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Nicotine Addiction & Dependence

Nicotine addiction and dependence not only negatively impacts the person struggling with the problem and their loved ones but their communities as well. It’s a problem that is worldwide. An estimated 8 million people die each year due to tobacco use, according to the World Health Organization, and 1.2 million of those deaths are attributable to secondhand smoke.[1] 

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Both in the short term and long term, nicotine can have a negative impact on the health. Short-term effects include increased blood pressure and heart rate as well as wear and tear on the heart muscle that can add up to cardiovascular problems in the long term.[2] Additionally, respiratory illnesses, reproductive issues, and cancer are common among those who struggle with chronic nicotine abuse and addiction.[2]

The healthcare costs related to nicotine-induced illnesses are not just borne by the individual and their families but by society as well. Healthcare costs increase and put a strain on the healthcare system, drawing more tax dollars and increasing the cost of insurance for everyone.[3]

How Addictive Is Nicotine?

Compared to other substances, nicotine is just as addictive as substances like cocaine and heroin. However, it is easily available wherever cigarettes and vapes are sold.[4] 

The substance triggers the brain’s reward system just like other substances, creating a “buzz” in users and cravings that cause them to want more and more. It is this quick action in the brain that makes it so addictive. The release of dopamine, a “feel-good” chemical, makes it hard to stop using nicotine once a dependence on the substance kicks in.[5]

Effects of Nicotine on the Brain

Nicotine impacts the brain by interacting with neurotransmitters like dopamine, which alters how the person feels, their cognitive functioning, and their tolerance of and dependence on nicotine. 

Neurotransmitter Interactions

Nicotine binds to the nicotinic acetylcholine receptors (nAChRs) in the brain, triggering the release of dopamine, serotonin, norepinephrine, and glutamate—all of which make the user feel good. Specifically, the dopamine release is involved in the stimulation of the pleasure and reward center of the brain, which plays a role in the development of dependence on nicotine.[6] 

Mood Boost

Dopamine is the chemical that makes you feel good, and when people use nicotine, they often immediately feel more relaxed and calm. In fact, many turn to nicotine as a way to manage their mood, self-medicating when they feel stressed or upset. 

The result, however, is that addiction to nicotine develops along with a host of physical health problems that can worsen the ability to manage mood effectively. 

Cognitive Function 

Initially, nicotine is said to enhance cognitive function, improving attention, memory, and analytical abilities.[7] However, these effects are minimal, short-lived, and diminish over time with repeated use of nicotine. 

Nicotine Tolerance & Dependence 

Repeated exposure to nicotine can cause the person to begin to build a tolerance to and a physical dependence on the substance. This process results in the person needing more and more nicotine in order to experience the same effects that they felt when they first started using it.[8]

When coupled with psychological dependence (or cravings for nicotine) and compounded by this physical dependence, it can add up to a full-blown, nicotine addiction. Should the person attempt to stop smoking or cut back on the amount of nicotine they consume, they may experience withdrawal symptoms that are both physical and mental, requiring support as they go through the detox process.

Effects of Nicotine on the Body

Nicotine use can have a significant and negative impact on the body and its metabolic and digestive functions. Repeated exposure to nicotine over time and in increasingly large amounts can mean health issues that impact every major system of the body and contribute to the risk of developing certain cancers.

Metabolic & Digestive Function

Nicotine has been found to increase metabolic rate for some users and decrease their appetite at the same time. Some may experience weight loss as a result or weight gain when they try to stop using nicotine. 

Nicotine can alter gastrointestinal function, which can cause people who use the substance to experience increased motility or diarrhea when using nicotine and constipation when they try to stop.[9]

Cardiovascular Health

Nicotine constricts blood vessels, causing them to narrow, which then leads to higher blood pressure and more rapid heart rate. Nicotine also increases the release of adrenaline in the system which can further increase blood pressure and heart rate, putting strain on the heart.[10]

These issues can increase the risk of developing diseases that impact the cardiovascular system, such as heart disease, stroke, and heart attack. 

