Nicotine (Tobacco) Addiction

By Edmund Murphy

Last updated: 16 April 2024 & medically reviewed by Dr. Celeste Small

What is nicotine?

Nicotine, found in tobacco plants and synthetic chemicals, is a stimulant that is one of the most widely abused substances along with alcohol in the world. It is also one of the most addictive substances on the planet and extremely harmful to health. Tobacco is normally smoked and inhaled into the lungs, causing increased alertness and relaxation for regular smokers.

Tobacco use and health

Though tobacco use has reduced significantly over the years, owing largely to public health campaigns and regulations on public smoking, it still causes thousands of deaths per year. 

In the United States alone, cigarettes and other tobacco products are responsible for more than 480,000 deaths annually. Of these, 41,000 are the result of second-hand smoking.^[1]

Tobacco use greatly increases the risk of developing various forms of cancer, especially those related to the lungs, throat, and mouth. It can also lead to other respiratory disorders as well as cardiovascular issues. On average, those who smoke live ten years less than non-smokers.

Is nicotine legal?

Nicotine is sold legally in tobacco-based products such as cigarettes, rolling tobacco, chewing tobacco, and pipe tobacco as well as in vape liquids; all of which are regulated by the Federal Drug Administration (FDA). As of 2019, it is illegal to sell nicotine products to anyone under the age of 21, and in some countries, such as New Zealand, tobacco products are banned altogether if you are born after 2008.

Read here to learn more about substance regulations.

Forms of tobacco and nicotine

Tobacco has been used across the globe for centuries and comes in many forms. The most common include:

Cigarettes - Also known as “smokes”, “straights”, “tabs”, and “fags”, cigarettes are the most widely used version of tobacco and nicotine intake. Cigarettes can come as pre-made sticks with a filter on the end or as rolling tobacco to be made by the smoker. 

Cigars - Cigars, such as Havanas or Robust, are a more concentrated form of tobacco. The smoke from cigars (or “stogies”) is not intended to be inhaled but rather held in the mouth to get the full effect of its pungent taste and aroma. 

E-cigarettes (E-cigs) - One of the primary reasons for increased nicotine abuse despite the crackdown on cigarettes is due to e-cigarettes. Often referred to as vapes, e-cigs contain a synthetic form of nicotine that is atomised into a flavored vapor that resembles smoke. Vaping is widely popular among young people, owing to increased nicotine addiction in America’s youth. 

Pipes - Less widely used than a century ago, pipes are a traditional method of inhaling tobacco smoke. Pipes are often seen today as gimmicky and are rarely used by anyone other than connoisseurs.

Chewing tobacco - Another form of tobacco use that has declined in popularity is chewing tobacco, or “dip”. Unlike other forms of tobacco use, dip is held in the mouth and chewed to release nicotine instead of inhaling it into the lungs. Though the risks of lung cancer are lower with chewing tobacco, it greatly increases the risk of oral and throat cancers.

Side effects of nicotine

Nicotine and smoking statistics

These statistics were compiled by the CDC and relate to cigarette use only.^[1]

• 13.7% of all adults (34.2 million people) in the US are smokers (2018)

• Of these, 15.6% are men and 12.0% are women.

• The total economic cost of smoking is more than $300 billion a year

• This includes more than $225 billion in direct medical care for adults and $156 billion in lost productivity due to premature death and exposure to secondhand smoke

• More than 16 million Americans are living with a disease caused by smoking.

• Each day, about 2000 people younger than 18 years smoke their first cigarette.

• Each day, over 300 people younger than 18 years become daily cigarette smokers.

• In 2018, more than half (55.1%) of adult cigarette smokers had made a quit attempt in the past year.

• More than 7 out of every 100 (7.5%) people who tried to quit succeeded.

How long does nicotine stay in your system?

How long nicotine stays in your system depends on many factors such as age, weight, gender, frequency of use, and physical fitness. However, nicotine will show up on most drug toxicology tests and an average for the four main types of tests can be given. These are:

The nicotine found in cigarettes and e-cigarette liquids is mainly absorbed into the body through membranes in the lungs, mouth, and throat. It can also be absorbed through the gastrointestinal tract if using a nicotine lozenge or chewing tobacco, as well as through the skin when using nicotine patches. 

Read here to learn more about how long substances stay in your system.

Nicotine addiction

Nicotine in all its forms is incredibly addictive. Regardless of what method of taking the substance, it reacts with the same pleasure and reward receptors in the brain as other stimulants such as cocaine or amphetamines, though on a smaller scale. 

