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What Nicotine Does to Your Body

Effects, Risks, and How to Get Help

John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH).

Verywell / Zoe Hansen

• Nicotine's Impact
• Side Effects

Signs of Use

• Addiction & Withdrawal

How to Get Help

History of nicotine.

Nicotine, a stimulant found in tobacco plants, is one of the most heavily used drugs in the United States—and it's just as addictive as cocaine or heroin , according to the surgeon general. Nicotine products are regulated by the Federal Drug Administration (FDA). While nicotine is legal, as of 2019, it is illegal to sell or distribute nicotine-containing products to people under 21.

Cigarette smoking is the primary source of nicotine, with one pack of cigarettes providing some 250 "hits" of the extremely addictive substance.

Fewer people over the age of 18 are smoking today than ever before, but smoking still remains the most preventable cause of death in the United States accounting for 480,000 deaths annually. Estimates from the Centers for Disease Control and Prevention (CDC) for 2018 indicate that 13.7% of the U.S. adult population smoke cigarettes.

Also Known As : Nicotine products include cigarettes (also known as "smokes"), pipes, cigars (sometimes referred to as "stogies"), chewing tobacco (also known as "dip" or "chew"), snuff , hookahs , and e-cigarettes (also known as "e-cigs" and " vapes ").

Drug Class : Nicotine is classified as a stimulant.

Common Side Effects : Nicotine is known to cause decreased appetite, heightened mood, increased heart rate and blood pressure, nausea, diarrhea, better memory, and increased alertness.

How to Recognize Nicotine

Nicotine is rarely sold as a singular product, rather it's most often found as an ingredient in tobacco products like cigarettes and some smoking cessation products like nicotine gum and patches. Nicotine is sold as a liquid for use in e-cigarettes.

The FDA requires warning statement labels on tobacco products: “WARNING: This product contains nicotine. Nicotine is an addictive chemical.”

What Does Nicotine Do to Your Body?

When a person inhales cigarette smoke, the nicotine in the smoke is rapidly absorbed into the blood and starts affecting the brain within 10 seconds. Once there, nicotine triggers a number of chemical reactions that create temporary feelings of pleasure and concentration. But these sensations are short-lived, subsiding within minutes.

These chemical reactions include the release of catecholamines such as adrenaline , the "fight or flight" hormone. Physically, adrenaline increases heart rate and blood pressure. When this occurs, the person may experience rapid, shallow breathing and the feeling of a racing heartbeat. Adrenaline also tells the body to dump excess glucose into the bloodstream.

Nicotine also curbs appetite and may contribute to weight loss in complex ways.

How Does Nicotine Make You Feel?

Nicotine may produce feelings of pleasure for a few minutes, but you may also feel your heart rate increase. If your body builds up a tolerance, you'll likely feel tired, edgy, or even depressed when the nicotine wears off, and you'll crave another cigarette.

Nicotine has effects on many different parts of the body:

• The brain : Nicotine can change the chemistry in your brain and is linked with an increased risk of psychiatric disorders such as major depressive disorder and bipolar disorder .
• Skin : Nicotine constricts the blood vessels, which prevent nutrients from getting to the skin. This may cause premature aging and wrinkles.
• Heart : In addition to an increase in heart rate and blood pressure, nicotine narrows the arteries, which increases the risk of a heart attack.
• Lungs : Smoking cigarettes or using vapes limits your lung capacity over time, which can also cause illnesses like chronic obstructive pulmonary disease (COPD) later on.

What the Experts Say

To date, there have been studies showing benefits of nicotine, including decreased tension and increased thinking, as well as the stimulant's potential in warding off cognitive decline into Alzheimer's, delaying the progression of Parkinson's disease , and as a therapeutic approach for ADHD and schizophrenia .

Still, health professionals continue to warn about the dangers of nicotine, especially when used by adolescents whose brains are still developing (until age 25). Nicotine may negatively impact the parts of the brain that play a role in attention , memory, learning, and brain plasticity .

