Nicotine dependence

Learn about the chemical in tobacco that makes it hard to stop smoking. Then find out about treatments and resources to help you quit.

Update Date: 14.06.2025

Overview
Symptoms
Causes
Risk factors
Complications
Prevention
Diagnosis
Treatment
Coping and support
Preparing for an appointment
Overview
Symptoms
Causes
Risk factors
Complications
Prevention
Diagnosis
Treatment
Coping and support
Preparing for an appointment

Overview

Nicotine dependence happens when your body craves nicotine and you can't stop using it. Nicotine is the chemical in smoked tobacco that causes the urge to smoke. The chemical brings on pleasant feelings, but these effects are short-lived. So you have another cigarette, cigar or pipe bowl.

The more you use smoked tobacco, the more nicotine you need to feel good. When you try to stop, you go through mental and physical changes that aren't pleasant. These are symptoms of nicotine withdrawal.

For some people, using any amount of smoked tobacco can quickly lead to nicotine dependence. But no matter how long you've used nicotine, stopping can improve your health. It isn't easy, but you can break your dependence on nicotine. There are treatment options. Ask your healthcare professional for help.

Symptoms

Symptoms of nicotine dependence can include the following:

  • You can't stop smoking. You've made one or more serious attempts to stop without long-term success.
  • You smoke within 30 minutes of waking up. The sooner you start smoking after waking and the more cigarettes you smoke during the day, the more dependent on nicotine you are.
  • You have nicotine withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical and mood-related symptoms. Withdrawal symptoms can include strong cravings, anxiety, irritable mood, restlessness, trouble focusing or sleeping, depression, frustration, anger, increased hunger, and constipation.
  • You keep smoking despite health conditions. Even though you've developed health conditions linked to smoking, you haven't been able to stop.
  • You give up social activities. You may stop going to smoke-free restaurants or stop socializing with family or friends because you can't smoke in these situations.

When to see a doctor

Talk with your healthcare professional if you've tried to stop smoking but haven't been able to stop for good. Most people who smoke make many attempts to stop smoking before they're able to quit long-term.

A treatment plan that includes medicine and counseling with a tobacco treatment specialist can boost your chances of success. Ask your healthcare team for a treatment plan that works for you. Or ask where to get help with stopping smoking.

Causes

Nicotine is the chemical in tobacco that keeps you smoking tobacco. Nicotine reaches the brain within seconds of taking a puff. In the brain, nicotine increases the release of brain chemicals called neurotransmitters. These brain chemicals help control mood and behavior.

When you're using nicotine, the reward center in your brain releases a neurotransmitter called dopamine. Dopamine causes feelings of pleasure and improved mood.

The more you smoke, the more nicotine you need to feel good. Nicotine quickly becomes part of your daily routine and affects your habits and feelings.

Common situations that trigger the urge to smoke include:

  • Drinking coffee or taking breaks at work.
  • Talking on the phone.
  • Drinking alcohol.
  • Driving your car.
  • Spending time with friends.

To overcome your nicotine dependence, you need to become aware of your triggers and make a plan for dealing with them.

Risk factors

Anyone who smokes or uses other forms of tobacco is at risk of becoming dependent. Factors that influence who is likely to use tobacco include:

  • Age. Most people begin smoking during childhood or the teen years. The younger you are when you begin smoking, the greater the chance of nicotine dependence.
  • Genetics. The genes passed from parents to children may play a role in the chance of a person becoming dependent on nicotine.
  • Parents and peers. Children who grow up with parents who smoke are more likely to smoke. Children with friends who smoke also are more likely to try it.
  • Depression or anxiety. Some people who have mental health conditions such as depression and anxiety try to get relief by smoking. But smoking cigarettes doesn't help relieve symptoms of these conditions.
  • Substance use. People who use alcohol and illicit drugs are more likely to smoke.

Complications

Tobacco smoke has hundreds of harmful chemicals in it. At least 69 of those chemicals can cause cancer. Even "all-natural" or herbal cigarettes have harmful chemicals.

People who smoke cigarettes are much more likely to develop and die of certain diseases than are people who don't smoke. But smoking can cause many different health issues, including:

  • Lung cancer and lung disease. Smoking is the leading cause of lung cancer deaths in countries such as the United States. Smoking also causes lung diseases such as emphysema and chronic bronchitis. Smoking makes asthma worse too.
  • Other cancers. Smoking raises the risk of many types of cancer. Some examples include cancer of the mouth, throat, also called the pharynx, esophagus, larynx, bladder, pancreas, kidney and cervix and some types of leukemia. Overall, smoking causes 30% of all cancer deaths in the United States.
  • Heart and blood vessel conditions. Smoking raises the risk of dying of heart and blood vessel diseases including heart attack and stroke. If you have a heart or blood vessel disease, smoking makes it worse.
  • Diabetes. Smoking raises the risk of type 2 diabetes. If you have diabetes, smoking can lead to other health concerns such as kidney disease and eye conditions.
  • Eye conditions. Smoking can raise the risk of serious eye issues such as cataracts and loss of eyesight from macular degeneration.
  • Infertility. Smoking can make it harder to start a pregnancy.
  • Complications during pregnancy. Pregnant people who smoke have a higher risk of miscarriages and preterm deliveries. Their babies have a higher risk of having medical conditions present at birth and lower birth weights.
  • Cold, flu and other illnesses. People who smoke are more prone to respiratory infections such as colds, the flu and bronchitis.
  • Tooth and gum disease. Smoking is linked to a higher risk of gum disease and tooth loss.

