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Nicotine addiction is serious due to the highly addictive nature of nicotine-based products, and it’s difficult to stop using them. The SAMHSA 2023 National Survey on Substance Use and Mental Health Survey reports 49.9 million people used a tobacco product in any given month and more than half of those people vaped.
The SAMHSA 2023 National Survey reported that almost 75% of adolescents between 12 and 17 use vape products.
The research is abundant that nicotine is destructive to the body and the leading cause of preventable death in the United States.
Key Facts
- Nicotine is a highly addictive substance and very difficult to quit. But help is available to those who want to stop using it.
- There are many different delivery systems for nicotine besides smoking cigarettes and vaping.
- Nicotine is the leading cause of medical complications and death in the U.S.
- Quitting is possible with medication and psychotherapy treatment options.
Understanding Nicotine Addiction
What is Nicotine & Why is It Addictive?
Nicotine is a naturally occurring alkaloid chemical that occurs in tobacco plants. The levels of nicotine in tobacco leaves can vary between 1-9% based on the species of tobacco.
Nicotine is addictive because it causes adrenaline and dopamine surges in the brain that stimulates a pleasure response. The more a person uses nicotine, the more tolerance the body builds and requires higher doses to experience the same pleasure.
These same pleasure centers that release dopamine are linked to the basic survival instincts. When pleasure is linked to survival, the brain associates nicotine as an essential for the body to function.
How Nicotine Affects the Brain & Body
Nicotine harms every part of the body, especially the heart, lungs and brain. These bodily impacts lead to debilitation and a lower quality of life. Some people experience strokes in early adulthood because of smoking. Research indicates women who smoke during pregnancy can harm the development of a fetus.
Smoking also harms development. Learning difficulties, mood disturbances, and impulsivity in early childhood have been linked to mothers who smoked during pregnancy. Adolescents who smoke increase the risk of developing psychiatric disorders and cognitive impairment.
Dependence vs. Addiction vs. habit (Tobacco Use Disorder)
The Diagnostic Manual of Statistics and Mental Health Disorders (DM-5) defines dependence as the body’s craving for substances it has become reliant upon. Addiction is defined as the continued use of a substance in spite of negative consequences. A habit is perpetual behavior.
You know you’re addicted to nicotine when cravings and usage increase and health problems exist directly because of this use. However, you can’t stop.
Forms of Nicotine Delivery
Combustible Tobacco (Cigarettes, Cigars, Pipes)
When people light their cigarettes, it starts a combustible chain reaction. Tobacco leaves don’t burn naturally so they’re soaked in over 7000 different types of carcinogens such as arsenic and cyanide. Filtered cigarettes don’t remove these chemicals, but may assist in removing small amounts of tar.
Tar is a sticky dark substance that lingers in the lungs and throat. Cigarettes contain around 10 to 17 milligrams of tar, while cigars contain up to 22 milligrams. Pipes can contain even higher amounts based on the type of tobacco.
E-Cigarettes & Vaping Devices
E-Cigarettes and vapes use vegetable glycerin or propylene glycol oil to mix with nicotine oils, THC and other flavors so they can burn. These devices are battery operated, and many are rechargeable. The 2023 SAMHSA Survey reports people ages 12 to 17 are the largest consumer group of e-cigarettes.
Smokeless Options (Chew, Snuff, Snus)
Chewing tobacco (dip) contains heavy metals and other carcinogens. Two cans of dip a week is similar to smoking 3½ packs of cigarettes a day. Snuff is a dry form of dip and is usually inhaled through the nose.
Snus is a powdered version of tobacco and is ingested orally. It can be prepackaged or loose. The package doesn’t dissolve like in pouches.
Emerging Products (Nicotine Pouches, Heated Tobacco)
Nicotine pouches are small dissolvable microfiber packages containing a powder made of nicotine, flavorings and other ingredients. Heated tobacco products are designed to heat rather than burn tobacco.
The pouch is put between the lip and gum and absorbed. Your body heat mixes with the dissolved package to produce an aerosol rather than smoke. However, they do contain nicotine and the addiction potential remains.
