Nicotine Addiction – The Ultimate Guide

All tobacco products contain nicotine, and if you find you can’t stop smoking, you could have a nicotine addiction.

Nicotine is a highly addictive chemical that constitutes between 0.6 to 3.0% of dry tobacco weight. That aside, cigarette manufacturers include a host of unhealthy additives to improve the taste, increase nicotine absorption and open bronchodilators in the lungs for increased exposure.

Recent years have seen a decline in smoking cigarettes, but e-cigarettes use has seen a sharp increase. As a result, tobacco use is still very socially acceptable, meaning that people continue to use it without realizing the risks.

The Centers for Disease Control and Prevention (CDC), tells us 34 million adults in the USA identified as smokers in 2019, and tobacco accounts for 480,000 preventable deaths annually.

This article looks at the effects of nicotine on the body and mind, how it creates addiction and the best ways to quit.

What is nicotine addiction?

Nicotine addiction, also known as nicotine dependence, is the continued use of nicotine despite its negative impact on physical health, social interactions and other aspects of daily life.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association formally recognizes tobacco use disorder.

You can consider yourself addicted when you can’t stop using, get cravings and experience withdrawal symptoms if you stop.

Cigarettes are the most popular means of getting nicotine into the body, but not the only way. Other tobacco products include –

• Cigars – tobacco wrapped in leaf tobacco or another tobacco substance instead of paper
• Cigarillos – miniature versions of cigars
• Water or hookah pipes – flavored tobacco filtered through water and smoked with a long flexible tube
• Smokeless tobacco – snuff, powdered tobacco and chewing tobacco that are inhaled or chewed

Inhaling tobacco smoke delivers nicotine into the bloodstream most efficiently, and it quickly gets to the brain. Research estimates that someone who smokes 20 cigarettes a day gets around 200 nicotine hits to the brain daily.

Tobacco that’s not inhaled enters the bloodstream through mucous membranes in the mouth, making absorption slower. It doesn’t, however, alter nicotine’s effect.

Key nicotine addiction statistics?

According to CDC research in 2019 –

• Smoking in the USA declined by 6.9% from 2005 to 2019
• Out of every 100 each, 15 adult men and 13 adult women are smokers
• Lower-income households have a higher level of smokers
• 34.5% of people with severe anxiety identified as smokers
• 12% of those with no or minimal anxiety identified as smokers
• 35% with a GED certificate smoked compared to 4% with a graduate degree
• Cigarette smoking was highest in the age group 25 to 64 years and lowest among 18 to 24-year-olds
• Smoking was higher in divorced, separated and widowed people than in those married or living with a partner

According to the American Lung Association research in 2019 –

• E-cigarette use among middle school students increased by 1650% from 2011
• E-cigarette use among high school students increased by 1733% from 2011, and 33% from 2018
• 2.9 million children started using e-cigarettes in 2019; that’s the equivalent of 7 900 a day

Other statistics –

• Smoking claimed over 100 million lives throughout the 20th century; mainly in First World countries
• Today the burdens of smoking are on low-income countries, and estimates suggest that over 1 billion people could die over the course of the 21st century
• More than 8 million people globally died prematurely in 2017 because of smoking
• 20% of the world’s population regularly smokes
• Scientific evidence shows that advertising and promotion influences young people to start using tobacco products

What causes nicotine addiction?

Approximately 50 to 75% of the risk to nicotine addiction can be attributed to genetic predisposition. Research indicates that genes might even impact the chances of successfully giving up nicotine.

Furthermore, long-term smoking can lead to changes in gene expression, which may contribute to associated medical consequences even long after quitting.

And while more research needs to be done, there is evidence that prenatal exposure to nicotine impacts gene structure and these changes persist well into childhood.

Anyone who uses nicotine regularly, though, stands a chance of becoming addicted since it’s a very addictive substance. But it’s a physical feel-good drug as opposed to other mind-altering substances.

Nicotine causes physical and psychological addiction, and that’s what makes it so tough to quit.