While cigarette smoking is on the decline, vaping and e-cigarettes are on the rise. The American Academy of Pediatrics (AAP) warns that "e-cigarettes are threatening to addict a new generation to nicotine."

Off-Label and Approved Uses

Nicotine replacement therapy (NRT) was the first pharmacological treatment approved by the FDA for smoking cessation. In fact, studies show that using the nicotine patch can double the rate of a person's smoking cessation success, especially when combined with support.

There are a variety of available NRT products, including:

• Nicotine gum
• Nicotine inhaler
• Nicotine lozenges
• Nicotine nasal spray
• Nicotine patch

Common Side Effects

Nicotine causes a range of effects on both the body and mind, including:

• Decreased appetite
• Gastrointestinal distress
• Heightened mood
• Improved memory and alertness
• Increased blood pressure
• Increased heart rate
• Increased production of saliva and phlegm

If your loved one is smoking cigarettes, you’ll likely be able to smell it on them. Detecting vaping can be a bit more difficult, but there are still some signs of use:

• Devices : E-cigarettes or "vape pens" can look like a thumb drive, pen, or stylus with holes on each end.
• Drinking more liquids : The vaporized liquid in e-cigs contains propylene glycol, which attracts and holds water molecules from the mouth, causing constant dry mouth.
• Irritability : This is a classic sign of nicotine withdrawal.
• Nosebleeds : Vaping can dry out the nasal passages and cause nose bleeds.
• Sweet smells : Vapor juice is often flavored, so if you suddenly catch a whiff of fruit punch or bubble gum and there’s no candy around, it could be a red flag.

Tolerance, Dependence, and Withdrawal

Nicotine is extremely addictive, and when used regularly, your body and mind learn to expect a certain amount of nicotine each day.

If you don't fulfill these cravings, withdrawal symptoms can be intense. You can quickly build a tolerance to nicotine, needing more to reach the desired effect. This is one reason why it's so hard (but not impossible) to quit smoking .

How Long Does Nicotine Stay in Your System?

Nicotine (in the form of a cigarette, pipe, or e-cigarette smoke) is mostly absorbed into the body through the lungs as well as the membranes in the mouth and throat. It can also be absorbed in your gastrointestinal tract (via chewing tobacco, nicotine gum, and lozenges) or your skin if you use a nicotine patch.

Nicotine is mainly metabolized in the liver and is excreted via urine through the kidneys as well as in feces. How long it stays in your system depends on many factors, including your age and weight; the type of nicotine product; frequency of use; and your hydration and physical activity levels.

That said, the following are estimates for how long nicotine is detectable in your system:

• Saliva test : One to four days
• Blood test : Two to four days
• Urine test : Two to four days
• Hair follicle test : Up to 90 days

Many routine drug tests screen for nicotine.

Nicotine is a highly addictive substance that's found in all tobacco products, including cigarettes, pipes, cigars, chewing tobacco, snuff, hookahs , e-cigarettes, and other vaping devices.

Nicotine activates the same reward pathways in the brain that other drugs such as cocaine or amphetamines do, although to a lesser degree. Research has shown that nicotine increases the level of dopamine in the brain, a neurotransmitter that is responsible for feelings of pleasure and well-being.

Unfortunately, it is the release of dopamine that contributes to the cycle of addiction, as the dopamine receptors in your brain crave more nicotine over time.

As the level of nicotine in the blood drops, people may begin to feel edgy and agitated. The acute effects of nicotine wear off within minutes, so people who smoke must continue dosing themselves frequently throughout the day to maintain the pleasurable effects of nicotine and to prevent nicotine withdrawal, which causes a host of physical and psychological symptoms:

• Constipation, gas, stomach pain
• Cravings to smoke
• Inability to concentrate
• Irritability, crankiness
• Postnasal drip
• Sore throat
• Sore tongue and/or gums
• Tightness in the chest

Treatment for Addiction and Withdrawal

Overcoming nicotine addiction is hard, but it is very possible. To set yourself up for success, try to prepare yourself to stop using nicotine by choosing a quit day.