Respiratory System

When nicotine is ingested through smoking or vaping, it directly exposes the lungs to everything in the product. This can include harmful chemicals and carcinogens, which can contribute to the development of lung cancer, chronic obstructive pulmonary disease (COPD), and emphysema.[11]

Cancer Risk 

Smoking causes 90% of all deaths due to lung cancer, and more women die of lung cancer than breast cancer. In fact, there are more deaths caused by smoking each year than deaths caused by HIV, drug and alcohol use, car accidents, and gun-related deaths combined.[12] 

Additionally, nicotine use and tobacco use has been found to be a contributing factor in the development of other cancers, including bladder, mouth, throat, esophageal, and pancreatic cancers.[13]

Why Does Nicotine Dependence Occur?

There are a number of factors, both psychological and physiological, that can contribute to the development of nicotine dependence, including these:[14] 

  • Stress management
  • Social exposure (both at home or in the community)
  • Easy access, especially for children who live with tobacco and nicotine users
  • Genetic predisposition to the development of addiction
  • Mental health issues, like depression or anxiety 

Signs & Symptoms of Nicotine Addiction

Beyond the regular use of nicotine products like cigarettes, tobacco, and vape devices, there are a number of signs that nicotine use has turned into an addiction, including these:[15] 

  • Cravings for nicotine that are hard to resist or cause agitation
  • Withdrawal symptoms when without nicotine for a period of time
  • Increased tolerance to nicotine that requires increased use in order to avoid withdrawal symptoms 
  • Difficulty quitting use of nicotine
  • Continued use of nicotine despite the development of health problems
  • Prioritizing nicotine use over interpersonal connections with others and responsibilities at home or work

What Are the Different Ways to Consume Nicotine?

There are a number of different products that contain nicotine as their primary ingredient, including cigarettes, chewing tobacco, nicotine gum, pouches, patches, toothpicks, lozenges, nasal sprays, and inhalers.

Nicotine Gum

Nicotine gum is generally used as a smoking cessation aid for those who are trying to quit the use of cigarettes and chewing tobacco. The gum is chewed to release nicotine into the system to help people manage cravings and limit their exposure to nicotine without cutting it out entirely. 

Some common side effects of using nicotine gum include jaw discomfort and hiccups. 

For those who are ready to stop using nicotine gum, it is a good idea to slowly cut down on the amount of gum chewed each day. Reach out and connect with support groups for people who are trying to quit smoking. 

Chewing Tobacco

Chewing tobacco is sold as loose tobacco that people generally tuck into their mouth between the teeth and lip, so nicotine is absorbed through the skin. 

Side effects of chewing tobacco use can include yellowed teeth, loss of bone in the jaw, oral cancers, and gum disease.[16]

Quitting chewing tobacco can be done by slowly lowering the amount used during the day until it is minimal and then stopping use entirely. Counseling can help to find other ways to manage any issues that were previously addressed through use of chewing tobacco. 

Nicotine Pouches

Nicotine pouches are small pouches that are placed between the lip and gum, like chewing tobacco, but they contain no tobacco. They have nicotine, plant-based fibers, and flavorings. They come in packages that look like mint containers. 

These pouches are growing in popularity, but they are not safe. They contain nicotine, which is addictive, and can impact the function of the brain.[17] They also come with potential side effects, such as nausea, gum irritation, hiccups, and sore mouth. 

For those who would like to stop using nicotine pouches, it is recommended to gradually reduce use until quitting entirely feels less overwhelming. Seek support in the form of support groups and therapy. 

Nicotine Patches

Nicotine patches are commonly used as a form of nicotine replacement therapy, helping people to stop using traditional nicotine products like cigarettes and chewing tobacco or synthetic tobacco found in e-cigarettes. 

Use of nicotine patches can cause skin irritation and nausea if the dose is higher than needed. It is recommended to only use them for a finite period of time, slowly lowering the patch strength until you can stop using the patch entirely. 

