Nicotine addiction is a complex condition in which one develops a physiological, cognitive, and emotional dependence upon nicotine. Nicotine is a highly addictive drug. Now with contemporary options for consumption, the way it is consumed has changed drastically. Though difficult, it is possible to discontinue use permanently. Smoking cessation treatment, medications, products, programs, support, and information are readily available for those ready to quit.
At this time, research has provided mounting evidence supporting the dangers of tobacco consumption. In fact, it is still the leading cause of preventable death.3 Much less is known regarding the effects of vaping. Although recent studies have provided a mix of information, it is important to know that these are relatively short-term studies, whereas we are still learning more about longer term effects.
What Is Nicotine Addiction?
The term nicotine addiction is not a formally recognized disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The manual does include tobacco use disorder,1 which includes symptomology built upon the addictive effects of nicotine. Traditional tobacco products include cigarettes, cigars, chewing tobacco, dip, and snuff. Today there are many ways to consume nicotine that go well beyond tobacco products. These include electronic smoking devices and nicotine gum as well as passive (secondhand) smoke.
How Nicotine Affects the Brain
Nicotine is a highly addictive substance in any form. Like other drugs, alcohol, and anything one enjoys; it activates the brain’s reward center. Essentially, nicotine activates nicotinic receptors (already present in the brain), which release dopamine.4 This sensation is what leads to the euphoric “buzz” that many nicotine users describe experiencing. As tolerance builds, it requires more nicotine to get the high.
All the while, one’s brain chemistry is changing. As one continues smoking, the brain develops additional nicotine receptors.4 In fact, research has found that addicted smokers have billions more nicotine receptors than non-smokers. 4 When nicotine use ceases, the pleasure ceases as well.4 This is what leads toward characteristic withdrawal syndrome with symptoms including irritability, frustration, or anger; anxiety; difficulty concentrating; increased appetite; restlessness; depressed mood; insomnia.1
Signs of Nicotine Addiction
The presentation among children, teens, adults, and seniors varies in part due to environmental conditions and accessibility. For instance, children and teens oftentimes live at home under supervised guardianship. Underage nicotine use in the household is generally frowned upon and a punishable offense. It is also illegal for them to purchase or be given nicotine products until they reach the age of 21.5
For adults 21 and over, nicotine products are easily accessible. They are for sale at grocery stores, gas stations, tobacco shops, vape shops, and online. Also, if one spends a lot of time with others who use nicotine, it is socially acceptable and reinforces the behavioral. These considerations are also true for teens, although they have more limitations.
Although anyone may begin consuming nicotine at any time for any reason, adults are more likely to be former tobacco smokers who switched to vaping in “hopes of quitting.” Although the intentions are good, this is not recommended.6 Nicotine is the most addictive substance in tobacco, and vaping products do vary in terms of nicotine content.
Some e-liquids contain even more nicotine. It is also likely that one may switch habits into smoking in places otherwise unpermitted, such as in the home, car, work, and social gatherings. In said cases one bad habit is replaced with another.
Symptoms of Nicotine Addiction
Although the means of nicotine consumption has changed in many cases, the presentation is similar to traditional tobacco use.
A modification of the DSM-5 symptoms for tobacco use disorder (essentially replacing the word “tobacco” with “nicotine” and abbreviating a bit) applied to nicotine addiction are as follows:
- Consuming nicotine in larger amounts over a longer period than intended
- Persistent desire or unsuccessful attempts toward cutting down or controlling nicotine consumption
- A great deal of time is spent obtaining and consuming nicotine
- Craving or strong urge to use nicotine
- Recurrent nicotine use resulting in a failure to fulfil major role obligations
- Continued nicotine use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by its effects
- Important social, occupational, or recreational activities are given up or reduced
- Recurrent nicotine use in situations in which it is physically hazardous
- Nicotine use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by nicotine
- Tolerance, as defined by either a need for increased amounts of nicotine to achieve the desired effect or diminished effect with continued use of the same amount.
