Nicotine dependence is an addiction to tobacco products caused by the drug nicotine. Nicotine dependence — also referred to as tobacco 
dependence — means you can’t stop using the substance, even though it’s causing you harm. While it’s the nicotine in tobacco that causes nicotine dependence, the toxic effects come mainly from other substances in tobacco. Smokers have much higher rates of heart disease, stroke and cancer than do nonsmokers.
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.
Many effective treatments for nicotine dependence are available to help you manage withdrawal and stop smoking for good. Ask your doctor for help.
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 or anger, increased hunger, insomnia, and constipation or diarrhea.
- You keep smoking despite health problems. Even though you’ve developed problems with your lungs or your heart, you haven’t stopped or can’t 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 have stable, long-term success.
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 stop-smoking counselor will significantly boost your chances of success.
Ask your doctor to help you create a treatment plan that works for you.
Causes
Nicotine is the chemical in tobacco that keeps you smoking. Nicotine is very addictive. It increases the release of brain chemicals called neurotransmitters, which help regulate mood and behavior. One of these neurotransmitters is dopamine, which makes you feel good. Getting that dopamine boost is part of the addiction process.
Nicotine dependence, also referred to as tobacco 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 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
- The 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.
Risk factors
Anyone who smokes or uses other forms of tobacco is at risk of becoming dependent on tobacco and nicotine. Most people begin smoking during childhood or adolescence. The younger you begin smoking, the greater the chance that you’ll become a heavy smoker as an adult.
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.
Other factors that influence nicotine dependence include:
- Genetics. The genes you inherit play a role in some aspects of nicotine dependence. For example, the likelihood that you will start smoking and keep smoking may be partly inherited. Some people experiment with smoking and don’t experience pleasure, so they never become smokers. Other people develop dependence very quickly. Some “social smokers” can smoke just once in a while, and yet another group of smokers can stop smoking with no withdrawal symptoms. These differences can be explained by genetic factors that influence how receptors on the surface of your brain’s nerve cells respond to nicotine.
- Depression, other mental illness and substance abuse. People who have depression, schizophrenia and other forms of mental illness are more likely to be smokers. Smoking may be a form of self-medication for these disorders. People who abuse alcohol and illegal drugs also are more likely to be smokers.
Complications
When you inhale tobacco smoke, you take in numerous chemicals that reach most of your body’s vital organs. Tobacco smoke contains more than 60 known cancer-causing chemicals and more than 4,000 other harmful substances.
Smoking harms almost every organ of your body. More than half the people who keep smoking will die because of it. 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.
- Heart and circulatory system problems. Smoking increases your risk of dying of cardiovascular disease, including heart attack and stroke. Even smoking just one to four cigarettes daily increases your risk of heart disease. If you have cardiovascular illness or heart failure, smoking worsens your condition. However, stopping smoking reduces your risk of having a heart attack by 50 percent in the first year.
- Other cancers. Smoking is a major cause of cancers of the esophagus, larynx, throat (pharynx) and mouth and is also related to cancers of the bladder, pancreas, kidney and cervix, and some leukemias.
- 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.
- Infertility and impotence. Smoking increases the risk of infertility in women and the chance of impotence in men.
- Pregnancy and newborn complications. Mothers who smoke while pregnant face a higher risk of miscarriage, preterm delivery, decreased birth weight and sudden infant death syndrome (SIDS) in their newborn. Low birth weight babies are more likely to die around the time of birth (perinatal period) or have learning and physical problems later in life.
- Cold, flu and other illnesses. Smokers are more prone to respiratory infections, such as colds, flu and bronchitis.
- 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.
- Weakened senses. Smoking deadens your senses of taste and smell, so food isn’t as appetizing.
- Risks to your family. 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 sudden infant death syndrome, asthma, ear infections and colds.
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