Nicotine Dependence (Tobacco Use Disorder)

What is nicotine dependence?

Nicotine is a type of stimulant found in tobacco products. Nicotine dependence occurs when your body gets used to having some level of nicotine in your system. In physical and psychological ways, your body “depends” on constantly having the chemical.

• Physical dependence is when your body needs nicotine to avoid withdrawal symptoms — the unpleasant feelings that you get when you stop using it. Symptoms include restlessness and agitation.
• Psychological dependence is, for example, feeling like you need nicotine to get through your day because it’s part of your routine.

What is a stimulant?

Stimulants like nicotine speed the messaging between your brain and body. They cause your brain to release more dopamine, which makes you feel pleasure. Stimulants also increase feelings of wakefulness and exhilaration.

Does nicotine make you dependent?

Using nicotine can make you dependent on it. Nicotine products change how your brain works, leading to dependence.

Who does nicotine dependence affect?

Nicotine affects people of all ages but is most dangerous among teens. The brain is still developing during the teenage years, making it easier to become addicted to nicotine.

Science has shown that the younger you are when you start using nicotine, the more likely you are to become addicted. A Surgeon General’s Report (SGR) found that about 3 of 4 high schoolers who smoke will still smoke in adulthood.

How common is nicotine dependence?

Nicotine dependence is common, affecting about 23.6 million Americans or 8.5% of people ages 12 and older.

Can you get nicotine dependence from vaping?

Yes. Using anything that contains nicotine can make you dependent. This includes tobacco products (like cigarettes, cigars or dip) and e-cigarettes used for vaping.

Is nicotine use a habit or an addiction?

Nicotine is an addictive substance. When your body needs nicotine for physical or psychological reasons, it’s called tobacco use disorder. Nicotine floods your brain’s reward circuits with a feel-good chemical called dopamine. This creates a pleasant feeling, and when it wears off, you often want more.

Using nicotine can also become a habit. For example, if you’re used to smoking a cigarette every morning when you wake up, doing so becomes part of your routine.

What is the difference between nicotine dependence and tobacco use disorder (also known as nicotine addiction?)

Nicotine dependence is when your body gets used to nicotine and the sensations it creates. Substance use disorder (SUD) is when your body needs nicotine to avoid withdrawal symptoms. Because nicotine disturbs your brain’s reward circuits, it’s highly addictive.

Which is more addictive: Nicotine or caffeine?

Caffeine is a common stimulant found in coffee, teas and sodas. You can develop a dependence on caffeine because your body gets used to it.

Caffeine and nicotine both cause the brain to release dopamine, but the release from caffeine is much smaller. Nicotine changes how the brain works, making it one of the most addictive substances in the world.

What causes nicotine dependence, and how does it affect me?

Using tobacco products is the main cause of nicotine dependence. When you use tobacco products, nicotine travels to your lungs and is quickly absorbed into your blood. Once in your bloodstream, it travels to other areas of your body. Your brain releases dopamine, which creates temporary feelings of happiness and satisfaction.

When the feel-good effects of nicotine wear off (usually within a few minutes), you might feel edgy or irritated. At this point, many people keep using nicotine to continue enjoying the pleasurable effects. The more you use nicotine, the higher your body’s tolerance. This means your body will gradually need more nicotine to feel good.

How long does it take to develop nicotine dependence?

Nicotine is incredibly addictive — possibly as addictive as alcohol, cocaine or heroin. Your body can start to depend on nicotine right away — even after one or two uses.

What are the signs of nicotine addiction?

The most common symptoms of tobacco use disorder include:

• Cravings and feeling like you need nicotine to function.
• Feeling sad, anxious or irritable.
• Withdrawal symptoms like restlessness and difficulty sleeping.
• Needing larger amounts of nicotine to feel satisfied.
• Using nicotine despite knowing the health risks.
• Wanting to quit using nicotine but not being able to.

What does a nicotine craving feel like?

When you feel a physical craving for nicotine, you’ll likely feel edgy, anxious and restless. You could also experience tightness in your throat or stomach. Cravings can come in waves of intensity, sometimes feeling subtle and then becoming stronger.