Smoking also poses health risks to those around you. Partners of people who smoke have a higher risk of lung cancer and heart disease compared with people who don't live with someone who smokes. Children whose parents smoke are more likely to get bronchitis, pneumonia, ear infections and colds. And if a child has asthma, secondhand smoke can make it worse.

Prevention

The best way to prevent nicotine dependence is to not start using tobacco.

The best way to keep children from smoking is to not smoke yourself. Children whose parents do not smoke or who successfully quit smoking are much less likely to take up smoking.

Diagnosis

Your healthcare professional may ask you questions or have you fill out a questionnaire to see how dependent you are on nicotine. Knowing your degree of dependence helps your healthcare professional figure out the right treatment plan for you. The more cigarettes you smoke each day and the sooner you smoke after waking up, the more dependent you are.

Treatment

Like most people who smoke, 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 be able to stop smoking if you use medicines and counseling. Both of these treatments work, especially if you use them together.

Medications

Some quit-smoking treatments are known as nicotine replacement therapy. That's because they have varying amounts of nicotine in them. An example of a long-acting nicotine replacement therapy is a nicotine patch that you place on your skin. Short-acting products include nicotine gums, lozenges and nose sprays.

Some nicotine replacement therapies require a prescription, but others don't. Two quit-smoking medicines called bupropion (Wellbutrin SR) and varenicline don't have nicotine in them. You can get these with a prescription.

Any of these products can help ease nicotine cravings and withdrawal symptoms. The products help make it more likely that you'll stop smoking for good. Using more than one may help you get better results.

Even though you can buy some quit-smoking products without a prescription, talk with your healthcare professional first. Together you can explore which products might be right for you and when to start taking them. You also can learn about the possible side effects.

Counseling

Medicines help you cope by easing withdrawal symptoms and cravings. Counseling helps you practice the skills you need to give up tobacco for good. The more time you spend with a counselor, the better your treatment results might be.

During individual or group counseling, you learn techniques that you can use to help you stop smoking. Many hospitals, healthcare plans, healthcare professionals and employers offer treatment programs. Some medical centers provide intensive outpatient treatment programs.

Methods to stay away from

If medicines and counseling don't help a person stop smoking after many tries, some healthcare professionals recommend use of electronic cigarettes. These devices heat a liquid that usually has nicotine in it and the user breathes in vapor.

But e-cigarettes are a controversial option because their long-term effects on health aren't clear. And many people who use e-cigarettes to stop smoking find themselves using both products rather than quitting. So do not use e-cigarettes unless your healthcare professional recommends them because approved treatments didn't help enough.

It's also not a good idea to substitute another type of tobacco use for smoking. Tobacco in any form is not safe. And forms of nicotine that haven't been approved by the U.S. Food and Drug Administration may not be safe.

Don't use these products as substitutes for smoked tobacco:

  • Dissolvable tobacco products.
  • Smokeless tobacco.
  • Nicotine lollipops and balms.
  • Cigars and pipes.
  • Hookahs.
  • Nicotine pouches.

Coping and support

Social support is key to leading a stable and solid smoke-free life. Ask your family, friends and co-workers to support and encourage you. Be direct and let them know what would help you most.

Also think about trying these resources:

  • Support groups. Support groups offer coaching and support from others trying to quit. You can often attend at little or no cost. For example, in the United States, Nicotine Anonymous groups can be found in many locations.
  • Telephone counseling. Quit lines offer convenient access to trained counselors. In the U.S., call 800-QUIT-NOW (800-784-8669) to connect directly to your state's quit line.
  • Text messaging and mobile apps. Services can send reminders and tips to your mobile phone.
  • Web-based programs. Sites such as BecomeAnEX provide free personalized support, interactive guides and tools, and discussion groups to help you quit.

Preparing for an appointment

You're likely to start by seeing your primary healthcare professional. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

To get ready for your appointment:

  • Write down your smoking triggers. List the conditions that make you most likely to smoke a cigarette. In what situations has smoking become a ritual?
  • Make note of any symptoms that may be related to smoking. Include the length of time you've had each one.
  • Make a list of your medications. Include any vitamins, herbs or other supplements.
  • Invite a family member or friend along. Sometimes it can be hard to remember all the information that your healthcare team tells you.

What to expect from your doctor

Be ready to answer questions that your healthcare professional may ask. This saves time to go over any points you want to spend more time on. Some questions that your healthcare professional may ask include:

  • How many cigarettes do you smoke each day? How soon after waking do you smoke?
  • Have you tried to stop smoking in the past? If so, what happened? What worked? What didn't work?
  • What is making you want to stop smoking now?
  • Do you have any health conditions that you suspect are related to smoking, such as heart disease or diabetes?
  • Has smoking caused any problems at work or in your relationships?

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