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Nicotine Addiction(Tobacco Use Disorder; Smoking Addiction)
Definition

Nictotine addiction is when a person becomes dependent on nicotine. Being dependent means there is a physical change in how your body reacts to a substance. Your body will also have a reaction when you stop using the substance.

Nicotine can be found in tobacco products such as cigarettes, snuff, chewing tobacco, cigars, or pipes. Tobacco use is also associated with several serious health conditions, such as:

Throat Cancer

Throat cancer

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Nicotine addition can be treated, often with a combination of treatments.

Causes

Nicotine acts on the brain's chemistry. It creates feelings of pleasure. However, the effects go away within a few minutes. Users will need to continue using nicotine to keep the good feelings going. This cycle can lead to addiction.

Risk Factors

Anyone who uses nicotine products can become addicted to the substance.

The risk may increased with:

  • Family history or exposure to smoking
  • Exposure to smoking in movies
  • Depression
  • Victims of bullying
Symptoms

Symptoms develop when nicotine is not being used, also known as withdrawal. Symptoms of withdrawal include:

  • Irritability
  • Craving
  • Nervousness
  • Headache
  • Thinking and attention problems
  • Trouble sleeping
  • Increased appetite
Diagnosis

Your doctor will ask about your symptoms, medical and smoking history. A physical exam will be done.

Breathing tests may also be done to see how well your lungs are working.

Your doctor may monitor your nicotine use by checking a cotinine level in your saliva or blood.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment may involve one or more therapies. Options include:

Nicotine Replacement Therapy (NRT)

NRT relieves withdrawal symptoms. NRT products:

  • Nicotine gum
  • Lozenges
  • Nasal sprays
  • Patches
  • Inhalers

The chance of abusing these products is low since NRT does not create "feel good" feelings.

NRT may help you to:

  • Avoid smoking
  • Reduce the amount of tobacco you use
  • Quit and stay smoke-free
Behavioral Therapy

Behavioral therapies include:

  • Counseling
  • Group behavior therapy
  • Telephone quit lines, cell phone programs, and text messaging programs
  • Internet and computer-based programs
  • Self-help classes and manuals
  • Cognitive behavioral therapy
Medication

Some antidepressants and nicotine partial agonists may help you quit. Other medications may help ease withdrawal symptoms or block the effects of nicotine if you start smoking again.

Prevention

The best prevention is to never use tobacco products. Try to avoid places where people are smoking.

RESOURCES:

American Cancer Society
http://www.cancer.org

American Lung Association
Freedom From Smoking
http://www.ffsonline.org

Smokefree
Telephone: 1-800-QUITNOW
http://www.smokefree.gov

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca

The Lung Association
http://www.lung.ca

References:

Kenfield SA, Stampfer MJ, Rosner BA, Colditz GA. Smoking and smoking cessation in relation to mortality in women. JAMA. 2008;299:2037-2047.

Questions about smoking, tobacco, and health. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/002974-pdf.pdf. Updated January 17, 2013. Accessed March 11, 2013.

Tobacco addiction. National Institute on Drug Abuse website. Available at: http://www.drugabuse.gov/publications/research-reports/tobacco-addiction. Updated July 12, 2012. Accessed March 11, 2013..

Tobacco use disorder. DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 16, 2013. Accessed February 24, 2014.

Tobacco use disorder. PEMSoft at EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 19, 2013. Accessed March 11, 2013.

2/27/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Etter JF, Stapleton JA. Nicotine replacement therapy for long-term smoking cessation: a meta-analysis. Tob Control. 2006;280-285.

9/24/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: LF Stead, T Lancaster. Interventions to reduce harm from continued tobacco use [review]. Cochrane Database of Systematic Reviews. 2007;3.

3/25/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Parkes G, Greenhalgh T, Griffin M, Dent R. Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial. BMJ. 2008;336:598-600.

10/14/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Shiffman S, Ferguson SG. Nicotine patch therapy prior to quitting smoking: a meta-analysis. Addiction. 2008;103:557-563.

12/16/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Eisenberg MJ, Filion KB, Yavin D, et al. Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials. CMAJ. 2008;179:135-144.

2/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Cochran CJ, Gallicchio L, Miller SR, Zacur H, Flaws JA. Cigarette smoking, androgen levels, and hot flushes in midlife women. Obstet Gynecol. 2008;112:1037-1044.

2/17/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev. 2009;(1):CD001007.

7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Myung SK, McDonnell DD, Kazinets G, Seo HG, Moskowitz JM. Effects of Web- and computer-based smoking cessation programs: meta-analysis of randomized controlled trials. Arch Intern Med. 2009;169:929-937.

7/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Lancaster T, Stead L. Self-help interventions for smoking cessation. Cochrane Database Syst Rev . 2009;(2):CD001118.

11/13/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Piper ME, Smith SS, Schlam TR, et al. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Arch Gen Psychiatry. 2009;66(11):1253-1262.

12/21/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Whittaker R, Borland R, Bullen C, et al. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2009;(4):CD006611.

11/30/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Rusanen M, Kivipelto M, Quesenberry CP Jr, Zhou J, Whitmer RA. Heavy smoking in midlife and long-term risk of alzheimer disease and vascular dementia. Arch Intern Med. 2010 Oct 25. [Epub ahead of print]

4/29/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

6/24/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed : Leonardi-Bee J, Britton J, Venn A. Secondhand smoke and adverse fetal outcomes in nonsmoking pregnant women: a meta-analysis. Pediatrics. 2011;127(4):734-741.

9/9/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Bullen C, Howe C, Laugesen M, et al. Electronic cigarettes for smoking cessation: a randomised controlled trial. The Lancet. Available at: http://download.thelancet.com/flatcontentassets/pdfs/S0140673613618425.pdf. Published September 7, 2013. Accessed September 9, 2013.

9/9/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Grana RA, Popova L, et al. A longitudinal analysis of electronic cigarette use and smoking cessation. JAMA Intern Med. 2014 May;174(5):812-813.



Last reviewed February 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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