Mark your quit day on your calendar, and from that point on, do your best to discontinue the use of any nicotine product (other than a nicotine replacement therapy product, if you're using one as a quit aid).

Cognitive behavioral therapy (CBT) can be an effective treatment for people who are looking to quit using nicotine. During a CBT session, a therapist will help you understand your triggers for using nicotine products and teach you healthy coping mechanisms to turn to instead.

Motivational interviewing is another therapeutic technique during which a counselor will help you become more motivated or inspired to pursue your goal of quitting smoking. They will help you answer important questions, such as: What is getting in your way of quitting? How can you align your values with your actions?

In a mindfulness session, a counselor teaches you how to detach yourself from your cravings for nicotine. Mindfulness practices can help you learn to tolerate your cravings and triggers to smoke instead of giving in to them.

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We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Find out which option is the best for you.

Medications

A doctor may recommend a prescription medication to quit smoking such as Chantix (varenicline) or Zyban (bupropion) .

Chantix works by reducing the feeling of pleasure a person gets when they use nicotine. Both Chantix and Zyban can also help relieve the symptoms of nicotine withdrawal. Zyban can also help reduce nicotine cravings.

There are potential side effects of Chantix and Zyban including headache, nausea, mood changes , trouble sleeping, and seizures.

A doctor might also recommend nicotine replacement therapy (NRT) separately or in addition to another quit smoking medication. NRT administers small amounts of nicotine without the other toxins in cigarettes and other nicotine products. It can help reduce cravings during nicotine cessation and lessen nicotine withdrawal symptoms.

Lifestyle Changes

Let your friends and family know that you're quitting. By enlisting their support, you improve your chances of success. If you have friends or family who use nicotine, you might request that they don't use nicotine around you.

Try making a list of smoke-free social activities to engage in , such as going to the movies or to a museum. Know your triggers to use nicotine, and have a plan to avoid or cope with them. If you associate alcohol with cigarettes, for example, you might avoid drinking or going to bars until you can manage your cravings.

There is evidence that behavioral support will likely increase the success rate by 10% to 20% for those who are already using pharmacotherapy for quitting smoking.

Whether you prefer to quit cold turkey or choose to use a quit aid to help you stop smoking, it's important to recognize that recovery from nicotine addiction is a process of gradual release over time.

Quitting nicotine doesn't happen overnight, but with perseverance, freedom from nicotine addiction is doable and will pay you back with benefits that go well beyond what you can probably imagine.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. 

For more mental health resources, see our National Helpline Database .

Nicotine is a substance found in the tobacco plant. Tobacco use likely began in the first century in Central America.

Native Americans would chew or smoke tobacco leaves. They used tobacco for religious rites of passage and medicinal cures for asthma, fever, depression, and more.

By the 1500s, Portuguese and Spanish sailors brought tobacco from the Americas to Europe. The French ambassador to Lisbon, Nicot de Villemain, introduced tobacco to the French court. His name would be used to create the name nicotine. In the 1600s, tobacco was cultivated in the present-day United States. By 1880, the first cigarette-rolling machine was invented.

In the 1950s, researchers were already linking smoking tobacco with diseases like lung cancer. By the 1970s, they found that nicotine was an extremely addictive substance.

Since the 1970s, there have been many landmark legislations in the United States to regulate smoking and educate people on the hazards of smoking. Still, the World Health Organization (WHO) reports that there are 1.3 billion people in the world who currently smoke tobacco.

Frequently Asked Questions

It is unclear. Some research suggests that nicotine can increase the risk of cancer because it damages DNA. However, tar and other toxic chemicals in cigarettes are more closely linked to cancer than nicotine.

