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Nicotine dependence

Nicotine dependence — also called tobacco dependence — is an addiction to tobacco products caused by the drug nicotine. Nicotine dependence means you can't stop using the substance, even though it's causing you harm.

Nicotine produces physical and mood-altering effects in your brain that are temporarily pleasing. These effects make you want to use tobacco and lead to dependence. At the same time, stopping tobacco use causes withdrawal symptoms, including irritability and anxiety.

While it's the nicotine in tobacco that causes nicotine dependence, the toxic effects of tobacco result from other substances in tobacco. Smokers have much higher rates of heart disease, stroke and cancer than nonsmokers do.

Regardless of how long you've smoked, stopping smoking can improve your health. Many effective treatments for nicotine dependence are available to help you manage withdrawal and stop smoking for good. Ask your doctor for help.

Symptoms Causes Risk factors Complications Prevention

In some people, using any amount of tobacco can quickly lead to nicotine dependence. Signs that you may be addicted include:

  • You can't stop smoking. You've made one or more serious, but unsuccessful, attempts to stop.
  • You experience withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical and mood-related signs and symptoms, such as strong cravings, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration, anger, increased hunger, insomnia, constipation or diarrhea.
  • You keep smoking despite health problems. Even though you've developed problems with your lungs or your heart, you haven't been able to stop.
  • You give up social or recreational activities in order to smoke. You may stop going to smoke-free restaurants or stop socializing with certain family members or friends because you can't smoke in these locations or situations.

When to see a doctor

You're not alone if you've tried to stop smoking but haven't been able to stop for good. Most smokers make many attempts to stop smoking before they achieve stable, long-term abstinence from smoking.

You're more likely to stop for good if you follow a treatment plan that addresses both the physical and the behavioral aspects of nicotine dependence. Using medications and working with a tobacco treatment specialist will significantly boost your chances of success.

Ask your doctor to help you develop a treatment plan that works for you or to advise you on where to get help to stop smoking.

Nicotine is the chemical in tobacco that keeps you smoking. Nicotine is very addictive when delivered to the lungs by inhaling tobacco smoke. It increases the release of brain chemicals called neurotransmitters, which help regulate mood and behavior. One of these neurotransmitters is dopamine, which may improve your mood and activate feelings of pleasure. Experiencing these effects from nicotine in tobacco is what makes tobacco so addictive.

Nicotine dependence involves behavioral as well as physical factors. Behaviors and cues that you may associate with smoking include:

  • Certain times of the day, such as first thing in the morning, with morning coffee or during breaks at work
  • After a meal
  • Drinking alcohol
  • Certain places or friends
  • Talking on the phone
  • Stressful situations or when you're feeling down
  • Sight or smell of a burning cigarette
  • Driving your car

To overcome your dependence on tobacco, you need to deal with the behaviors and routines that you associate with smoking.

Anyone who smokes or uses other forms of tobacco is at risk of becoming dependent. Factors that influence nicotine dependence include:

  • Genetics. The genes you inherit play a role in some aspects of nicotine dependence. The likelihood that you will start smoking and keep smoking may be partly inherited — genetic factors may influence how receptors on the surface of your brain's nerve cells respond to high doses of nicotine delivered by cigarettes.
  • Home and peer influence. Children who grow up with parents who smoke are more likely to become smokers. Children with friends who smoke also are more likely to try cigarettes. Evidence suggests that smoking shown in movies and on the Internet can encourage young people to smoke.
  • Age. Most people begin smoking during childhood or the teen years. The younger you begin smoking, the greater the chance that you'll become a heavy smoker as an adult.
  • Depression or other mental illness. People who have depression, schizophrenia, post-traumatic stress disorder (PTSD) or other forms of mental illness are more likely to be smokers.
  • Substance use. People who abuse alcohol and illegal drugs are more likely to be smokers.

Tobacco smoke contains more than 60 known cancer-causing chemicals and thousands of other harmful substances. Even "all natural" or herbal cigarettes have chemicals that are harmful to your health. When you inhale tobacco smoke, you take in these chemicals, which reach most of your body's vital organs.

Smoking harms almost every organ of your body, and more than 60 percent of people who keep smoking will die because of it. Women smokers are now at equal risk to men smokers of dying from diseases caused by using tobacco. The negative health effects include:

  • Lung cancer and other lung diseases. Smoking causes nearly 9 out of 10 lung cancer cases, as well as other lung diseases, such as emphysema and chronic bronchitis. Smoking also makes asthma worse.
  • Other cancers. Smoking is a major cause of cancers of the esophagus, larynx, throat (pharynx) and mouth and is related to cancers of the bladder, pancreas, kidney and cervix, and some leukemias.
  • Heart and circulatory system problems. Smoking increases your risk of dying of heart and blood vessel (cardiovascular) disease, including heart attack and stroke. Even smoking just one to four cigarettes daily increases your risk of heart disease. If you have heart or blood vessel disease, such as heart failure, smoking worsens your condition. However, stopping smoking reduces your risk of having a heart attack by 50 percent in the first year.
  • Diabetes. Smoking increases insulin resistance, which can set the stage for the development of type 2 diabetes. If you have diabetes, smoking can speed the progress of complications, such as kidney disease and eye problems.
  • Eye problems. Smoking can increase your risk of serious eye problems such as cataracts and loss of eyesight from macular degeneration.
  • Infertility and impotence. Smoking increases the risk of infertility in women and the risk of impotence in men.
  • Pregnancy and newborn complications. Mothers who smoke while pregnant face a higher risk of miscarriage, preterm delivery, lower birth weight and sudden infant death syndrome (SIDS) in their newborn.
  • Cold, flu and other illnesses. Smokers are more prone to respiratory infections, such as colds, flu and bronchitis.
  • Weakened senses. Smoking deadens your senses of taste and smell, so food isn't as appetizing.
  • Teeth and gum disease. Smoking is associated with an increased risk of developing inflammation of the gum (gingivitis) and a serious gum infection that can destroy the support system for teeth (periodontitis).
  • Physical appearance. The chemicals in tobacco smoke can change the structure of your skin, causing premature aging and wrinkles. Smoking also yellows your teeth, fingers and fingernails.
  • Risks to your family. Nonsmoking spouses and partners of smokers have a higher risk of lung cancer and heart disease compared with people who don't live with a smoker. If you smoke, your children will be more prone to SIDS, worsening asthma, ear infections and colds.

The best way to prevent tobacco dependence is to not smoke in the first place. The best way to prevent your children from smoking is to not smoke yourself. If you're a parent who smokes, the younger your children are when you quit, the less likely they are to become smokers themselves.

Even if you don't smoke, here are some things you might try as a parent:

  • Promote smoke-free environments. Support legislation to make all workplaces smoke-free. Encourage smoke-free public places, including restaurants or other places where your teen may work.
  • Support legislation to increase taxes on tobacco products. Higher prices discourage teens from starting to smoke. Higher prices on tobacco products, coupled with smoke-free workplace laws, are the most effective public health policies to reduce smoking in adults and prevent young people from ever starting.
  • Talk with your teenagers. Ask whether their friends smoke. Most teenagers smoke their first cigarette with a friend who already smokes. Let your child know that other forms of tobacco, including cigars and smokeless tobacco, also carry significant health risks.
  • Learn what your children think about smoking. Ask them to read this article so that you can discuss it together. You can be a great influence on whether your children smoke, despite what they see in movies and on the Internet.
  • Help your children explore personal feelings. Use nonjudgmental questions and rehearse with them how they could handle tough situations regarding peer pressure and smoking.
  • Note the social repercussions. Remind your teenager that smoking gives you bad breath and makes your hair and clothes smell.
  • Work with your schools. Become active in community and school stop-smoking programs.
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