Nicotine Toothpicks

Nicotine-infused toothpicks are exactly what they sound like: regular toothpicks that contain nicotine that is absorbed into the skin by users when they hold the toothpick in their mouth. 

Like nicotine pouches, they can cause oral inflammation and irritation, nausea, and hiccups. If they are used as a tool to stop smoking, they can be beneficial as long as use is short term. Users should seek out new behavioral strategies to manage addictive use of nicotine without nicotine products of any kind. 

Synthetic Nicotine

Synthetic nicotine and traditional nicotine differ in their origin. Synthetic nicotine is created in a lab, while traditional nicotine comes from the tobacco plant. However, both share the same chemical makeup.[18]

While the FDA regulates nicotine products, their Center for Drug Evaluation and Research defines nicotine as being derived from tobacco. Thus, there are regulatory issues with products made with synthetic nicotine. 

Synthetic nicotine is usually found in e-cigarettes or vaping devices. Though there has been little research on the effects of using synthetic nicotine regularly, and by this method, early reports suggest that these products contribute to the development of potentially deadly respiratory disease.[19]

Quitting use of synthetic nicotine is recommended, just as it is recommended for the use of traditional tobacco-based nicotine. This means transferring to use of nicotine gum, nicotine patches, or nicotine toothpicks and slowly reducing the rate of use with the support of addiction treatment professionals. 

Nicotine Lozenges

Nicotine lozenges are often used as a tool for smoking cessation, but they are not without their own potential hazards. They do contain nicotine, so it is important to use them only as a tool to stop using nicotine altogether. They can irritate the mouth and cause inflammation, hiccups, and nausea.[17]

Quitting nicotine lozenges is similar to quitting the use of any nicotine product. It is recommended to taper off use and connect with people who can provide positive behavioral support. 

Nicotine Cigarettes

Traditional nicotine cigarettes are sold in most gas stations and corner stores. They cause a number of deadly diseases, such as respiratory diseases and various forms of cancer, which can be fatal.[12]

Quitting smoking generally starts with nicotine replacement therapy if the use of cigarettes is high, stopping all use of cigarettes and starting to use nicotine lozenges, pouches, patches or other replacement options. 

Over time, use of those nicotine replacement products can be decreased until the person is free from all nicotine use. It is not an easy process, and it is recommended to engage with support groups and work with addiction treatment professionals who can offer resources for sustained abstinence from nicotine use.  

Nicotine Nasal Spray

Nicotine nasal spray is another option for those who are trying to quit smoking. This product is a spray that is injected into the nose that contains nicotine. With use of nicotine nasal spray, withdrawal symptoms may be controlled during the quitting process. 

However, nasal sprays containing nicotine can irritate the nasal passages. It is recommended to use them as minimally as possible or to swap out nicotine replacement therapy options to minimize these effects. 

Stopping use of nicotine nasal sprays can be done by tapering off use of the tool over time and seeking professional support. 

Nicotine Inhalers

Nicotine inhalers provide a dose of nicotine to those who are trying to quit smoking without experiencing severe withdrawal symptoms.[20] They are another smoking cessation or replacement tool that can help people to avoid the harmful effects of smoking cigarettes or using e-cigarettes, as they slowly lower their nicotine dose over time. 

There is a risk of negative respiratory effects, such as lung inflammation, so using these for a short period is recommended. In order to stop using nicotine inhalers, it is best to swap them out for another replacement option or taper off use with the support and supervision of a medical professional. 

Finding Treatment for Nicotine Addiction

There are a number of treatment options available to those who would like to break free from nicotine addiction. Nicotine replacement products can help to limit the negative effects of exposure to smoke, vape steam, and tobacco leaves while slowly reducing the dose of nicotine over time. 

Behavioral interventions are helpful in creating new lifestyle choices that promote healthy living. New habits and coping mechanisms can ease psychological stress that may pre-date nicotine use and often worsen during the detox process. Healthcare providers can be helpful in this process, as they can often provide resources and ideas for lifestyle change that can be beneficial to cessation efforts.

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Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More

Updated February 21, 2024
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