- Withdrawal, as manifested by either the characteristic withdrawal syndrome for nicotine or it is taken to relieve or avoid withdrawal symptoms.
If there is any wonder as to whether one is addicted to nicotine or not, a telltale sign is whether one experiences withdrawal symptoms and an urge to consume upon abstaining.
Causes & Triggers of Nicotine Addiction
Causes and triggers of nicotine addiction do vary by individual but may be considered through one’s biological, social, and psychological factors. Although anyone may try nicotine or become addicted at any time, there are common causes and triggers that contribute toward addiction being more likely. The more causes and triggers present, the more likely one’s vulnerability.
Causes and triggers for nicotine addiction may include the following:
- Genetic predisposition to addiction
- Family history of nicotine use/addiction
- People in one’s social group (e.g., loved ones, family, friends, co-workers) use nicotine
- Easy access to nicotine consumption devices
- Having a personal history of smoking or other nicotine use
- Enjoying the euphoric “high” or “buzz” associated with nicotine use
- Stress
- Boredom
- Loneliness
- Trauma or loss
- Easing the tension of drug and/or alcohol recovery
- Current diagnosable mental health and/or substance use disorder
This list is by no means all-inclusive but does consider many common factors for concern. If any of these causes and triggers are present, it is especially important to be mindful of nicotine use with abstinence being the most recommended approach.
Treatment for Nicotine Addiction
There are many options for treating nicotine addiction. The preferred method of treatment will vary depending upon the severity of the addiction, accessibility to various treatment options, and one’s personal preferences. Common options include behavioral treatments, support groups, nicotine replacement therapies (NRTs), and other medications. The more comprehensive the treatment, the higher likelihood of successful outcomes. Many engage in multiple forms of treatment.
Therapy
During therapy, you may focus on the biological, psychological, and social factors that contribute to a nicotine addiction. Therapist may consider genetic predispositions, medical conditions, mental health, beliefs, thoughts, emotions, attitudes, behavior, past trauma, and the environment in which one lives and is generally active.
Common Types of Therapies
Cognitive behavioral therapy (CBT) is a recommended therapy for treating nicotine addiction. With CBT, a therapist and patient explore the beliefs, thoughts, and behaviors associated with the patient’s nicotine use.
A strategy oftentimes used with substance use disorders, motivational interviewing (MI), may help assess from the onset of therapy how motivated one is to change. If one is not motivated, then the focus will be on educating the individual about the harm of nicotine while determining what will serve as motivation. If one is motivated, then the actual work may begin toward enacting change.
Some specially trained and certified therapists even employ hypnotherapy to stop nicotine use.
Intended Treatment Outcome & Timeline
Given the addictive nature of nicotine, it is likely that treatment will take time. Recent statistics provided by the Centers for Disease Control and Prevention (CDC) revealed that in 2018 about 55.1% of adult smokers had attempted to quit smoking in the past year.3 Of those who attempted quitting, about 7.5% succeeded.3 Although these numbers may seem discouraging, the fact is that people can and do quit every day. It is a matter of personal motivation and perseverance to attain and maintain recovery.
Though relapse is highly probable, it is important to redirect oneself back on track. Given the sensitivity of these individual factors, the treatment outcome and timeline will vary. Remember, every bit that one cuts back from using nicotine is a step in the right direction, and it’s possible to create an effective relapse prevention strategy.
Lifestyle Changes
It may prove necessary to change one’s “persons, places, and things” as they say in recovery. At the very least, one will need to distance from nicotine related products and devices. The better able one is to remove potential triggers, the greater likelihood of successful outcomes.