Still, people who are addicted to nicotine and smoke heavily are at a greater risk of developing lung cancer than those who do not use nicotine products.

While it's possible, most people find it easy to stop using nicotine medicine after several months. In general, these products deliver nicotine to your body more slowly and in smaller doses than smoking.

Technically, e-cigarettes contain fewer chemicals than those found in cigarettes. But e-cigarettes still contain harmful substances like nicotine, heavy metals, and cancer-causing agents.

Nicotine is poisonous and overdose is possible, though not common. Most often, nicotine poisoning occurs when children mistake nicotine gum or lozenges for candy. Exposure to liquid nicotine in e-cigarettes is also a concern for people of all ages because of its high nicotine concentration.

If you or someone you care about experiences the following signs of nicotine overdose, call 911 or poison control (800-222-1222) immediately:

• Difficulty breathing
• Increased or decreased heart rate

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Yuan S, Yao H, Larsson SC. Associations of cigarette smoking with psychiatric disorders: evidence from a two-sample Mendelian randomization study .  Sci Rep.  2020;10:13807. doi:10.1038/s41598-020-70458-4

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By Terry Martin Terry Martin quit smoking after 26 years and is now an advocate for those seeking freedom from nicotine addiction.

• Health Conditions
• Health Products

Everything you need to know about nicotine

Researchers still do not know the safety and long-term health effects of using e-cigarettes and other vaping products. In September 2019, federal and state health authorities began investigating an outbreak of a severe lung disease associated with e-cigarettes and other vaping products. We are closely monitoring the situation and will update our content as soon as more information is available .

Nicotine is a substance found in all tobacco products and some e-cigarette liquids. Nicotine is a highly addictive substance, which is naturally present in the tobacco plant. Laboratories can also produce nicotine synthetically.

People also use the substance as an insecticide in the agricultural industry.

Any product containing tobacco also contains nicotine. This includes cigarettes, heated tobacco products, cigars, and most e-cigarettes .

This article discusses the history and effects of nicotine, its potential impact on health, and treatment options for nicotine dependence .

History of nicotine

Nicotine comes from the Nicotiana species, which are tobacco plants and part of the nightshade family. Tobacco plants originated in South America before spreading to North America, Africa, and Australia.

Native people of these areas originally used the leaves of tobacco plants to chew, smoke, or use in religious rituals. European colonists exported tobacco crops for profit and changed the focus of tobacco to recreational use.

The tobacco industry has a substantial history of using racial profiling, demographics of an area, and cultural factors to target particular communities and promote tobacco use.

Tobacco companies have also disproportionately marketed menthol products to Black people and low-income communities. Tobacco companies add menthol to cigarettes to make them more palatable.

According to the Centers for Disease Control and Prevention (CDC) , among people who smoke cigarettes, non-Hispanic Black or African American people are more likely to smoke menthol cigarettes compared to other races or ethnicities.

Menthol may increase the addictive effects that nicotine has on the brain. People who smoke menthol cigarettes are more likely to continue using tobacco products, which increases the risk of them developing conditions relating to tobacco use.

Effects of nicotine

Nicotine creates a temporary feeling of well-being and relaxation, and increases heart rate and the amount of oxygen the heart uses. As nicotine enters the body, it causes a surge of endorphins , which are chemicals that help to relieve stress and pain and improve mood.

The body quickly absorbs nicotine into the bloodstream so it can reach the brain . Nicotine levels peak quickly after entering the body, so the feelings of reward are short-lived. This can create a cycle of people continuing to smoke to keep feeling the pleasurable sensations.

Nicotine also increases levels of dopamine , a neurotransmitter that is part of the brain’s reward system and creates feelings of pleasure and reward. The release of dopamine reinforces a person’s behavior of taking nicotine.

Frequent use of nicotine creates changes in the way the brain works in relation to self-control, stress, and learning. Long-term changes can lead to addiction and withdrawal symptoms when a person is not smoking .

