the urge will have passed. This is why you want to get rid of tobacco supplies when you decide to quit. You don’t want to have any on hand when a craving hits.
  • Identify rationalizations. If you find yourself thinking, “I’ll just smoke one to get through this tough time” or “Just one won’t hurt,” recognize it as a message that can derail your plan. Review your reasons for quitting, and replace that thought with something positive to support your stopping.
  • Talk to a support person. If you’re feeling anxious or depressed or need encouragement, a support person can help you get through a difficult craving.
  • Avoid high-risk situations. Know your triggers, and stay away from people, places and situations that tempt you to smoke.
  • Eat regular, healthy meals. Include plenty of fruits and vegetables, and drink more water.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: October 2, 2017 | Last Modified: October 2, 2017