Other risk aspects that can make people more susceptible to using include –

• Prenatal exposure to nicotine
• Other existing addictions to substances
• Existing behavioral addictions, such as gambling
• Underlying mental illness, like depression and anxiety
• Social circles and regularly mixing with smokers
• Growing up in a home with tobacco users makes people more inclined to smoking
• People who start smoking when they’re young are more likely to continue as adults

Physical addiction

Immediately on exposure to nicotine, the adrenal glands get a “kick” to release adrenaline, which stimulates the body, increasing blood pressure, heart rate and respiration. Adrenaline makes people feel excited and more focused and alert.

Simultaneously, neural reward pathways are activated, releasing small amounts of dopamine and reinforcing feelings of pleasure.

The pleasing effects are short-lived, though. So to re-experience it, users reach for another dose, and gradually the body develops a tolerance, meaning it needs more to get the same effect.

Once tolerance and dependence develop, withdrawal symptoms are inevitable when you try to stop, which is why so many smokers “want to quit” but don’t.

Psychological addiction

Smoking is a habit, and as simple as that sounds, many habits are hard to break because we come to rely on them, and they become part of life. Once someone has started smoking regularly, rituals begin to develop and can become very deeply rooted. They make people feel good, secure and able to cope.

Rituals are prevalent in all addictions, and they’re devised routines recognized by the brain and associated with behaviors or actions. These behaviors and actions in themselves can become triggers for cravings.

For example, having a cigarette first thing in the morning and last thing at night. Or associating a cup of coffee with smoking. Otherwise, enjoying a smoke after a meal or sex.

People do that because nicotine adds to the pleasure of, say, a cup of coffee, a meal or sex, bringing on feelings of relaxation and contentment.

The same effects of nicotine can be attached to stressful situations as well. High-pressure situations can be made easier as the body gets a surge of adrenaline and the brain is flooded with pleasurable feelings. But, unfortunately, this can make people smoke even more than usual when they’re trying to reach a challenging goal or get through a rough patch.

Socializing is another way people can subconsciously create smoking rituals. Caught up in the enjoyment of good company, they enhance the experience with nicotine, especially when with other smokers.

The effects of psychological addiction are subtle, pliable and vary from person to person. Most people are unaware that they have a psychological dependence. However, they know if they can’t complete their rituals, which immediately results in frustration and stress.

Signs you have a nicotine addiction

The DSM-5 lays out guidelines for the diagnosis of a tobacco use disorder, which include –

• An individual has regularly used tobacco for more than a year
• More tobacco is used than intended, and it increases over time
• Inability to quit or cut down, despite genuine efforts
• Cravings and a desire for tobacco develops
• Excessive time is spent to find, get or use tobacco
• The user will relinquish responsibilities because of tobacco use
• Use persists despite negative impacts on relationships and social life
• The user is willing to abandon social, career and other activities to use tobacco
• The user is prepared to use tobacco in harmful situations if necessary
• Use remains persistent even when faced with physical or emotional challenges related to tobacco
• Withdrawal symptoms occur when an effort is made to stop or reduce usage

Some of the DSM-5’s framework might seem extreme when you first read it, and many smokers may be inclined to dismiss it. If you think it doesn’t apply to you, look a little closer.

Maybe you could think that your smoking doesn’t make you relinquish responsibilities or that it has no impact on your career.

Ask yourself a few questions. For example, how long are your smoke breaks? Do you expect others to watch your workstation while you’re puffing away? Would you resign if your employer banned smoking entirely on the premises? What if your favorite restaurant banned smoking; would you still go there? Or how about people who openly object to secondhand smoke; do you side-step them socially or at work?

The other point that trips people up is “be prepared to use tobacco in harmful situations if necessary”. Think of people who smoke while at a gas station or sneak a cigarette while admitted to a hospital. And how often have you carelessly discarded a cigarette butt in a public place without considering it’s a potential fire hazard?

Careless handling of lighted cigarettes causes an average of 100,000 fires annually in the USA.

When we look at all the diagnostic criteria this way, we can see how much time is spent perusing and using tobacco products, and sometimes, how thoughtless smokers are. Often displaying a “my way or the highway” attitude to protect or pursue their next nicotine hit.

Such single-minded pursuit of something defines addiction.

