(Tobacco Use Disorder; Smoking Addiction)
Nicotine addiction is a dependence on nicotine when it is used regularly. Nicotine can be found in tobacco products, such as:
- Chewing tobacco
Drugs stimulate unnecessary chemical release in the brain.
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Nicotine acts on the brain's chemistry. It creates feelings of pleasure. These feelings go away within a few minutes. People will need to keep using nicotine to feel this way again. This cycle can lead to addiction.
Use of nicotine products is the main risk factor.
The risk of addiction increases with:
- Family history or exposure to smoking
Symptoms only happen when nicotine is not being used. This is known as withdrawal. Symptoms are:
- Increased hunger
- Thinking and attention problems
- Trouble sleeping
The doctor will ask about symptoms and past health. The person will also be asked about their history of using tobacco products. A physical exam will be done.
A blood test can check cotinine level in the saliva or blood. This will show changes in nicotine use. The doctor may use it to check the person's progress.
The doctor can help the person develop a treatment plan. Treatment may involve one or more therapies. Options include:
Nicotine Replacement Therapy (NRT)
NRT eases withdrawal symptoms. NRT products include:
- Nicotine gum
- Nasal sprays
The chance of becoming dependent on these products is low. NRT does not create the same "feel good" feelings as nicotine.
NRT may help the person to:
- Avoid smoking
- Reduce the amount of tobacco they use
- Quit and stay smoke-free
Electronic cigarettes (e-cigarettes) turn liquid nicotine into a vapor. There is conflicting evidence on whether or not they may help a person quit. In addition, the long-term effects of e-cigarette use are not known.
Behavioral therapies include:
Medicine that may help a person quit include:
- Nicotine partial agonists—mimics effect of nicotine to ease withdrawal
Other medicine may help ease withdrawal symptoms. A third type may be used if a person starts smoking again. It blocks the pleasure feeling when they use nicotine.
The best prevention is to never use tobacco products. Try to avoid places where people are smoking as well.
- Jenssen BP, Walley SC. E-cigarettes and similar devices. Pediatrics. 2019;143(2):e20183652.
- Prochaska JJ, Benowitz NL. Current advances in research in treatment and recovery: Nicotine addiction. Sci Adv. 2019 Oct 16;5(10):eaay9763.
- Stay away from tobacco. American Cancer Society website. Available at: https://www.cancer.org/cancer/risk-prevention/tobacco.html.
- Tobacco, nicotine, and e-cigarettes research report. National Institute on Drug Abuse website. Available at: https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/introduction.
- Tobacco use. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/tobacco-use-22.
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