What are nicotine withdrawal symptoms?

You get nicotine withdrawal symptoms when you stop giving your body nicotine. While withdrawal symptoms from nicotine dependence vary from person to person, the most common ones include:

Physical withdrawal symptoms:

• Chest tightness.
• Difficulty sleeping.
• Dizziness.
• Gas, constipation or diarrhea.
• Headaches.
• Increasing hunger and weight gain.
• Nasal drip, coughing, dry mouth and throat irritation.
• Nausea.

Psychological/emotional withdrawal symptoms:

• Feeling uneasy, jittery, agitated or angry.
• Feeling worn out, fatigued or apathetic.
• Having trouble focusing.
• Sadness or depression.

When do nicotine withdrawal symptoms start?

Symptoms of nicotine withdrawal usually start a few hours after your last dose. They’ll be most intense on the second or third day after quitting.

Talk to your healthcare provider if you’re worried about nicotine withdrawal. They’ll work with you to find a treatment or combination of treatments to help you manage withdrawal. Treatment often involves a combination of medication and therapy.

How is nicotine dependence diagnosed?

Your healthcare provider can diagnose nicotine dependence by asking a few questions or having you fill out a questionnaire. This is called the Fagerström Test for Nicotine Dependence.

Your provider determines your level of dependence according to:

• How many tobacco products you use in a day.
• How soon after waking up you use tobacco or nicotine.

Is there a cure for nicotine dependence?

You can cure nicotine dependence. Eliminating your need for nicotine takes time, but you can end your dependence for good.

Are there treatments for nicotine dependence?

You don’t need treatment to cure nicotine dependence, but those who get treatment are often more successful. There are cessation treatments that effectively cure nicotine dependence and help reduce withdrawal symptoms. Treatments include medications approved by the U.S. Food and Drug Administration and behavioral therapies.

Research shows that those who use a combination of behavioral therapies and medications have more success quitting nicotine than those who only use one treatment or none at all.

Treatments include:

• Nicotine replacement therapy (NRT).
• Prescription medication for nicotine cessation.
• Behavioral therapies like mindfulness and motivational interviewing (MI).

What medications treat nicotine dependence?

Medications available for nicotine dependence include:

• Nicotine replacement therapy (NRT): These over-the-counter (OTC) medications help stimulate your brain’s receptors that respond to nicotine. They include transdermal (on your skin) patches as well as gums and lozenges. You can also talk to your provider about prescription-only nasal sprays and inhalers.
• Bupropion: This prescription medication is as effective as NRT. It lowers the absorption of norepinephrine and dopamine in your brain. Bupropion was originally developed as an antidepressant.
• Varenicline: This medication reduces nicotine cravings by stimulating the alpha-4 beta-2 nicotinic receptor in your brain. Some studies found it was more effective than NRTs and bupropion.
• Other antidepressants: Small studies show that antidepressants such as nortriptyline may help break nicotine dependence.

What behavioral treatments can treat nicotine dependence?

Your provider may recommend behavioral therapy along with medication:

• Cognitive behavioral therapy (CBT): By learning CBT, you can identify triggers — things that compel you to use nicotine — and effective coping strategies. CBT teaches you how to avoid the psychological need for nicotine.
• Motivational interviewing (MI): This style of therapy helps you address your mixed feelings about using nicotine and increases your motivation to quit. It promotes optimism, self-efficacy and the ability to adjust to change.
• Mindfulness: With this technique, you turn inward to learn how to tolerate negative feelings and cravings without turning to nicotine.
• Telephone support and quit lines: If you want to quit using nicotine, look for telephone or in-person support groups and counselors.

Are there side effects of treatment for nicotine dependence?

You may experience some side effects from the medications used to treat nicotine dependence.

Side effects of NRT patches include:

• Dizziness.
• Fast heartbeat.
• Headache.
• Muscle aches and stiffness.
• Nausea.
• Skin redness or itching.
• Sleep troubles or strange dreams (more often with the 24-hour patch).