Withdrawal

Withdrawal can start within a few hours or a day or two, depending on the frequency and amount of usage. They usually peak within the first week and subside after a few weeks, but they can continue for months. There are indications that the severity of withdrawal is influenced by genetics.

Symptoms can include –

• Cravings
• Anger, frustration or irritability
• Anxiety, agitation or nervousness
• Depression or mood swings
• Diarrhea or constipation
• Difficulty concentrating
• Fatigue and insomnia
• Headaches
• Increased appetite
• Increased coughing
• Reduced heart rate
• Tremors

The severity of withdrawal symptoms depends on how long and how much nicotine you’ve been using.

Remission or recovery is outlined too in the DSM-5 –

• Early remission: no tobacco use for 3 to 13-months
• Sustained remission: no tobacco use for more than a year

How to treat nicotine addiction

There’s no formal treatment for nicotine addiction and no specific rehab programs. Where parallel addictions exist, admission to a treatment center may be necessary.

Pre-existing mental health issues such as depression, anxiety, schizophrenia and bipolar disorder may initially benefit from nicotine intake, but over-reliance can develop into nicotine addiction. Treatment for the mental health problems must, however, be addressed separately from nicotine dependency.

Giving up nicotine is beneficial, whether you’ve been smoking for decades or a short while only. Scientific research indicates a combination of medication, counselling, mindfulness training and joining a support group works well for most people.

For any treatment to be effective, though, the addict must be willing. Persistent reservations will impact long-term recovery and increase the chances of relapse.

The US Food and Drug Administration (FDA) has approved drugs to help give up tobacco. Known as smoking cessation medications, they ease withdrawal and help curb cravings. Pharmaceutical medications include bupropion and varenicline and are intended for short term use only.

Nicotine replacement therapy (NRT) involves replacing tobacco products with nicotine substitutes such as nicotine gum, inhalers, lozenges, nasal sprays and patches. They relieve withdrawal symptoms and reduce cravings by delivering small, controlled doses of nicotine into the body. It’s crucial to note, though, that overuse can lead to addiction.

However, simply giving up nicotine completely and conquering withdrawal won’t deliver long-lasting results, and chances of relapse are high. This is because tobacco use is physically and psychologically addictive, so both aspects must be addressed. Completely cutting nicotine out only gets it out of the system, but not the mind.

Addicts need to accept psychological addiction and be willing to identify and break ritual habits, including other smokers attached to their using. No one else can do this for them because rituals are unique to the addict’s lifestyle.

Giving up tobacco needs preparation, planning and external support. Nicotine addicts must be prepared to maintain their long term recovery by working on the psychological triggers of their dependence.

Recommended therapies include –

Cognitive Behavioral Therapy (CBT) helps patients identify triggers and equips them with relapse prevention tools. It also teaches coping skills, and therapists will help devise strategies to handle future triggering situations. Research indicates that CBT is particularly beneficial for people who use NRT and CBT simultaneously.

Mindfulness training teaches patients to become more aware of and detached from cravings, sensations and thoughts that may cause relapse. Instead of resisting them, triggering thoughts are observed purposely and cognitively reframed as expected and tolerable. Patients also learn techniques to tolerate negative emotions without reaching for nicotine. Mindful-based treatments benefit overall mental health and well-being and prevent nicotine relapse.

Telephone support and quitlines have been implemented across all states and by the US department of health and Human Services to control nicotine addiction. Trained smoking cessation counsellors are available to answer questions and offer multiple counselling sessions. Statistics show that tobacco users who participate in three or more calls are more likely to quit altogether than those who use smoking cessation medications or NRT only.

Quitting nicotine

Since there’s no inpatient treatment for coming nicotine-clean, addicts must plan their lives around the early days to allow the symptoms of withdrawal to run their course.

There’s no need to do this alone because doctors are aware of the problem, and there are different medications to treat the various symptoms.

Being aware that you might experience discomfort and distress prepares you and others, which leads to more consideration and less friction.

Here’s how to approach quitting nicotine –

Before you actually stop using, keep a nicotine diary. It’s an excellent starting place to get a clear picture of how much you use, why and when. The diary must be user-friendly and readily available so you can record all habits and triggers as you become aware of them. Also, record every time you use.

