What is nicotine dependence?

People who become addicted to nicotine, the main addictive chemical in tobacco, suffer from tobacco addiction.

Tobacco use is the leading cause of preventable death, causing more than 6 million deaths per year.

Common related conditions
Alcoholism (Alcohol Use Disorder) Anxiety Disorders Insomnia

Causes of nicotine dependence

Nicotine is a highly addictive substance.

As a person smokes, nicotine travels directly to the bloodstream from the lungs and on to the brain. In the brain, chemicals are released that entice people to smoke more.

Quitting smoking is very challenging, and the younger you start smoking, the harder it will be to quit.

Risk factors for nicotine dependence

Anyone who currently smokes or uses tobacco products is at higher risk of developing a tobacco addiction.

Other factors that could determine who will start smoking include:

  • Age — if you start smoking at a young age, you are very likely to smoke heavily as an adult.
  • Mental illness or depression — people who suffer from a mental illness, such as depression, are more likely to start smoking and develop a tobacco addiction.
  • Genetics — tobacco addiction could be partially genetic. Genetic factors potentially influence how the cells respond to nicotine.
  • Substance abuse — people who use illicit drugs or drink alcohol excessively are more likely to suffer from tobacco addiction.

Symptoms of nicotine dependence

If you are a smoker and cannot quit, you are likely addicted to tobacco.

Other symptoms of nicotine addiction include:

  • Experiencing withdrawal symptoms when trying to quit
  • Withdrawal from other activities to smoke
  • Needing tobacco to feel “normal”
  • Continuing to smoke despite other health problems

Diagnosis of nicotine dependence

Your primary care doctor will ask a series of questions to determine how dependent on nicotine you are.

If you smoke soon after you wake up and smoke multiple packs a day, you are more dependent.

Your doctor will determine the most appropriate course of treatment based on your dependency level.

Treatments for nicotine dependence

There are a variety of treatments available to help people stop smoking including:

Nicotine replacement treatments (NRTs)

Nicotine gum and the nicotine patch are NRTs that help patients relieve symptoms of withdrawal. When used in conjunction with behavioral treatments, there is a higher rate of success.

Types of NRTs include:

  • Nicotine patch — worn on the skin, somewhere between neck and waist, and delivers nicotine directly to bloodstream, each day for eight weeks or more.
  • Nicotine gum — delivers nicotine to the blood through the mouth lining; patients are encouraged to chew the gum when they feel a craving to smoke coming on.
  • Nicotine lozenge — delivers nicotine directly to the blood through the lining of the mouth; patients are instructed to place the lozenge between the cheek and gum line to allow it to dissolve.

Nicotine replacement therapy available by prescription include:

  • Nicotine nasal spray — sprayed into the nostrils and absorbed through the nasal membranes; delivers nicotine quicker than the patch, gum or lozenge.
  • Nicotine inhaler — delivers nicotine into your mouth, where it can enter the bloodstream through the lining of the mouth.


Medications for smoking cessation such as Zyban, Pamelor and Chantix help patients quit smoking by easing withdrawal symptoms. These drugs also can block the effects of nicotine if people start smoking again.

Behavioral treatments

Smoking intervention programs can help patients quit smoking with a variety of resources, including self-help materials and cognitive-behavioral therapy. The greatest successes come when the therapy is tailored to the patient’s situation.

In many patients, blood pressure and heart attack risk decreases as soon as they quit smoking.

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