Effects on cognitive function

Nicotine may also temporarily improve concentration and memory. However, long-term smoking of cigarettes may link to a decline in cognitive ability and an increased risk of Alzheimer’s disease . Therefore, any short-term benefits on cognitive function do not outweigh the long-term risks from nicotine use.

When people stop using nicotine, they may experience withdrawal symptoms affecting their attention or memory. Withdrawal from severe nicotine use may also result in sleep impairment .

Side effects of nicotine

Nicotine can affect various systems throughout the body and may cause :

• dizziness and lightheadedness
• sleep disturbances
• changes in blood flow
• increased risk of blood clotting
• increased blood pressure
• changes in heart rhythm and rate
• shortness of breath
• peptic ulcer
• indigestion or heartburn

Certain nicotine products may also have specific side effects. According to the American Cancer Society , side effects of nicotine patches include:

• skin irritation
• racing heartbeat
• sleep problems
• aching muscles or stiffness

A racing heartbeat may mean the dose of nicotine is too high, and people can talk with a healthcare professional about lowering the dosage.

Side effects of nicotine gum may include:

• bad taste in the mouth
• irritation of the throat
• mouth sores
• jaw discomfort

Other nicotine products may also cause a racing heartbeat, nervousness, and headaches. If a person thinks they are experiencing nicotine poisoning , they need to contact Poison Control or seek emergency medical help.

Nicotine may interact with some other drugs or medications. Nicotine may cause benzodiazepines to be less effective. If a person is taking a contraceptive pill , nicotine may increase the risk of blood clots forming.

Learn more about types of drug interactions here.

Nicotine is addictive and the main psychoactive substance in tobacco, which means it alters how the brain works. According to the National Institute on Drug Abuse (NIDA), most people who smoke use tobacco regularly due to nicotine addiction.

Smoking is the most common preventable cause of death in the United States. Smoking causes damage to almost every organ in the body and increases the risk of severe health problems, including heart disease , stroke , and lung cancer .

Nicotine does not cause cancer , but tobacco smoke contains at least 69 chemicals that are carcinogenic, meaning they are cancer-causing chemicals.

Are e-cigarettes and vaporizers safe?

Electronic nicotine delivery systems, which people may refer to as e-cigarettes or vaporizers, are small, portable devices that heat a liquid into vapor. The liquid usually contains nicotine, along with solvents and flavorings.

E-cigarettes containing nicotine are not suitable for pregnant people , as nicotine may cause prenatal development issues.

The Food and Drug Administration (FDA) has issued a report on the potential dangers of using vaping products containing tetrahydrocannabinol (THC) , a component of cannabis .

The FDA also warns against using any vaping product from an unknown source or bought off the street. There have been over 1,000 reports of serious lung injuries as a result of using vaping products.

There are currently a lot of unknowns about vaping, including the chemicals they may contain and the effect they have on health.

If people are using e-cigarettes to help them quit smoking , other methods may be a better option.

Nicotine dependence treatment

According to NIDA, a 2020 survey found that around 23.6 million people aged 12 and older had nicotine dependence in the previous 30 days. Treatment for nicotine dependency may include:

Nicotine replacement therapy

Nicotine replacement therapy (NRT) provides people with a small amount of nicotine that attaches to some of the body’s nicotine receptors to reduce nicotine cravings.

NRT may include nicotine patches, sprays, lozenges, or gum. FDA-approved NRTs are the least harmful types of nicotine products.

Medications

Certain medications may also help treat nicotine dependence.

Bupropion is a medication that affects brain chemicals and is as effective as NRT for helping people quit.

Varenicline is a medication that stimulates a specific nicotine receptor but to a lesser extent than nicotine. It may be more effective than bupropion in helping people quit.

Counseling and psychological support

Research suggests that a combination of NRT or medications to stop smoking alongside behavioral treatment is more effective in helping people quit smoking.

