What is nicotine dependence?
The latest statistics from the Centers for Disease Control and Prevention (CDC), recorded in 2016, suggest that 15.5 percent of people aged 18 years or older in the United States considered themselves smokers at the time.
The CDC also advises that smoking is the leading cause of preventable death in the U.S.
Several nations have significantly increased taxes on tobacco products and regularly launch anti-smoking campaigns. Many countries have legislation banning smoking in shops and other public places.
Cigarettes can lead to addiction and associated symptoms, such as withdrawal.
Symptoms can depend on the individual. Some people become completely dependent fairly rapidly.
- at least one serious, unsuccessful attempt to stop
- withdrawal symptoms, including cravings, moodiness and irritability, poor concentration, depressed mood, increased appetite, and insomnia. Diarrhea or constipation may also occur.
- continuing to smoke despite smoking-related illnesses, such as a lung or heart condition
- giving up activities because of smoking, for example, avoiding smoke-free restaurants
The prospect of coping without cigarettes can feel daunting. The first step is to think carefully about how you feel about smoking. Afterward, compile a list of your personal reasons for quitting. Finally, set a quit date.
Some people have been moving onto vapes and e-cigarettes in an attempt to quit. While these nicotine delivery methods have shown fewer harmful effects than smoking cigarettes, this would not help a person combat an addiction to nicotine, unless it is seen as a temporary measure as part of a guided smoking cessation program.
The benefits of quitting are profound. The following tips may help the individual stop smoking forever:
- Identify the triggers and situations that make you smoke. This will help you to plan and prepare yourself.
- Family, friends, work colleagues, or school friends can help support or encourage you. It is important to be open about quitting and to explain the importance of their encouragement is.
- Focus on positive thoughts that reinforce quitting. See this move as a liberation and not a sacrifice.
- Reduce exposure to smoking as much as possible. If there are people in your household who smoke, try to come to some arrangement, at least until you have become more confident about your prospects of quitting long-term.
- Regularly read your list of reasons to give up smoking. Remind yourself of its importance.
- Avoid drinking alcohol until you are completely smoke-free.
- When you reach certain milestones, treat yourself. You could save the money you would have spent on cigarettes and put it towards something you really want.
- Relieve stress in other ways. Exercise is great for stress relief, as well as yoga and meditation. An exercise program will also encourage you to remain smoke-free as your fitness levels improve.
- When you have a craving, breathe in deeply and visualize your lungs are filling with fresh, clean air. Remind yourself why you quit and the benefits you are gaining.
- Cravings are temporary. If you are experiencing these, take a 10-minute break from whatever you are doing. This break may give you time to move beyond the craving.
Smoking is harmful, but you can start reversing the damage today.
Treating nicotine dependence involves reducing the impact of withdrawal symptoms and address the psychological urges.
Psychological therapy or medications may help; a combination of the two has been shown to be the most successful.
Breaking the habit can be difficult, but the benefits make quitting worthwhile.
Anybody who gives up before they are 50 years of age can reduce their risk of dying during the next 15 years by 50 percent, compared with people who continue smoking.
Quitting smoking can help you by providing the following benefits:
- slower heart rate
- lower carbon monoxide levels in the blood
- improved lung function within 3 months
- improvements in circulation and a lower risk of heart attacks
- reduced risk of stroke within 5 to 15 years
Medications and therapies
There are several proven medications and therapies available today to help a person quit nicotine. A doctor can offer useful advice on the available options.
Combining two methods, for example, nicotine-replacement-therapy (NRT) plus a nicotine patch, may be more effective.
Nicotine replacement therapy
Nicotine replacement therapy can help break the habit.
Nicotine replacement therapy (NRT) is a way of taking in nicotine without smoking.
NRT releases nicotine into the bloodstream at lower doses than tobacco smoke.
This steady supply may help alleviate the cravings that occur when giving up smoking. There are different types available depending on ease of use, the severity of nicotine dependence, and personal choice.
Examples of NRT include:
- Nicotine patch: A patch is placed on the skin, where it usually remains for a whole day before being replaced. The nicotine enters the bloodstream through the skin. A typical nicotine patch course lasts from 8 to 12 weeks. In many cases, it may be longer.
- Nicotine gum: This is a chewing gum that contains nicotine. The nicotine enters the bloodstream through the mucosal lining of the mouth. Different doses are available depending on how much a person smokes.
- Chew the gum until a mild peppery taste is felt, then place it between the cheek and the gum for about 20 minutes. Avoid fizzy drinks and coffee while the gum is in place and releasing nicotine.
- Nicotine lozenge: This tablet dissolves in the mouth and delivers a small dose of nicotine into the bloodstream through the mucosal lining of the mouth. There are 2mg and 4mg doses. Place it either under the tongue or between the gumline and cheek, and leave it there until it dissolves.