It might take a few days to get a clear picture, so be dedicated, precise and honest. Remember, smoking rituals are ingrained habits; consequently, they might be trying to identify them since the intention to use can come long before you smoke.

A perfect example is if you associate eating and drinking with smoking. Early in the morning, you subconsciously decide what you’re having for lunch and know that a cigarette will follow it. Therefore, the trigger and intent exist long before you take action, and it’s part of your daily routine, making it less noticeable.

Once you know how much you take in and why you can set a date to stop.

Take a few days leave if you can and clear as many responsibilities from your schedule as possible. Get the support of family and friends to help you through the early days, which can be challenging.

Remove all tobacco products from your environment and if you live or work with smokers, ask them to keep their cigarettes out of your sight and reach. Remove all paraphernalia you relate with using, like lighters and ashtrays as well.

At the same time, make a doctor’s appointment to get a prescription to ease withdrawal. Over-the-counter options like gum, patches, and lozenges are available from pharmacies but use them only when necessary because they can continue addiction if overdone.

Cravings

As soon as you start quitting, convert your nicotine diary to a craving diary. Keep a record of how you feel and when cravings kick in. Carefully consider what preceded a craving and what you were thinking just before.

This way, you can distract and gradually retrain your mind to break rituals and habits by finding healthier behavioral alternatives. On average, cravings last for no longer than 20 minutes and start to diminish steadily the longer you stay clean.

These are some ideas to cope with cravings in the first few weeks –

• Occupy your mind – stay busy with things that require thinking, like reading, crossword puzzles or online games
• Keep your hands occupied – tactile stimulation is part of smoking rituals, so use your hands by squeezing a ball or doing something similar
• Satisfy your mouth – keep healthy options such as mints, fruit, veggie sticks or nuts at hand
• Brush your teeth – freshly brushed teeth can get rid of cravings for the taste of tobacco
• Hydrate your body – water eases the effects of withdrawal and also reduces cravings
• Get active – take a long slow walk or go for a jog; being active occupies your body and mind and speeds up blood flow and metabolism to enable the elimination of toxins
• Stay calm – doing things that relax you slows down your heart rate and encourage sleep, which is essential for healing and

By understanding the triggers of your cravings, you can choose activities that will best distract your mind and make quitting nicotine more manageable.

Nicotine and cancer

Nicotine itself doesn’t cause cancer. Instead, cancer is caused by carcinogenic chemical additives to tobacco products. Smoking cigarettes accounts for at least 30% of all cancer deaths in the US. Cancer deaths are twice as high among average smokers and four times higher in heavy smokers as non-smokers.

Lung cancer incidents are highest, with smoking being linked to up to 90% of cases. Other cancers associated with smoking include cancer of the mouth, esophagus, larynx, pancreas, stomach, kidneys, bladders and cervix.

It’s not only smoking that causes cancer, though. Smokeless tobacco has been linked to cancer of the esophagus, lungs, pharynx, stomach and colon.

Physical health risks

Smoking harms almost every organ in the body and is the leading cause of premature death in the US.

Apart from cancer, tobacco use causes lung diseases like emphysema and bronchitis and worsens asthma. Cigarette smoking is linked to chronic obstructive pulmonary disease. Once developed and established in the lungs, it can’t be repaired over time, even if smoking ceases.

Other complications include increased risk of heart disease and stroke. Cardiovascular disease accounts for 40% of all smoking-related deaths. Smoking is also linked to rheumatoid arthritis, inflammation, impaired immune function and type 2 diabetes.

The effect of passive smoke

Passive or secondhand smoke is the smoke inhaled by people other than the smoker, including non-smokers, babies and children.

It’s become a significant public health concern and the reason why smoke-free policies have been enforced in many public places.

Medical research has shown that passive smoke increases the risk of disease and exposure to secondhand tobacco smoke increases the risk of lung cancer in non-smokers by around 20%.

Secondhand smoke is responsible for 53,800 deaths annually in the USA. Regular exposure to tobacco in the home is also a risk factor for asthma in children.

Another issue that’s come to light is third-hand smoke. This is the residue left by smoking on surfaces. There’s increasing evidence that it poses dangers to people, and children in particular, as well as pets.