People may choose to speak with a mental health professional for advice or use psychotherapy such as cognitive behavioral therapy (CBT) . Mindfulness, helplines, automated text messages, and self-help materials may also help people to quit.

Nicotine is the highly addictive substance found in tobacco products, and can be the reason for many people for consuming tobacco. It may cause side effects such as dizziness, racing heartbeat, and headaches.

It is also a toxic substance that can cause poisoning. If people suspect they have nicotine poisoning, they will require immediate medical help.

Nicotine may also cause people to use tobacco products such as cigarettes more often, which can cause severe health problems.

Medications, nicotine replacement therapies, and behavioral treatment can help people to stop using products that contain nicotine.

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Last medically reviewed on July 29, 2022

• Alcohol / Addiction / Illegal Drugs
• Smoking / Quit Smoking

How we reviewed this article:

• Health effects of cigarette smoking. (2021). https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm
• Mark, J. J. (2021). A brief history of tobacco in the Americas. https://www.worldhistory.org/article/1677/a-brief-history-of-tobacco-in-the-americas
• Menthol smoking and related health disparities. (2022). https://www.cdc.gov/tobacco/basic_information/menthol/related-health-disparities.html
• Menthol tobacco products are a public health problem. (2022). https://www.cdc.gov/tobacco/basic_information/menthol/public-health-problem.html
• Nicotine. (n.d.). https://www.cancer.gov/publications/dictionaries/cancer-terms/def/nicotine
• Nicotine. (2022). https://adf.org.au/drug-facts/nicotine
• Nicotine addiction explained. (2021). https://www.quit.org.au/articles/nicotine-addiction-explained
• Nicotine is why tobacco products are addictive. (2022). https://www.fda.gov/tobacco-products/health-effects-tobacco-use/nicotine-why-tobacco-products-are-addictive
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• Nicotine side effects. (n.d.). https://tobaccofreelife.org/why-quit-smoking/smoking-effects/nicotine-effects/
• Sierro, N. (2020). Background and history of tobacco genome resources [Abstract]. https://link.springer.com/chapter/10.1007/978-3-030-29493-9_1
• Structural racism & tobacco. (2022). https://www.heart.org/-/media/Files/About-Us/Policy-Research/Fact-Sheets/Tobacco-and-Clean-Air/Structural-Racism-and-Tobacco-Fact-Sheet.pdf
• Tobacco, nicotine, and E-cigarettes research report. (2022). https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/introduction
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Nicotine Dependence (Tobacco Use Disorder)

Nicotine is highly addictive — some say it’s as addictive as cocaine, heroin and alcohol. Using nicotine just one time puts you at risk of becoming dependent on the drug because of its immediate effect on your brain. There are several treatments that can help you quit.

What is nicotine dependence?

Nicotine is a type of stimulant found in tobacco products. Nicotine dependence occurs when your body gets used to having some level of nicotine in your system. In physical and psychological ways, your body “depends” on constantly having the chemical.

• Physical dependence is when your body needs nicotine to avoid withdrawal symptoms — the unpleasant feelings that you get when you stop using it. Symptoms include restlessness and agitation.
• Psychological dependence is, for example, feeling like you need nicotine to get through your day because it’s part of your routine.

What is a stimulant?

Stimulants like nicotine speed the messaging between your brain and body. They cause your brain to release more dopamine, which makes you feel pleasure. Stimulants also increase feelings of wakefulness and exhilaration.

Does nicotine make you dependent?

Using nicotine can make you dependent on it. Nicotine products change how your brain works, leading to dependence.

Who does nicotine dependence affect?

Nicotine affects people of all ages but is most dangerous among teens. The brain is still developing during the teenage years, making it easier to become addicted to nicotine.

Science has shown that the younger you are when you start using nicotine, the more likely you are to become addicted. A Surgeon General’s Report (SGR) found that about 3 of 4 high schoolers who smoke will still smoke in adulthood.

How common is nicotine dependence?