- Nicotine inhaler: A cartridge containing nicotine is placed in a device similar to a cigarette holder. The user sucks on it, inhaling nicotine vapor that is absorbed into the bloodstream through the mucosal lining of the mouth and throat. In many countries, the nicotine inhaler is only available on prescription.
- Nicotine nasal spray: User sprays a solution that contains nicotine directly into each nostril. The nicotine enters the bloodstream through the nasal membranes. Some prefer this method because the nicotine reaches the brain faster than a gum, patch, or lozenges, but slower than a cigarette.
It is best to quit within 6 months of starting nicotine-assisted treatment to stop smoking.
There are other medications available to treat nicotine dependence. These include:
- Varenicline (Chantix/Champix): This interferes with nicotine receptors in the brain, removing the pleasurable sensation of smoking. People taking varenicline should try to quit 7 to 12 days after starting, and courses usually last 12 weeks.
- Clonidine (Catapres): This is a blood-pressure medication used for nicotine dependence as a last resort, due to the side effects of drowsiness.
- Bupropion: This is an antidepressant drug that has similar effects to nicotine and releases dopamine and norepinephrine. It is often prescribed alongside a nicotine patch. Aim to quit within 14 days of starting the prescription.
The cause of nicotine addiction is the addictive quality of nicotine itself. Nicotine increases the release of neurotransmitters, which regulate behavior and mood.
Nicotine triggers the release of dopamine, a neurotransmitter that gives people a pleasant feeling. People who smoke nicotine crave the dopamine rush.
Experts say that when nicotine is inhaled, the brain is affected within seconds. The heart rate increases levels of the hormones noradrenaline and dopamine, enhancing mood and concentration.
If a person then does not smoke for a few hours, the levels of these hormones drop, creating feelings of anxiety and possible irritability. This can leave someone in need of another nicotine boost.
Certain times of the day, such as during a morning coffee or after eating, or places, such as bars, pubs, or toilets, can trigger the urge to smoke. Drinking alcohol can also set off these urges.
Dependence experts say that the nicotine addict must identify and deal with their behaviors, triggers, cues, and situations that are linked to smoking.
Nicotine dependence can affect anyone who smokes.
Many people who regularly smoke start when they are teenagers or even younger. The younger a person starts smoking, the more likely it is that they will experience dependence. One study in the New England Journal of Medicine advises that 80 percent of people with nicotine dependence started before the age of 18 years.
A family history of nicotine dependence might also contribute.
There is no current diagnostic test that can determine whether somebody is addicted to nicotine, and to what degree.
A doctor can help the patient determine their degree of dependence by asking pertinent questions, or using a specific questionnaire.
Often, a diagnosis of nicotine dependence will normally arise once a person seeks medical assistance for the addiction. Alternatively, they may seek treatment for a related condition, such as COPD, that requires smoking cessation to avoid making the condition worse.
Non-medicinal options include:
Counseling, support groups, and smoking cessation programs: People who receive a combination of medication and behavioral counseling tend to have better success rates.
While medications may help with the immediate physical problems, behavioral therapy helps people remain smoke-free on a long-term basis. Tobacco treatment specialists are available for this type of counselling, but a family doctor or primary care physician can also administer care for nicotine dependence.
Local or national telephone counseling services are available for people who are trying to quit, such as the National Cancer Institute's 800-784-8669 and the American Cancer Society's Quitline at 800-227-2345.
Online information and support: There are many websites that offer support and encouragement to people who are trying to give up smoking. A notable example is Nicotine Anonymous.
Smoking can make it 25 times more likely that a person will develop lung cancer.
Smoking causes a range of complications. It is responsible for nearly 1 in every 5 deaths in the U.S.
- Lung diseases: Smoking increases the risk of lung cancer by 2,500 percent. People with asthma usually find that smoking makes it worse or triggers attacks.
- Cardiovascular problems: People who smoke regularly have a significantly higher risk of angina, peripheral vascular disease, stroke, and a heart attack. Just five cigarettes a day can increase the risk of cardiovascular diseases, including Buerger's disease, a condition that causes dangerous clotting.
- Cancer: Smoking can cause cancer in almost every part of the body and increases the risk of death if cancer does occur.
- Skin: Smoking damages the skin.
- Sexual difficulties: Women who smoke regularly have a higher risk of infertility, and men who do the same face a significantly higher risk of developing erectile dysfunction.
- Harm during pregnancy: Smoking while pregnant can seriously harm mothers and their developing infants.
- Insulin resistance: Smoking raises insulin resistance, increasing the risk of developing diabetes type 2. People with diabetes who smoke are more likely to experience complications than people with diabetes who do not smoke.
- Premature or sudden death: On average, a man who has smoked throughout his life lives ten years less than a man who has never smoked. Smoking also increases the risk of sudden death.
Start your journey to quitting nicotine today.
By Christian Nordqvist