Nicotine Addiction

Nicotine addiction, or dependence, happens when a person needs nicotine and can’t stop using tobacco products. The chemical produces pleasurable effects, but when an addicted person tries to stop, it causes withdrawal symptoms. Treatment includes medication, nicotine replacement and counseling.

Last Modified: September 5, 2023
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Nicotine is one of the most addictive substances. Studies show that nicotine is as addictive as cocaine and heroin, according to the University of California San Francisco.

About 40 million American adults smoke traditional cigarettes and about 4.7 million middle and high school students use e-cigarettes or another tobacco product, according to the Centers for Disease Control and Prevention.

Most of these smokers want to stop smoking. Each year, about half of them try to quit, but only about six percent are able to quit in a given year, according to the National Institute on Drug Abuse. It can take many tries to stop permanently.

Part of the reason Americans can’t stop smoking is the addictiveness of nicotine. But with the help of counseling and medical intervention, smokers can stop using tobacco products for good.


Everyone is different and the symptoms of nicotine addiction vary from person to person. But even people who consider themselves “light smokers” or “social smokers” who only smoke a few cigarettes a day can become addicted, according to

Symptoms and signs of nicotine addiction include:
  • Continuing to use tobacco or smoke even with health conditions such as heart problems or lung problems.
  • Cravings for tobacco products.
  • Feeling anxious or irritable if you want to use tobacco but can’t.
  • Giving up social activities with situations where you can’t smoke or use tobacco.
  • Mood-related and physical symptoms (withdrawal symptoms) when you try to stop, including insomnia, increased appetite, difficulty concentrating, anger, frustration, depression, anxiety, diarrhea or constipation.
  • You go out of your way to get a tobacco fix.
  • You have to use tobacco within minutes of waking up.
  • You’ve tried to stop using tobacco multiple times but can’t.

How Nicotine Causes Addiction

Nicotine causes addiction by causing chemical changes in the brain. Using nicotine-containing products, including smoking cigarettes or vaping, causes the release of a chemical in the brain called dopamine.

Dopamine trains people to act a certain way by reinforcing certain behaviors. It does this by rewarding a person with a pleasurable sensation. This is called reinforcement. Each time a person takes a puff on a cigarette or vapes, they get a dopamine hit. This causes them to use nicotine-containing products over and over.

It doesn’t take much to trigger this response. In fact, just one 15-minute exposure to nicotine caused long-term excitability in neurons responsible for reward, according to a study by University of Chicago Medical Center researcher Danyan Mao and colleagues. Study authors also found that nicotine and cocaine similarly affect dopamine.

Nicotine causes a temporary boost in memory and attention that may cause people to keep using it to focus. But these feelings only last a short time. Long-term smoking actually leads to an increased risk of Alzheimer’s disease and cognitive decline.

When a person doesn’t smoke, they suffer withdrawal symptoms. These begin a few hours after a person has their last cigarette. The unpleasant physical and mental symptoms force a person to use tobacco again.

Behaviors that Trigger the Need to Smoke

Nicotine hits become so ingrained in a person’s life that certain behaviors trigger the desire to smoke, according to Mayo Clinic.

Addiction triggers include:
  • Being on the phone
  • Being with friends
  • Consuming alcohol
  • Drinking coffee
  • Driving
  • Partying
  • Social situations
  • Taking work breaks

Risk Factors for Addiction

Certain people are more susceptible to developing nicotine addiction. For example, people who begin smoking when they are young have a greater chance of becoming addicted.

Susceptibility to nicotine addiction can also be inherited. Genetics influence how a person responds to high doses of nicotine. People with parents and friends who smoke are more likely to try smoking.

Those who abuse illegal drugs or alcohol or have mental illness are more likely to smoke.

How Bad Is Addiction?

Nicotine addiction is dangerous because it increases the risk that a person can be a lifelong tobacco user. Young people are especially susceptible to nicotine addiction because their brains are still developing. Nicotine can rewire the brain to become addicted to other drugs.

Cigarettes are especially dangerous because they contain thousands of harmful chemicals. These chemicals can harm every organ in the body and many increase cancer risk.

Complications of smoking include:
  • Cancer
  • Diabetes
  • Eye problems
  • Greater susceptibility to respiratory illnesses such as flu, bronchitis or colds
  • Gum infections and disease
  • Heart problems
  • Impotence
  • Infertility
  • Lung disease
  • Pregnancy complications

Some studies claim e-cigarettes are more addictive, while others say they are less addictive. But e-cigarettes have the ability to deliver nicotine faster and in greater amounts to the brain. For example, high voltage e-cigarettes can heat the vape juice at higher temperatures, causing a greater hit of nicotine.

Nicotine addiction leads to more tobacco use, which can cause more health problems.

A November 2022 study found more teens are getting addicted to nicotine in vape products. Researchers found about 2.5 million young people used e-cigarettes in 2022 compared to 2.1 million in 2021. About 27.6% used the devices daily, compared to 24.7% in 2021.


It can take a long time to get rid of a nicotine addiction, and it may take several tries for a person to finally quit for good. Stopping nicotine addiction requires a lot of support. Most addiction treatments are geared toward smokers, but many strategies for smoking can help with quitting vaping, too.

Light smokers who smoke a few cigarettes a week may be able to quit with counseling. But for more severe addiction, successful treatment plans typically involve a combination of medications, nicotine replacement therapy and behavioral counseling.

Talk to your healthcare provider about your options — they may vary depending on the type of nicotine you are addicted to.

Help Quitting, The American Lung Association and the Centers for Disease Control and Prevention’s 1-800-QUIT-NOW helpline are all free addiction support tools.


Severely dependent people may require a prescription medication to help them quit. These can be used with nicotine replacement therapy. Chantix and bupropion are the most popular.

Chantix (Varenicline)

Chantix works by inhibiting nicotine receptors in the brain. It lessens withdrawal symptoms and the pleasure a person gets from nicotine hits.

Zyban, Wellbutrin or Aplenzin (Bupropion)

Bupropion is an extended-release antidepressant that helps reduce withdrawal symptoms and cravings. It works by acting on chemicals related to nicotine. Don’t take this drug if you have had seizures, cirrhosis, heavy alcohol use, a serious head injury, bipolar illness or an eating disorder.

Nicotine Replacement Therapy (NRT)

Nicotine replacement therapy or NRT gives a person a small amount of nicotine to manage withdrawal symptoms. Research shows NRT is safe and effective when used as a part of a treatment plan.

Types of NRT
TypeOver the Counter or PrescriptionHow They’re Used
GumOTCChew until your mouth tingles and then place between gums and cheek
InhalerPrescription Inhale specific amount of nicotine through a mouthpiece
LozengeOTC Acts like a hard candy and releases nicotine as it dissolves in the mouth
Nasal SprayPrescriptionPut in nose and spray
PatchOTCSmall steady amount of nicotine delivered through the skin
Please seek the advice of a medical professional before making health care decisions.