Signs, Symptoms & Diagnosis
Physical and Psychological Signs of Addiction
Two out of every three people who use nicotine products try to quit, but fail to maintain abstinence. Nicotine addiction is similar to other chemical dependencies, such as cocaine and opioids.
The signs of addiction to nicotine are likewise similar to those of other substances. Some people hide their smoking from others due to the stigmatism. Others spend money on cigarettes instead of food. Sometimes the need to smoke is so strong, a person may neglect responsibilities and find a place to smoke.
Assessment Tools (e.g., Fagerstrom Test)
The Fagerstrom Test for Nicotine Dependence (FTND) is a self-report survey with six questions that determines the level of physical dependence on nicotine.
The Hooked on Nicotine Checklist (HONC) and the Heaviness of Smoking Index (HSI) are also tools that assess the severity of nicotine dependence. These tools are helpful in creating a plan to quit.
Withdrawal Symptoms & Typical Timeline
Withdrawal from nicotine starts within a few hours of the last use and is at its worst 2-3 days into detox.
Physical dependence causes symptoms such as cravings, anxiety and depression, headaches, coughing and spitting up phlegm, trouble focusing, feeling grumpy and irritated, sleep disturbances and bad dreams, wanting to eat more and weight gain.
In addition, dreams about smoking can occur for years after last use. These dreams are so real, a person may wake up believing they have relapsed.
Health Effects & Complications
Short-Term Physiological Effects
When used, nicotine stimulates the adrenal glands to release adrenaline and raises the blood pressure and heart rate.
Dopamine is released in the brain and causes euphoric pleasure. This can cause sleep disturbances and impulse control problems. Some people feel a dizzy buzz-like response caused by a lack of oxygen as the lungs are filled with toxic smoke.
The euphoria lasts a few minutes and then people experience a depressive drop in mood when the nicotine wears off.
Long-Term Diseases (Cancer, Cardiovascular, Respiratory)
Over 500,000
Over 500,000 people die every year from preventable diseases caused by smoking and other nicotine products.
Heart disease, various types of cancer, and other respiratory diseases such as chronic obstructive pulmonary disease (COPD) are linked to smoking.
Secondhand & Thirdhand Smoke Hazards
People who don’t use but are exposed to smoke from cigars and cigarettes are at risk of developing the same diseases. Children are especially vulnerable due to their ongoing development. Asthma and other respiratory tract infections have been noted. Sudden infant death syndrome has been linked to secondhand smoke.
Third hand hazards refer to lingering toxic chemicals on surfaces that are exposed to skin and may be ingested.
Impact or Pregnancy & Child Development
Women who smoke while pregnant have babies with lower birth weight. Infants may experience withdrawal symptoms at birth.
Children may have developmental delays such as learning disabilities and speech impediments. Children who start smoking in early adolescence are more likely to develop other substance use problems later in life.
Financial Costs of Nicotine Use
The average price of cigarettes ranges from $8-10 in the United States and up to $15 per pack in other countries.
$300/month
If a person smokes one pack of cigarettes a day, the cost is approximately $300 a month.
Research indicates that the cost to employers and the healthcare industry due to smoking related diseases was estimated to be approximately $185 billion each year.
Treatment & Quitting Options
If you are trying to quit smoking or using nicotine products, multiple effective, proven treatments and therapies can help reduce or eliminate use entirely.
Nicotine Replacement Therapy (Patches, Gum, Lozenges, Inhalers, Sprays)
Nicotine replacement therapy is titration treatment. Titration dosages depend on how much a person uses nicotine products.
Nicotine patches
Nicotine patches come in various dosages and are worn on the arm for 24 hours.
Nicotine gum
Nicotine gum comes in 2 mg and 4 mg doses and is designed to be chewed and remain in the gum line until the full effect of the nicotine is absorbed.
Nicotine lozenges
Nicotine lozenges also come in 2 and 4 mg dosages.
These products are all available over the counter. However, it’s recommended to try an additional method of titration if they’re still being used after 3-4 months.
Nicotine sprays and inhalers are prescription-only products. Sprays are administered through the nose and nicotine inhalers used similarly to an asthma inhaler. These products aren’t recommended for usage beyond six months.
