Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Nicotine Addiction

(Tobacco Use Disorder; Smoking Addiction)
by Krisha McCoy, MS
Definition

Nicotine addiction is when a person becomes dependent on tobacco. Tobacco contains nicotine. Tobacco may be found in:

  • Cigarettes
  • Cigars
  • Pipes
  • Smokeless tobacco products (eg, snuff, chewing tobacco)

This condition can harm a person's health, but it can be treated. Talk to your doctor if you think you have nicotine addiction.

Causes

Nicotine can create feelings of pleasure. But the effects go away within a few minutes. Tobacco users need to keep using tobacco to keep feeling good. This can lead to addiction.

Risk Factors

The following increase your chance of developing nicotine addiction. If you have any of these risk factors, tell your doctor:

Symptoms

If you have any of these symptoms, do not assume it is due to nicotine addiction. They may be caused by other health problems. See your doctor if you have any of these symptoms:

  • Nicotine withdrawal
    • Trouble sleeping
    • Feeling irritable
    • Having cravings
    • Headache
    • Increased appetite
    • Nervousness
    • Thinking and attention problems
  • Nicotine “highs”
    • Increase in blood pressure, blood sugar level, breathing rate, or heart rate
  • Tobacco-related health problems
    • Hot flashes in women
    • Smoker’s cough

If you are addicted to nicotine, you may be at risk for these health problems:

Diagnosis

Your doctor will:

  • Ask about your symptoms and medical history
  • Do a physical exam
  • Test how well your lungs work

He will ask you questions like:

  • How long you have you been using tobacco?
  • How often do you use it?
Treatment

Talk with your doctor about the best treatment for you. Treatment options include:

Nicotine Replacement Therapy (NRT)

NRT relieves withdrawal symptoms. NRT products:

  • Inhalers
  • Lozenges
  • Nasal sprays
  • Nicotine gum
  • Patches

The chance of abusing these products is low since NRT does not create "feel good" feelings.

NRT may help you to:

  • Avoid smoking
  • Quit and stay smoke-free
  • Reduce the amount of tobacco you use
Behavioral Therapy

Behavioral therapies include:

  • Internet and computer-based programs
  • Cognitive behavioral therapy—This teaches people to recognize high-risk tobacco situations, develop coping strategies, manage stress, improve problem-solving skills, and increase social support.
  • Counseling
  • Group behavior therapy
  • Self-help classes and manuals
  • Telephone quit lines, cell phone programs, and text messaging programs
Medicines

Certain medicines, like some antidepressants, may help you quit. Some medicines may help ease withdrawal symptoms and block nicotine effects if you start smoking again. One side effect though is that medicines may increase the risk of serious behavior changes.

Secondhand Smoke Exposure

Even if you do not smoke, regularly being around tobacco smoke is dangerous.

  • Children exposed to secondhand smoke are at risk for:
    • SIDS
    • Ear problems
    • Lung infections
    • Severe asthma
  • Being exposed to secondhand smoke while pregnant can increase the risk of stillbirth and birth defects.
  • Parents who smoke can cause breathing problems and slow lung growth in their children.
  • Secondhand smoke affects the heart and causes coronary heart disease and lung cancer in adults.
  • Secondhand smoke causes disease and premature death in children and adults who do not smoke.

Separating smokers from nonsmokers and cleaning the air cannot prevent nonsmokers from inhaling secondhand smoke. But preventing smoking in indoor spaces can protect nonsmokers.

Prevention

The best prevention is to never use tobacco products. They are very addictive. Also, stay away from places where people are smoking.

Last reviewed: March 2011 by Theodor B. Rais, MD.

RESOURCES:
CANADIAN RESOURCES:
References:
  • Diagnostic codes (ICD9-CM). Surgeon General website. Available at: http://www.surgeongeneral.gov/tobacco/codes.htm. Accessed September 25, 2006.
  • Kenfield SA, Stampfer MJ, Rosner BA, Colditz GA. Smoking and smoking cessation in relation to mortality in women. JAMA. 2008;299:2037-2047. In: nicotine addiction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed May 22, 2008.
  • Questions about smoking, tobacco, and health. American Cancer Society website. Available at: http://www.cancer.org/. Accessed September 25, 2006.
  • Research report series: tobacco addiction. National Institute on Drug Abuse website. Available at: http://www.nida.nih.gov/ResearchReports/Nicotine/Nicotine.html. Accessed September 25, 2006.
  • 2/27/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Etter JF, Stapleton JA. Nicotine replacement therapy for long-term smoking cessation: a meta-analysis. Tob Control. 2006;280-285.
  • 9/24/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : LF Stead, T Lancaster. Interventions to reduce harm from continued tobacco use [review]. Cochrane Database of Systematic Reviews. 2007;3.
  • 3/25/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Parkes G, Greenhalgh T, Griffin M, Dent R. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ. 2008;336:598-600.
  • 10/14/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Shiffman S, Ferguson SG. Nicotine patch therapy prior to quitting smoking: a meta-analysis. Addiction. 2008;103:557-563.
  • 12/16/2008 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Eisenberg MJ, Filion KB, Yavin D, et al. Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. CMAJ. 2008;179:135-144.
  • 2/5/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Cochran CJ, Gallicchio L, Miller SR, Zacur H, Flaws JA. Cigarette smoking, androgen levels, and hot flushes in midlife women. Obstet Gynecol. 2008;112:1037-1044.
  • 2/17/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev. 2009;(1):CD001007.
  • 7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Myung SK, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials. Arch Intern Med. 2009;169:929-937.
  • 7/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Lancaster T, Stead L. Self-help interventions for smoking cessation. Cochrane Database Syst Rev. 2009;(2):CD001118.
  • 11/13/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Piper ME, Smith SS, Schlam TR, et al. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Arch Gen Psychiatry. 2009;66(11):1253-1262.
  • 12/21/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Whittaker R, Borland R, Bullen C, et al. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2009;(4):CD006611.
  • 11/30/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Rusanen M, Kivipelto M, Quesenberry CP Jr, Zhou J, Whitmer RA. Heavy smoking in midlife and long-term risk of alzheimer disease and vascular dementia. Arch Intern Med. 2010 Oct 25. [Epub ahead of print]
  • 4/29/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
  • 6/24/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Leonardi-Bee J, Britton J, Venn A. Secondhand smoke and adverse fetal outcomes in nonsmoking pregnant women: a meta-analysis. Pediatrics. 2011;127(4):734-741.