Some suggestions for helpful lifestyle changes include the following:
- Identify triggers and situations in which you typically use nicotine and prepare accordingly.8
- Be honest with your social network in letting them know you are quitting nicotine and would appreciate their support.8
- Focus on those positive thoughts that reinforce quitting.8
- Avoid environments that expose you to nicotine use.8
- Consistently remind yourself why you quit smoking and review literature that supports those thoughts.8
- Avoid drinking alcohol until you have completely given up nicotine and feel confident in your ability to maintain.8
- Treat yourself when you achieve certain milestones (e.g., one week, month, year abstained).8
- Recognize that cravings are temporary and will pass. Utilize positive self-talk, structured breathing exercises, and other social support to work through cravings when having a difficult time.8
Medications
Various NRTs and medications have demonstrated positive outcomes for those who are committed to nicotine cessation. Oftentimes, these are suggested or prescribed as part of a treatment regimen. Commonly used NRTs include nicotine gum, transdermal patch, nasal sprays, inhalers, and lozenges.9
Other medications include bupropion (Zyban) and varenicline (Chantix).9 Whether taking something over the counter or prescribed, it is important to first consult a physician before taking one. Each person’s chemistry is different, and the side effects of such medications may prove as—if not more—detrimental than nicotine consumption itself.
How to Get Help for Nicotine Addiction
Getting help for nicotine addiction begins with an acknowledgement of the problem. Because nicotine is known as an unhealthy product for consumption, any use may be determined problematic. Continued and progressive use, however, may meet the criteria for addiction. First, it is important to become as informed on nicotine addiction as possible. Second, it is important to review available treatment options and resources. Upon finding some appropriate options, research them in full.
Note that nicotine addiction is not a formally recognized diagnosable disorder. Tobacco use disorder is. Prior to beginning any treatment with associated costs, it is recommended to discuss cost with the provider. Further, it is recommended to check with one’s managed care organization (e.g., insurance, Medicaid, Medicare) to determine coverage. There are numerous free resources both online and offered through various organizations. These include information, structured smoking cessation strategies, and support groups.
How to Get Help for a Loved One
When getting help for a loved one it is important to begin by following the previously mentioned steps. From there, you may engage in a supportive conversation. Remember that nicotine addiction is something that most people cannot just quit on a whim. It takes hard work, time, and support.
It is likely that your loved one may be in denial about the problem or become resistant. Should this happen, remain as supportive and objective as possible. Try to avoid lecturing, shaming, or insulting your loved one. The two of you are in this together.
If you are also addicted to nicotine, quit together. This may involve reviewing the same research, attending groups, and engaging in treatment together. Setting a positive example is helpful, as actions speak louder than words. A final tip is to anticipate and work through relapses. Relapse is a likely occurrence in recovery. Because one relapses does not mean that all recovery efforts are lost, and the person will reengage in habitual use. Rather, it is an indication that something went wrong and needs to be adjusted. Work through the relapse together.
Living With Nicotine Addiction
With the appropriate mindset and support, one may live a healthy life in recovery—rebalancing the biological, psychological, and social factors that initially led toward addiction. The keys to any recovery effort are intention and consistency. This entails keeping recovery at the forefront of one’s mind while taking the appropriate steps to get back on track whenever that effort is threatened.
Considerations for living with nicotine addiction in recovery include:
- Actively engaging in treatment
- Taking medications (if appropriate) as directed or prescribed
- Establishing and maintaining positive support
- Removing all nicotine related products and devices from one’s home, person, etc.
- Focusing on the positive
- Refraining from other forms of substance use (e.g., alcohol, drugs)
- Engaging in healthy hobbies and activities (e.g., exercise, hiking, reading, writing, etc.)
- Attending support groups
- Sponsoring someone else recovering from nicotine addiction
- Keeping informed on the latest literature regarding nicotine addiction
- Living a generally healthy lifestyle
Although this list provides some key considerations for life in recovery, it is by no means all-inclusive. What works for one may not work for another. Do consider what works best for you and go from there. These activities are ones that will be explored in therapy.
Nicotine Addiction Tests, Quizzes, and Self-Assessment Tools
Many nicotine addiction tests, quizzes, and self-assessment tools have been developed to assist with determining whether one has an issue with nicotine use and to what extent. Such tools are available for professional and personal use. For those who believe they may have a problem with nicotine, it is recommended to complete one or more of these tests and follow up with a professional.