Prescription Medications (Varenicline, Bupropion, Cytisine)
Varenicline and its brand name Chantix can be obtained through prescriptions. It blocks the receptors in the brain that trigger dopamine production. This allows the brain to produce its own dopamine without the use of nicotine. The brain no longer responds to nicotine the same way, and the cravings stop.
Cytisine is another prescription medication that functions the same way Chantix does. However, it has a shorter period of effectiveness and is used for shorter periods.
Bupropion, under the brand names Wellbutrin or Zyban, has also helped people stop smoking. Commonly used for depression, this medication changes the way the brain processes dopamine.
It doesn’t help with cravings or withdrawal symptoms like Chantix. Bupropion can be used as long as a person needs and is only available via prescription.
Evidence-Based Behavioral Therapies (CBT, Motivational Interviewing, Mindfulness)
Research indicates the best methods of recovery from any addiction is the combination of pharmacological and psychological treatment.
Behavioral counseling that uses one-on-one or group sessions incorporating cognitive behavioral therapy (CBT) and motivational interviewing (MI) help ascertain your level of commitment to quitting.
CBT addresses core messages foundational to destructive behaviors. Mindfulness and other relaxation techniques help people learn how to endure cravings and stop anxiety that accompanies nicotine use and cessation.
Digital & Mobile Quit Tools (Apps, Text Programs, Tele-Health)
The CDC, American Cancer Society and other organizations provide smoking cessation support via text messaging and telephone quit lines. Other web based intervention programs are also available, such as peer group support and telehealth counseling or medical appointments.
Inpatient, Outpatient & Residential Programs
Treatment modalities for smoking cessation often accompany other substance use programs. It’s rare that a person would enter inpatient or residential programming solely for nicotine addiction. However, outpatient support is available through local therapists and peer support groups.
Harm-Reduction & Gradual Reduction Strategies
Harm reduction programs are sponsored through local health departments. Some provide titration supplies to people. Other reduction strategies include accountability peer support groups.
Special Populations & Considerations
Teens & Young Adults
Special grant funds have traditionally been available to health departments and junior or senior high schools for smoking cessation programs.
The FDA’s Real Cost Campaign has developed research and resources for advertising across popular media used by teens to provide education to reduce e-cigarette and vape use among adolescents.
Pregnant People & New Parents
Special grant funds are usually available for pregnant moms and new parents to learn about the dangers of second- and third-hand smoke hazards to newborns and children in the home.
LGBTQ+ Communities
Smoking cessation programs for the LGBTQ+AI community focus on peer support, psychotherapy, and medication treatment.
Individuals with Mental Health Disorders
Individuals with dual diagnoses and co-occurring mental health disorders and participate in smoking cessation programs should be medically supervised to avoid any mixing between medications.
Treatment for ongoing mental health can be combined with smoking cessation education.
Dual Use & Other Substance Dependencies
Many people who enter substance use treatment also have addictions to nicotine. Treatment facilities for residential and inpatient clients generally offer smoking areas along with titration supplies.
Frequently Asked Questions About Nicotine Addiction
Nicotine can stay in the system for several days depending on how much and how often it is used. Detox symptoms tend to increase in severity when the last amount of nicotine in the system is used up.
Yes. Vapes and electronic cigarettes also contain nicotine and that is the addictive substance.
Yes. Any product that contains nicotine can cause addiction. Some people chew gum for years while quitting smoking.
The immediate effect is the lowering of blood pressure and a drop in the escalated heart rate. The euphoria lasts only briefly.
Depending how much you smoke a day, or use other nicotine products, it can be $300.00 per month if you smoke one pack a day, or use two dip containers a week.
Yes. Any therapy that builds new coping skills for anxiety, depression or any other mental health reason a person smokes can be helpful. The relaxation alternative therapies such as massage, meditation and exercise have all been proven helpful.
Find Treatment Near You
Browse these directories to find treatment centers.
Call to Speak with Someone for more help.
- CDC Resources
- Text QUITNOW to 333888
- Phone 1800-Quit-Now 1-800-335-3369
- Quitstart app for smartphones.
Find Help Now
Smoking kills. But that doesn’t mean you’re helpless. There are resources around you to stop this habit in its tracks. It isn’t easy, but you and your family can enjoy a healthier, smoke-free future. Call the number below, and get help today!
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