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by McCoy K

Nicotine Addiction

(Tobacco Use Disorder; Smoking Addiction)

Definition

Dependence is a physical change in how your body reacts to a substance. In this case, nicotine. Your body will also have a reaction when you stop using it. Nicotine can be found in tobacco products such as:
  • Cigarettes
  • Snuff
  • Chewing tobacco
  • Cigars
  • Pipes
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Causes

Nicotine acts on the brain's chemistry. It creates feelings of pleasure. However, the effects go away within a few minutes. Users will need to continue using nicotine to keep the good feelings going. This cycle can lead to addiction.

Risk Factors

Use of nicotine products is the main risk factor.
The risk of addiction increases with:
  • Family history or exposure to smoking
  • Depression
  • Victims of bullying

Symptoms

Symptoms only develop when nicotine is not being used. This is known as withdrawal. Symptoms of withdrawal include:
  • Irritability
  • Craving
  • Nervousness
  • Headache
  • Thinking and attention problems
  • Trouble sleeping
  • Increased appetite
Tobacco use is also associated with several serious health conditions such as:

Diagnosis

Your doctor will ask about your symptoms, medical, and smoking history. A physical exam will be done.
A blood test can check cotinine level in your saliva or blood. This will show changes in nicotine use. The doctor may use it to check your progress.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment may involve one or more therapies. Options include:

Nicotine Replacement Therapy (NRT)

NRT relieves withdrawal symptoms. NRT products include:
  • Nicotine gum
  • Lozenges
  • Nasal sprays
  • Patches
  • Inhalers
The chance of becoming dependent on these products is low. NRT does not create the same "feel good" feelings as nicotine.
NRT may help you to:
  • Avoid smoking
  • Reduce the amount of tobacco you use
  • Quit and stay smoke-free

Electronic Cigarettes

Electronic cigarettes (e-cigarettes) turn liquid nicotine into a vapor. There is conflicting evidence on whether or not they may help you quit. In addition, the long-term effects of e-cigarette use are not known.

Behavioral Therapy

Behavioral therapies include:
  • Counseling
  • Group behavior therapy
  • Telephone quit lines, cell phone programs, and text messaging programs
  • Internet and computer-based programs
  • Self-help classes and manuals
  • Cognitive-behavioral therapy

Medication

Medicine that may help you quit include:
  • Antidepressants
  • Nicotine partial agonists—mimics effect of nicotine to ease withdrawal
Other medicine may help ease withdrawal symptoms. A third type may be used if you start smoking again. It blocks the pleasure feeling when you use nicotine.

Prevention

The best prevention is to never use tobacco products. Try to avoid places where people are smoking as well.

RESOURCES

American Cancer Society
https://www.cancer.org
Freedom From Smoking—American Lung Association
http://www.freedomfromsmoking.org

CANADIAN RESOURCES

Canadian Cancer Society
https://www.cancer.ca
The Lung Association
https://www.lung.ca

References

Kenfield SA, Stampfer MJ, Rosner BA, Colditz GA. Smoking and smoking cessation in relation to mortality in women. JAMA. 2008;299(17):2037-2047.
Tobacco, nicotine, and e-cigarettes. National Institute on Drug Abuse website. Available at: https://www.drugabuse.gov/publications/tobacco-nicotine-e-cigarettes/introduction. Updated January 2018. Accessed April 18, 2018.
Tobacco and cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer.html. Updated April 18, 2018.
Tobacco use. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114788/Tobacco-use . Updated March 8, 2018. Accessed April 18, 2018.
2/27/2007 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T905141/Treatment-for-tobacco-use : Etter JF, Stapleton JA. Nicotine replacement therapy for long-term smoking cessation: A meta-analysis. Tob Control. 2006;15(4):280-285.
9/24/2007 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T361003/Nicotine-replacement-therapy-for-tobacco-cessation : LF Stead, T Lancaster. Interventions to reduce harm from continued tobacco use. Cochrane Database of Syst Rev. 2007;(3):CD005231.
10/14/2008 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T361003/Nicotine-replacement-therapy-for-tobacco-cessation : Shiffman S, Ferguson SG. Nicotine patch therapy prior to quitting smoking: a meta-analysis. Addiction. 2008;103(4):557-563.
12/16/2008 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T361003/Nicotine-replacement-therapy-for-tobacco-cessation : Eisenberg MJ, Filion KB, Yavin D, et al. Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. CMAJ. 2008;179(2):135-144.
2/5/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114788/Tobacco-use : Cochran CJ, Gallicchio L, Miller SR, Zacur H, Flaws JA. Cigarette smoking, androgen levels, and hot flushes in midlife women. Obstet Gynecol. 2008;112(5)1037-1044.
2/17/2009 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T576484/Counseling-for-tobacco-cessation : Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev. 2009;(1):CD001007.
7/6/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114788/Tobacco-use : 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(10):929-937.
7/21/2009 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T576484/Counseling-for-tobacco-cessation : Lancaster T, Stead L. Self-help interventions for smoking cessation. Cochrane Database Syst Rev. 2009;(2):CD001118.
12/21/2009 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T576484/Counseling-for-tobacco-cessation : Whittaker R, Borland R, et al. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2009;(4):CD006611.
11/30/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114788/Tobacco-use : Rusanen M, Kivipelto M, et al. Heavy smoking in midlife and long-term risk of Alzheimer disease and vascular dementia. Arch Intern Med. 2011;171(4):333-339.
6/2/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T905141/Treatment-for-tobacco-use : 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.
9/9/2013 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T361003/Nicotine-replacement-therapy-for-tobacco-cessation : Bullen C, Howe C, et al. Electronic cigarettes for smoking cessation: A randomised controlled trial. Lancet. 2013;382(9905):1629-1637.
3/19/2015 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T361003/Nicotine-replacement-therapy-for-tobacco-cessation : McRobbie H, Bullen C, et al. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Rev. 2014;12:CD010216.
9/29/2016 DynaMed Plus Systematic Literature Surveillance https://www.dynamed.com/topics/dmp~AN~T361003/Nicotine-replacement-therapy-for-tobacco-cessation : Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med. 2016;4(2):116-128.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrian Preda, MD
  • Review Date: 03/2018
  • Update Date: 07/12/2018
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