Side effects of NRT gum include:

• Bad taste in your mouth.
• Fast heartbeat.
• Hiccups.
• Jaw aches and pains.
• Mouth sores.
• Nausea.
• Throat soreness.

Side effects of NRT nasal spray include:

• Coughing.
• Nasal irritation.
• Runny nose.
• Sneezing.
• Throat soreness.
• Watery eyes.

Side effects of NRT inhalers include:

• Coughing.
• Mouth and/or throat soreness.
• Runny nose.
• Upset stomach.

Side effects of NRT lozenges include:

• Coughing.
• Difficulty sleeping.
• Fast heartbeat.
• Headache.
• Heartburn.
• Hiccups.
• Nausea.
• Sore throat.

Bupropion side effects may include:

• Anxiety or restlessness.
• Dizziness.
• Dry mouth.
• Headache.
• Insomnia.
• Nausea.
• Tiredness.

What should I know before starting medication for nicotine dependence?

If you choose to use medication to help cure nicotine dependence, make sure to:

• Talk to your provider before beginning any cessation medication. Pregnant people or teens shouldn’t use NRTs. And don’t use NRTs if you’re still using tobacco products, including dip.
• Read and follow package instructions carefully for all medications.

How else can I manage nicotine withdrawal symptoms?

Other strategies for managing nicotine withdrawal symptoms include:

• Exercise: Find a physical activity that you enjoy. Exercising can get your mind off nicotine withdrawal symptoms and benefit your health.
• Spend time with friends who don’t smoke: Inform everyone around you that you’re quitting so they can support and cheer you on.
• Keep your hands occupied: Use a stress ball or fidget toy to keep your hands busy.
• Use a straw, toothpick or cinnamon stick: These items can replicate the feeling of something touching your lips and mouth. Gum chewing helps keep your mouth active, too.
• Beat your temptations: Write down rational responses to internal voices that falsely tell you using nicotine products is OK.

How long does it take to cure nicotine dependence?

Symptoms of nicotine withdrawal can last from a few days to several weeks. Every day your symptoms will improve a little more. When your withdrawal symptoms go away, your body is no longer dependent on nicotine.

How can I reduce my risk of nicotine dependence?

The best way to prevent nicotine dependence is to avoid it. Don’t use any products containing nicotine, including e-cigarettes. Using nicotine just one time can start the process of nicotine dependence. If you can, avoid putting yourself in situations where you might be tempted to use nicotine.

What can I expect if I have tobacco use disorder?

If you have tobacco use disorder, you need a constant supply of the substance in your body. When nicotine fades out of your bloodstream, you’ll experience unpleasant withdrawal symptoms. Having a nicotine dependence also creates a higher tolerance for the substance over time, meaning you’ll need larger amounts of nicotine to feel the effects.

How long does nicotine dependence last?

You can have tobacco use disorder for as long as you keep using nicotine. For some people, it can last a lifetime. Quitting nicotine is the only way to successfully cure tobacco use disorder, and you must make a conscious effort to quit.

What is the outlook for beating nicotine dependence?

Breaking nicotine dependence is hard but doable. It might not happen on your first try, but 3 in 5 adults who ever smoked have quit. It takes consistency and perseverance, but it’s possible.

When you stop using nicotine products, you benefit almost immediately. For example, your heart rate and blood pressure return to normal during the first 20 minutes after quitting. Over time, you’ll:

• Have better breathing and be able to exercise more effectively.
• Experience improved sense of smell and taste.
• Lower your risk of disease, including certain cancers and heart disease, to typical levels.
• Have healthier teeth and gums.
• Save hundreds or thousands of dollars.

A note from Cleveland Clinic

Nicotine is one of the most addictive substances in the world. Using nicotine a handful of times can quickly turn into dependence, and this harmful drug can have long-lasting effects on your body. To beat tobacco use disorder, healthcare providers recommend a combination of medications and behavioral treatments to reduce withdrawal symptoms. If you have tobacco use disorder, talk to your provider about quitting. With their support, your journey to a nicotine-free life is around the corner.