Fumes released by the residue get inhaled and ingested, and although research is still in the early stages, indications are that it can cause behavioral and physical complications.

How to help someone with a nicotine addiction

If you think you might be nicotine dependent, even if you’re not a heavy smoker, you probably are and should make quitting a priority.

When it’s someone else, unless they have confided their addiction in you, it’s much more of a challenge. Smokers tend to socialize with other smokers, which complicates decisions because stopping doesn’t only mean cutting out nicotine but potentially losing friends as well.

Many people have also become immune to the warnings that smoking is bad for their health and will shy away from what they perceive to be another lecture.

Without their buy-in, you’ll make little progress, so initial efforts must be to get them to see the potential dangers in using nicotine regularly. Instead of confronting them, rather focus on the effects of their addiction and voice genuine concern.

For example, if the person avoids smoking-free outings, tell them that you’d love to spend more time together and miss their company when they don’t join in. Or, if they have health issues, explain that you’re concerned that their tobacco use is making it worse.

Avoid being accusing or issuing harsh ultimatums because that will only push them away. Tell them about your research and encourage them to do some of their own. Suggest they keep a nicotine diary for a week and work through it with them in a reassuring way.

Once they see how much nicotine they take in and the potential effects on their mental and physical health, it can motivate them to take action. Only if they decide they want to quit can you offer genuine help.

Work together on a recovery plan, discuss a stop date and be there to support them through the early days of withdrawal and change of lifestyle. Offer to keep them accountable and motivated once they’re through early recovery and in the months afterwards.

Breaking a nicotine habit isn’t an overnight event; it’s a long and often complex process that impacts many levels of life, so be patient and kind.

The longer someone is nicotine-free, the more significant the positive impact on their life and the less help they’ll need.

Helpful telephone numbers

In the case of a medical emergency, always call 911 immediately for help.

• Poison Control Centre: 1-800-222-1222 (24 hours a day, 365 days a year)
• SAMHSA: 1-800-662-4357/ 1-800-487-4889 (24 hours a day, 365 days a year info service)
• National Suicide Prevention Lifeline: 1-800-273-8255 (24 hours a day, 365 days a year)
• Across-states Quitline: 1- 800-784-8669 (24 hours a day, 365 days a year)
• US Department of Health and Human Services Quitline: 1-877-448-7848 (24 hours a day, 365 days a year)

Books worth reading

All books listed are available on amazon.com –

• The Craving Mind: From Nicotine To Smartphones To Love – Why We Get Hooked And How We Can Break Bad Habits – Judson Brewer and Job Kabat-Zinn
• How To Stop Dying For A Nicotine: A Workbook-Diary To Enable Smokers To Break The Habit Without Drugs, Substitutes Or Withdrawal – Ruthe price
• My Gift To Help You Quit Smoking: Stop Smoking And Stay Nicotine Free. Why I Started To Smoke Nicotine And How I Liberated Myself from Tobacco Addiction – Peter Kruse
• The Smoking Cure: How To Quit Smoking Without Feeling Sh*t  – Caroline Cranshaw and Grant Bodle
• Allen Carr’s Easy Way To Stop Smoking: Read This Book And You’ll Never Smoke A Nicotine Again – Allen Carr

Conclusion

All addictions impact people close to the addict, and nicotine addiction has the added effect of negatively affecting strangers through inhaling passive smoke and inhaling and ingesting third-hand nicotine deposits.

Health warnings are sincere, and there’s extensive research to back up claims that nicotine not only causes addiction but is directly linked to reduced quality of life and premature death.

Unfortunately, it’s readily available and socially acceptable, meaning that many people ignore warnings and put themselves and others at risk.

That said, recovery from nicotine addiction is equally well researched, and there are tried and tested treatment options available to ensure success. According to the CDC, around 62% of people who wanted to quit smoking in 2018 succeeded.

Whilst there’s no doubt that giving up tobacco is challenging in the early stages, it’s doable once you set your mind to it. And there are plenty of resources to get you through.

Overcoming nicotine addiction will improve every aspect of your life. The good news is that many existing physical health conditions that are not yet chronic can heal and eventually disappear the longer you’re nicotine and tobacco-free.