Nicotine dependence is common, affecting about 23.6 million Americans or 8.5% of people ages 12 and older.

Can you get nicotine dependence from vaping?

Yes. Using anything that contains nicotine can make you dependent. This includes tobacco products (like cigarettes, cigars or dip) and e-cigarettes used for vaping .

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Is nicotine use a habit or an addiction?

Nicotine is an addictive substance. When your body needs nicotine for physical or psychological reasons, it’s called tobacco use disorder. Nicotine floods your brain’s reward circuits with a feel-good chemical called dopamine. This creates a pleasant feeling, and when it wears off, you often want more.

Using nicotine can also become a habit. For example, if you’re used to smoking a cigarette every morning when you wake up, doing so becomes part of your routine.

What is the difference between nicotine dependence and tobacco use disorder (also known as nicotine addiction?)

Nicotine dependence is when your body gets used to nicotine and the sensations it creates. Substance use disorder (SUD) is when your body needs nicotine to avoid withdrawal symptoms. Because nicotine disturbs your brain’s reward circuits, it’s highly addictive.

Which is more addictive: Nicotine or caffeine?

Caffeine is a common stimulant found in coffee, teas and sodas. You can develop a dependence on caffeine because your body gets used to it.

Caffeine and nicotine both cause the brain to release dopamine, but the release from caffeine is much smaller. Nicotine changes how the brain works, making it one of the most addictive substances in the world.

Symptoms and Causes

What causes nicotine dependence, and how does it affect me.

Using tobacco products is the main cause of nicotine dependence. When you use tobacco products, nicotine travels to your lungs and is quickly absorbed into your blood. Once in your bloodstream, it travels to other areas of your body. Your brain releases dopamine, which creates temporary feelings of happiness and satisfaction.

When the feel-good effects of nicotine wear off (usually within a few minutes), you might feel edgy or irritated. At this point, many people keep using nicotine to continue enjoying the pleasurable effects. The more you use nicotine, the higher your body’s tolerance. This means your body will gradually need more nicotine to feel good.

How long does it take to develop nicotine dependence?

Nicotine is incredibly addictive — possibly as addictive as alcohol, cocaine or heroin. Your body can start to depend on nicotine right away — even after one or two uses.

What are the signs of nicotine addiction?

The most common symptoms of tobacco use disorder include:

• Cravings and feeling like you need nicotine to function.
• Feeling sad, anxious or irritable.
• Withdrawal symptoms like restlessness and difficulty sleeping.
• Needing larger amounts of nicotine to feel satisfied.
• Using nicotine despite knowing the health risks.
• Wanting to quit using nicotine but not being able to.

What does a nicotine craving feel like?

When you feel a physical craving for nicotine, you’ll likely feel edgy, anxious and restless. You could also experience tightness in your throat or stomach. Cravings can come in waves of intensity, sometimes feeling subtle and then becoming stronger.

What are nicotine withdrawal symptoms?

You get nicotine withdrawal symptoms when you stop giving your body nicotine. While withdrawal symptoms from nicotine dependence vary from person to person, the most common ones include:

Physical withdrawal symptoms:

• Chest tightness.
• Difficulty sleeping.
• Dizziness .
• Gas , constipation or diarrhea .
• Headaches .
• Increasing hunger and weight gain.
• Nasal drip, coughing , dry mouth and throat irritation.

Psychological/emotional withdrawal symptoms:

• Feeling uneasy, jittery, agitated or angry.
• Feeling worn out, fatigued or apathetic.
• Having trouble focusing.
• Sadness or depression .

When do nicotine withdrawal symptoms start?

Symptoms of nicotine withdrawal usually start a few hours after your last dose. They’ll be most intense on the second or third day after quitting.

Talk to your healthcare provider if you’re worried about nicotine withdrawal. They’ll work with you to find a treatment or combination of treatments to help you manage withdrawal. Treatment often involves a combination of medication and therapy.

