Nicotine dependence is an addiction to tobacco products caused by one of its ingredients – the drug nicotine. Nicotine is an addictive drug which causes mood-altering changes in the brain which are temporarily pleasing, making people want to use it more and more.

When a person is addicted to nicotine they have unpleasant withdrawal symptoms, which temporarily go away when they receive the nicotine through smoking tobacco. Experts say that nicotine is one of the hardest of all addictions to break.

Put simply – nicotine dependence means the individual cannot stop using the substance.

Unfortunately, while the smoker is addicted to the nicotine, they consume thousands of toxic substances present in tobacco smoke in order to get their fix.

In the USA in 1988, the Surgeon General reported that:

  • Cigarettes and other tobacco products are addicting
  • The addiction is caused by the drug nicotine
  • Pharmacologic and behavioral characteristics that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine.

Menthol cigarettes more addictive – the FDA (US Food and Drug Administration) says it is to investigate the usage of menthol in tobacco cigarettes.

According to preliminary findings, menthol cigarettes are more addictive than other tobacco products. The FDA is seeking additional information as it decides whether to introduce new regulations which could include “tobacco product standards, sale and distribution restrictions among other regulatory actions and considerations.”

Menthol cigarettes are very popular in the USA. The FDA says that over 40% of young smokers and 30% of older smokers prefer and regularly smoke menthol cigarettes.


Signs and Symptoms

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, sleepiness may be a symptom while dilated pupils may be a sign.

Signs and symptoms of nicotine addiction may vary, according to the individual. Some people become totally dependent (addicted) fairly rapidly. Examples include:

  • The individual smokes and cannot stop – they have made at least one serious attempt to stop, but unsuccessfully.
  • Withdrawal symptoms – when trying to stop the individual had physical and mood-related symptoms. There were cravings, bouts of moodiness and irritability, poor concentration, a feeling of being depressed and hollow/empty, anger, frustration, increased appetite, and insomnia. In some cases there may also have been diarrhea or constipation.
  • Smoking prevails despite the emergence of health problems – the individual continues to smoke, even though they have developed smoking related illnesses, such as a lung or heart condition.
  • Social and/or recreational sacrifices – some activities were given up because of smoking. For example, certain restaurants or pubs that became smoke free. Perhaps the individual stopped visiting friends whose environments/homes are smoke free. The regular Friday night bowling get-together with friends stopped because smoking was not allowed there anymore.

Tobacco contains a substance – nicotine – which keeps the smoker smoking. Experts say it may be as addictive as some recreational drugs, such as cocaine. Nicotine increases the release of neurotransmitters which regulate behavior and mood.

A neurotransmitter is a chemical that is released from a nerve cell. The neurotransmitter transmits an impulse from one nerve cell to another nerve, tissue, organ or muscle – it is a messenger of neurologic information from one cell to another.

Nicotine triggers the release of dopamine, a neurotransmitter which give people a pleasant feeling. Obtaining that dopamine rush is said to be a major part of the addiction process – smokers crave that neurotransmitter (especially dopamine) rush.

Experts say that when nicotine is inhaled the brain is affected within seconds. After an inhalation the smoker’s heart rate increases, levels of the hormones noradrelanine also increase, as well as dopamine – the whole experience is said to enhance mood, as well as the ability to concentrate.

Some time after the last cigarette, the levels of these hormones drops, leaving the smoker feeling anxious and possibly irritable, and in need of another nicotine boost.

There are other physical as well as psychological factors which influence the addiction process. The following situations, cues or behaviors may be linked to smoking urges:

  • Certain moments during the day may be associated with a greater desire to smoke, such as with the first cup of coffee, during work breaks, or after routine tasks.
  • After eating – most smokers have a stronger desire to smoke immediately after a meal.
  • Alcohol – most smokers who drink alcohol say that tobacco and alcohol are enjoyed together.
  • Some places – smokers often find certain places, such as the toilet, some bars and pubs (if smoking is allowed there), or car parks (after getting down from the car or coming into the car park from a supermarket and walking towards the car) trigger a desire to smoke.
  • Some people – smokers often find that meeting other people, especially if they are also smokers, make them want to smoke more.
  • Moments of stress – the majority of smokers will typically have an urge to smoke when faced with a stressful, exciting or emotional situation.
  • The telephone – when the telephone rings at home many smokers run for their cigarettes before picking it up.
  • Tobacco smell – the smell of other people smoking can be a strong trigger for smokers to want to light up.
  • Driving – smokers usually smoke when driving on their own.

Dependence experts say that the nicotine addict must identify and deal with his/her behaviors, triggers, cues and situations which are linked to smoking.

If a smoker does not receive nicotine for an extended period, for example 24 hours, the following signs and symptoms of withdrawal may emerge:

  • A drop in mood (depressed mood)
  • Agitation
  • Anger
  • Anxiety
  • Frustration
  • Greater appetite
  • Heart rate (pulse) slows down
  • Insomnia
  • Lightheadedness
  • Problems focusing
  • Tetchiness, sometimes even hostility.