Tests performed by Professionals
Tests performed by professionals are the best means of achieving accurate insights into nicotine addiction. Professionals are trained and experienced with the administration of these tools and diagnostic protocol. Further, the tests they use are developed through a rigorous research process and retested to ensure validity and reliability.
The Fagerstrom Test for Nicotine Dependence (FND) is one recommended screening tool for clinicians available through the National Institute of Drug Abuse (NIDA).11 The tool asks questions specific to smoking cigarettes, which may also be considered in terms of a different preferred method of nicotine consumption.11
Self Assessment
Quizzes and self-diagnosis tests are an appropriate means of personally assessing whether an issue might be present. Depending on the results of said test, one is encouraged to follow up with a professional. These tests are readily available online, at various health centers, and elsewhere. At no point should a person without clinical training attempt to diagnose oneself or another person. Again, these are meant as a general indication of a problem and require further professional assessment.
Nicotine Use Statistics
Most research pertaining to nicotine use is specific to tobacco, as tobacco use disorder is an officially diagnosable condition. As vaping has grown in popularity, more studies have begun exploring its effects. Comparing the two conditions has helped provide insight into how significant of a problem nicotine use is both within our nation and globally.
According to a data collection on studies researching smoking and tobacco use, the CDC highlighted some of the following:
- More than 16 million Americans are living with a disease caused by smoking.13
- For every person who dies because of smoking, at least 30 people live with a serious smoking-related illness.3
- Worldwide, tobacco use causes more than 7 million deaths per year. If the pattern of smoking all over the globe doesn’t change, more than 8 million people a year will die from diseases related to tobacco use by 2030. 3
- Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including more than 41,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1,300 deaths every day.3
- On average, smokers die 10 years earlier than nonsmokers.3
- If smoking continues at the current rate among U.S. youth, 5.6 million of today’s Americans younger than 18 years of age are expected to die prematurely from a smoking-related illness. This represents about one in every 13 Americans aged 17 years or younger who are alive today.3
- Percentage of U.S. adults aged 18 years or older who were current cigarette smokers in 2018 include 13.7% of all adults (34.2 million people): 15.6% of men, 12.0% of women3
- Thousands of young people start smoking cigarettes every day with about 2000 people younger than 18 years smoking their first cigarette and over 300 becoming daily cigarette smokers.3
Key findings from the 2018 National Health Interview Survey revealed the following regarding e-cigarette use among adults:
- In 2018, 14.9% of adults had ever used an electronic cigarette (e-cigarette), and 3.2% were current e-cigarette users.10
- The prevalence of adults who had ever used an e-cigarette and were current users was highest among men, non-Hispanic white adults, and those aged 18–24.10
- Compared by cigarette smoking status, adults who quit smoking cigarettes within the past year were the most likely to have ever used (57.3%) and to be current (25.2%) e-cigarette users.10
Regarding electronic cigarette use among youth, the CDC gathered the following statistics:
- E-cigarettes have been the most commonly used tobacco product among youth since 2014.2
- After increasing between 2017 and 2019, current (past 30 day) use of e-cigarettes went down among middle and high school students from 2019 to 2020.2
- About 1 of every 20 middle school students (4.7%) reported in 2020 that they used e-cigarettes in the past 30 days—a decrease from 10.5% in 2019.2
- About 1 of every 5 high school students (19.6%) reported in 2020 that they used electronic cigarettes in the past 30 days—a decrease from 27.5% in 2019.2
- Flavorings in tobacco products can make them more appealing to youth. 2
- In 2020, 85% of high school students and 74% of middle school students who used tobacco products in the past 30 days reported using a flavored tobacco product during that time.2
These numbers are quite alarming, especially considering that e-cigarette use among youth is rapidly increasing, meaning that there will be a new generation of adults vaping. This cycle will continue without appropriate awareness and precaution.
For Further Reading
The following are helpful resources for anyone impacted by nicotine addiction:
