Everyone knows that smoking causes cancer. It’s written on all the warning labels. There are antitobacco commercials on television and on billboards off the side of the highway. However, people are also likely to recognize the famous Marlboro Man, a cowboy smoking a cigarette in Marlboro advertising campaigns. Cigarettes are often made to look “cool” in movies, video games, and advertisements, and malleable teenagers may be more apt to listen to commercials than warning labels. Certain professions, like the U.S. military, also have a higher prevalence of tobacco use compared to the general public (24% vs. 19% in 2011). Being exposed to such a culture of nicotine use may persuade others to take up the habit.

What is nicotine?

Nicotine is an addictive chemical found in tobacco, a plant grown throughout the United States. North Carolina and Kentucky produce over 70% of the tobacco grown in the country, the majority of which goes to produce both smoked and smokeless tobacco products. Tobacco products come in many shapes and sizes: cigarettes, cigars, hookah, pipe tobacco, chewing tobacco (dip), and snuff. Though electronic cigarettes are not technically tobacco products, they contain nicotine, the same addictive chemical found in tobacco.

Nicotine is a stimulant, meaning that once it reaches the brain, adrenaline is released into the body. At the same time, the brain experiences a rise in dopamine, a chemical that increases feelings of pleasure and motivation but is also connected with rewards.

Dopamine, then, is inherent in many addictions: When an individual sees what he or she is addicted to, the brain is flooded with dopamine, and the person will therefore take action to give the brain what it wants (in this case, nicotine). After a time, the brain becomes accustomed to a new normal. Continuing to provide nicotine to the brain will continue to raise the level of dopamine that the brain considers normal. Hence, an addiction.

Why is nicotine dependence something to worry about?

• Increased risk of lung, mouth, throat, bladder, kidney, pancreatic, and cervical cancers: A person who smokes is at least two times as likely to die from cancer than a nonsmoker is. The overwhelming majority (90%) of lung cancer cases are caused by smoking. Lung cancer has one of the lowest cancer survival rates.
• Increased risk of heart attack and stroke: Cardiovascular diseases (like heart attacks and strokes) caused by smoking are responsible for one-third of all deaths from such diseases. Tobacco lowers “good” cholesterol, increases the likelihood of blood clots, and causes blood vessels to narrow, all of which increase the risk of cardiovascular disease.
• Increased risk of chronic obstructive pulmonary disease (COPD), which can include chronic bronchitis, emphysema, or asthma. These conditions are often brought on by smoking and as a result, an individual’s ability to breathe is compromised. There is no cure.
• Premature death: Smokers die an average of 10 years earlier than nonsmokers. Think of the time that you could be spending with your significant other and your (future) children and grandchildren. That’s more than a decade, and if you end up with a tobacco-related disease, your last years may be expensive and painful.
• Increased risks of problems during pregnancy: For a couple who wants to have a child, using smokeless tobacco may make it hard to conceive. If conception does take place, the use of smokeless tobacco increases the risk of life-threatening consequences for the baby and mother, such as premature birth, low birth weight, and preeclampsia.

This list isn’t comprehensive. It doesn’t even include the fact that smokers’ teeth, fingers, and nails may turn yellow; their clothes, home, and car may adopt a permanent smoking smell; and they may experience premature aging and development of wrinkles. Smokeless tobacco users may develop patchy oral lesions, tooth decay, and gum disease. The side effects of tobacco use can affect everyone, young or old, male or female.

In the 2017 Monitoring the Future survey, 7.9% of college students said that they’d smoked cigarettes within the past 30 days and 6% admitted to using e-cigarettes within the past month. Male students have a higher rate of cigarette usage, and college students use cigarettes less than half as often as noncollege individuals of the same age. Still, 2% of college students smoke daily. You don’t want to risk it.

What are the signs of nicotine dependence?

Nicotine affects the body very quickly, releasing adrenaline and dopamine for a pleasant or calm feeling. In reality, heartbeat and blood pressure have increased. After smoking has ceased, individuals may feel anxious, nervous, or depressed, which is why many people use tobacco many times throughout the day. Eventually, when an addiction becomes strong enough, individuals crave nicotine so much that they may use it habitually throughout the day.

Withdrawal symptoms may appear within hours of the cessation of tobacco use and may last from several days to several weeks, depending on the severity of the addiction. Withdrawal symptoms include:

• Insomnia and restlessness
• Cravings
• Anxiety and nervousness
• Depression
• Dizziness
• Irritability and anger
• Weight gain
• Lack of concentration
• Headaches

The symptoms of nicotine withdrawal are often enough to convince an individual to begin using tobacco products again.

Is there a good way to quit?

Wanting to quit using tobacco products or e-cigarettes is the first step, but quitting can be difficult. Often, tobacco and cigarettes are used in a social setting, meaning that a physical dependence on nicotine isn’t the only thing that must be overcome to end an addiction. For users of smokeless tobacco, there is often still a need to have something in their mouths, despite trying to quit. These individuals may benefit from chewing gum. Using a nicotine patch or nicotine gum may help reduce the cravings while weaning an individual off nicotine. These should be used in combination with therapy or group counseling to address the mental, social, and emotional aspects of quitting the use of tobacco products.

How is nicotine addiction treated?

Together with your doctor, you can talk about all aspects of your addiction, including its severity, and come up with a plan of action that is specific to you that will provide the best chance of recovery. Your doctor may recommend certain prescription medications to help beat nicotine addiction and combat symptoms of withdrawal, but they may also recommend over-the-counter nicotine replacement therapies, such as gum, patches, or lozenges. He or she may also refer you to a mental health specialist for one-on-one counseling.

What resources are available for individuals with a nicotine addiction?

For individuals who want to join a program:

• Quitter’s Circle is an online resource for individuals interested in kicking their nicotine addiction. The website hosts an app, available on Apple and Android phones where users can create a virtual support system, called their “Quit Team,” and a plan for tackling their addiction.
• Nicotine Anonymous is a 12-step support group for former smokers or smokers who hope to quit. It provides information about smoking cessation tools and allows you to search for face-to-face, phone, and internet meetings.
• Freedom From Smoking is a program run by the American Lung Association. It offers online resources, a quitting guide, and small group sessions throughout the United States.

For individuals who want to talk to someone:

• American Cancer Society
  • Call 1-800-227-2345 toll-free.
  • Helpline is open 24 hours a day, seven days a week.
  • Live chat with a representative.
• Freedom From Smoking Helpline
  • Call 1-800-586-4872 toll-free to connect to the American Lung Association Lung HelpLine and Tobacco QuitLine. Experts are available Monday through Friday, 8:00 am to 10:00 pm EST and Saturday and Sunday, 10:00 am to 6:00 pm EST.
  • Submit a question to be answered via email here.
• Smokefree.gov
  • Call 1-800-784-8669 toll-free to connect to your state’s quitline.
  • Call 1-877-448-7848 Monday through Friday, 9:00 am to 9:00 pm EST to speak to a representative from the National Cancer Institute in English or Spanish.
  • Live chat with a representative Monday through Friday 9:00 am to 9:00 pm EST in English or Spanish.
• Nicotine Anonymous
  • Call 1-877-879-6422 toll-free or one of these numbers to participate in a phone meeting offered at various times throughout the week.
  • Online meetings are also available.
• Smoke Free Español
  • Call 1-855-335-3569 to be redirected to your state’s quitline in Spanish. Hours of operation vary by state.

Page last updated: 04/2019