by Preda A
(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:

  • Cigarettes
  • Snuff
  • Chewing tobacco
  • Cigars
  • Pipes
Chemical Release in Brain
Drugs stimulate unnecessary chemical release in the brain.
Copyright © Nucleus Medical Media, Inc.


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.

Risk Factors

Use of nicotine products is the main risk factor.

The risk of addiction increases with:

  • Family history or exposure to smoking
  • Depression
  • Bullying


Symptoms only happen when nicotine is not being used. This is known as withdrawal. Symptoms are:

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


You will be asked about your symptoms and health history. You will also be asked about your history of using tobacco products. A physical exam will be done.

A blood test can check cotinine level in your saliva or blood. This will show changes in nicotine use. The doctor may use it to check your progress.


Talk with your doctor about the best treatment plan for you. Treatment may involve 1 or more therapies. Options include:

Nicotine Replacement Therapy (NRT)

NRT relieves withdrawal symptoms. NRT products include:

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

The chance of becoming dependent on these products is low. NRT does not create the same "feel good" feelings as nicotine.

NRT may help you to:

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

Electronic Cigarettes

Electronic cigarettes (e-cigarettes) turn liquid nicotine into a vapor. There is conflicting evidence on whether or not they may help you quit. In addition, the long-term effects of e-cigarette use are not known.

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


Medicine that may help you quit include:

  • Antidepressants
  • Nicotine partial agonists—mimics effect of nicotine to ease withdrawal

Other medicine may help ease withdrawal symptoms. A third type may be used if you start smoking again. It blocks the pleasure feeling when you use nicotine.


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


American Cancer Society 

Freedom From Smoking—American Lung Association 


Canadian Cancer Society 

The Lung Association 


Benowitz NL. Nicotine addiction. N Engl J Med. 2010 Jun 17;362(24):2295-2303.

Tobacco and cancer. American Cancer Society website. Available at: Accessed September 2, 2020.

Tobacco, nicotine, and e-cigarettes research report. National Institute on Drug Abuse website. Available at: Accessed September 2, 2020.

Tobacco use. EBSCO DynaMed website. Available at: . Accessed September 2, 2020.

9/29/2016 EBSCO DynaMed Systematic Literature Surveillance : Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. Lancet Respir Med. 2016;4(2):116-128.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrian Preda, MD
  • Review Date: 03/2020
  • Update Date: 02/19/2021