In the past, it was believed that because nicotine does not cause intoxication or impairment, using tobacco was simply a bad habit, not an addiction. Today, nicotine is recognized as the very addictive drug found in tobacco products.
Nicotine dependence (also called tobacco addiction) involves physical and psychological factors that make it difficult to stop using tobacco, even if the person wants to quit.
Nicotine releases a chemical called dopamine in the same regions of the brain as other addictive drugs. It causes mood-altering changes that make the person temporarily feel good. Inhaled smoke delivers nicotine to the brain within 20 seconds, which makes it very addictive—comparable to opioids, alcohol and cocaine. This "rush" is a major part of the addictive process.
When the person stops using tobacco, nicotine levels in the brain drop. This change triggers processes that contribute to the cycle of cravings and urges that maintains addiction. Long-term changes in the brain caused by continued nicotine exposure result in nicotine dependence, and attempts to stop cause withdrawal symptoms that are relieved with renewed tobacco use.
Nicotine dependence involves physical and psychological factors.
Signs of physical dependence on nicotine include:
Tobacco use causes feelings of pleasure and alertness, but people with nicotine dependence become tolerant to the desired effects. They may no longer experience pleasure from using tobacco, but they continue to use it because they have cravings and want to avoid nicotine withdrawal.
Signs and symptoms of nicotine withdrawal include:
These symptoms usually stop within a couple of weeks, but some people continue to have problems concentrating or experience strong nicotine cravings weeks or months after quitting.
In addition to physical factors involved in nicotine dependence, there are psychological factors. People develop conditioned signals, or “triggers,” for tobacco use. For example, some people always smoke after a meal or when they feel anxious. These triggers lead to behaviour patterns that can be difficult to change.
Anyone who smokes or uses other forms of tobacco is at risk of developing nicotine dependence. Various factors influence who is more likely to use tobacco and to develop nicotine dependence:
Health care providers determine whether a person has nicotine dependence, and how severe it is, by asking certain questions. The most important questions are:
Quitting tobacco use can take many attempts, so it is important to keep trying.
Medications and behavioural counselling are the two main types of tobacco cessation treatment. Combining these two types of treatment is the most successful way to quit tobacco use.
Stop-smoking medications reduce withdrawal symptoms and nicotine cravings. The choice of medication, dosage and duration of use depend on each person's needs and preferences.
Two types of medications exist for treating nicotine dependence: over-the-counter products that contain nicotine and prescription medications that do not contain nicotine.
Behavioural counselling teaches the person coping and problem-solving skills they can use to avoid tobacco and prevent relapse. It can also provide social support and encouragement. The more time a person spends in counselling, the more likely that they will succeed in quitting tobacco use.
Various types of counselling are used to treat nicotine dependence:
Some people don't feel ready to quit but are willing to start by cutting down. Cutting down before quitting can lessen nicotine withdrawal symptoms, and it allows the person to change their tobacco behaviours gradually. Strategies for cutting down include delaying cigarettes, smoking fewer cigarettes and smoking less of each cigarette. Although cutting down may reduce some health risks, there is no safe level of tobacco use.
Most people who use tobacco do not go on to develop other substance use problems, but for some people, tobacco does seem to be a gateway drug.
Nicotine is often the first drug used by people who later develop alcohol or other substance use problems. A history of smoking, particularly daily, increases the likelihood that young adults will use alcohol, cannabis and illegal drugs. More than 80 per cent of youth who have substance use disorders use tobacco, develop nicotine dependence and continue using tobacco as adults.
Yes. Some treatment providers think it is unrealistic to expect people to try quitting tobacco at the same time that they are dealing with another substance use problem. They know that quitting tobacco can be even harder than quitting the other substance for which the person is getting treatment. But there are reasons why people can and should try to quit both tobacco and other substances together:
It is unlikely that a person will develop an addiction to NRT for two reasons:
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