These receptors release the chemical dopamine into the brain which is responsible for happiness and pleasure. When nicotine is taken regularly, the brain builds up a tolerance to the levels of dopamine being produced, eventually becoming unable to produce the same levels on its own. 

This leads to physical dependence, where more nicotine is required to feel normal. As the effects of nicotine are felt quickly and dissipate rapidly, those with a physical dependence will often need high amounts of the substance to feel its effects. 

Once someone has developed a dependence on cigarettes and other sources of nicotine, the signs of addiction will often not be far behind. One of the strongest indicators of addiction is withdrawal, which occurs when someone stops smoking suddenly.

E-cigarettes and teen nicotine addiction

E-cigarettes have become increasingly popular among young people and teens over the last decade. Once seen as an acceptable alternative to traditional tobacco products, research has shown that more young people are moving on to smoke real cigarettes after using e-cigs. In fact, a 2019 study published by JAMA found that young people who vaped were more than four times as likely to move on to real cigarettes than those who didn't.  

This is in part due to the increased nicotine content found in e-cigarettes and vaping liquid. Prior to 2015 and the introduction of JUUL to the vaping market, most e-cig products contained between 1% and 2.4% nicotine. JUUL introduced pods that contained 5% nicotine, which is equivalent to around 20 normal cigarettes. This has driven up the average nicotine content in vaping liquids across the market and has led to more young people becoming addicted to the substance as well as increased numbers of teens moving on to real cigarettes.

Nicotine withdrawal

Treating nicotine addiction: Does it require rehab?

Quitting nicotine can be extremely hard to do without help but it is not impossible. Unlike harder drugs such as heroin or crack, there isn’t as much social stigma around nicotine addiction, meaning more people are likely to seek treatment and effective remedies are widely promoted. 

Dedicated addiction treatment via a rehab facility is rare for nicotine addiction as the physical and psychological treatment needed can often be obtained via other means.  

Here are some of the most common methods of quitting nicotine.

Therapy

Therapy is fast becoming one of the best methods for quitting smoking and other types of nicotine addictions. There are a wide variety of therapies with a proven track record of successful nicotine addiction treatment. These include:

• Cognitive behavioral therapy

• Motivational interviewing

• Hypnotherapy

• Dialectical behavioral therapy

• Mindfulness sessions

The advantages of therapy and counseling for nicotine addiction is its wide availability throughout the US and the ability to try different methods. The downside is that these types of treatment are often expensive, making them inaccessible for certain people. That said, the cost of therapy will never outweigh that of ongoing nicotine addiction.

Medications

Many people addicted to smoking are able to quit with the aid of nicotine replacements such as patches, gum, e-cigs, and pills. These are good options to reduce the harmful effects of cigarettes and tobacco products but do not solve the issue of nicotine addiction. 

There are other alternatives to nicotine replacement products in the form of medications. Chantix (varenicline) is a popular drug to help quit smoking as it interferes with nicotines' ability to cause pleasure as well as reduce withdrawal symptoms. 

Zyban (bupropion) has similar effects but can also reduce nicotine cravings. The downside of these medications is their adverse side effects, which can include nausea, headaches, irritability, insomnia, and in extreme cases seizures.

Changes in lifestyle

Though quitting smoking and nicotine can be unpleasant and extremely difficult, thousands of people manage it each year without the need for therapy or medication. There are a few small lifestyle changes you can make that will greatly help your success in quitting nicotine.

1. Tell people you’re quitting. By telling those close to you that you’re trying to quit smoking you will increase your support network and have friends and family to help you along the way.

2. Break routine. One of the most common patterns of nicotine use among addicts is how it is used in certain scenarios. You may have a cigarette with your morning coffee every day, or need to vape after encountering a stressful situation. Breaking the cycle of when you take nicotine can help reduce the brains association with it. 

3. Set achievable goals. Quitting isn’t about stopping cold turkey and many find they have better success by reducing their intake gradually. Make a plan for how you will reduce your cigarette or tobacco intake and stick to it. 

4. Get a hobby. Distraction is a great way to take your mind off smoking, and taking up a new hobby or activity can not only reduce your nicotine cravings, but it may also just teach you a new life skill. 

5. Download an app. Motivational and health-related apps are everywhere these days and there are many fantastic ones on the market that are dedicated to helping you reduce your nicotine intake.

6. Accept that smoking isn’t failing. Quitting nicotine is a long process and occasionally you may trip up. Don’t take moments of weakness as failures though, getting back on track and sticking to your plan is the main goal and judging yourself for indiscretions is not conducive to success.