Diagnosis and Tests

How is nicotine dependence diagnosed.

Your healthcare provider can diagnose nicotine dependence by asking a few questions or having you fill out a questionnaire. This is called the Fagerström Test for Nicotine Dependence.

Your provider determines your level of dependence according to:

• How many tobacco products you use in a day.
• How soon after waking up you use tobacco or nicotine.

Management and Treatment

Is there a cure for nicotine dependence.

You can cure nicotine dependence. Eliminating your need for nicotine takes time, but you can end your dependence for good.

Are there treatments for nicotine dependence?

You don’t need treatment to cure nicotine dependence, but those who get treatment are often more successful. There are cessation treatments that effectively cure nicotine dependence and help reduce withdrawal symptoms. Treatments include medications approved by the U.S. Food and Drug Administration and behavioral therapies.

Research shows that those who use a combination of behavioral therapies and medications have more success quitting nicotine than those who only use one treatment or none at all.

Treatments include:

• Nicotine replacement therapy (NRT).
• Prescription medication for nicotine cessation.
• Behavioral therapies like mindfulness and motivational interviewing (MI).

What medications treat nicotine dependence?

Medications available for nicotine dependence include:

• Nicotine replacement therapy (NRT) : These over-the-counter (OTC) medications help stimulate your brain’s receptors that respond to nicotine. They include transdermal (on your skin) patches as well as gums and lozenges . You can also talk to your provider about prescription-only nasal sprays and inhalers .
• Bupropion: This prescription medication is as effective as NRT. It lowers the absorption of norepinephrine and dopamine in your brain. Bupropion was originally developed as an antidepressant.
• Varenicline: This medication reduces nicotine cravings by stimulating the alpha-4 beta-2 nicotinic receptor in your brain. Some studies found it was more effective than NRTs and bupropion.
• Other antidepressants: Small studies show that antidepressants such as nortriptyline may help break nicotine dependence.

What behavioral treatments can treat nicotine dependence?

Your provider may recommend behavioral therapy along with medication:

• Cognitive behavioral therapy (CBT): By learning CBT, you can identify triggers — things that compel you to use nicotine — and effective coping strategies. CBT teaches you how to avoid the psychological need for nicotine.
• Motivational interviewing (MI): This style of therapy helps you address your mixed feelings about using nicotine and increases your motivation to quit. It promotes optimism, self-efficacy and the ability to adjust to change.
• Mindfulness: With this technique, you turn inward to learn how to tolerate negative feelings and cravings without turning to nicotine.
• Telephone support and quit lines: If you want to quit using nicotine, look for telephone or in-person support groups and counselors.

Are there side effects of treatment for nicotine dependence?

You may experience some side effects from the medications used to treat nicotine dependence.

Side effects of NRT patches include:

• Fast heartbeat.
• Muscle aches and stiffness.
• Skin redness or itching.
• Sleep troubles or strange dreams (more often with the 24-hour patch).

Side effects of NRT gum include:

• Bad taste in your mouth.
• Jaw aches and pains.
• Mouth sores .
• Throat soreness .

Side effects of NRT nasal spray include:

• Nasal irritation.
• Runny nose .
• Throat soreness.
• Watery eyes .

Side effects of NRT inhalers include:

• Mouth and/or throat soreness.
• Runny nose.
• Upset stomach.

Side effects of NRT lozenges include:

• Sore throat.

Bupropion side effects may include:

• Anxiety or restlessness.

What should I know before starting medication for nicotine dependence?

If you choose to use medication to help cure nicotine dependence, make sure to:

• Talk to your provider before beginning any cessation medication. Pregnant people or teens shouldn’t use NRTs. And don’t use NRTs if you’re still using tobacco products, including dip.
• Read and follow package instructions carefully for all medications.

How else can I manage nicotine withdrawal symptoms?

Other strategies for managing nicotine withdrawal symptoms include:

• Exercise: Find a physical activity that you enjoy. Exercising can get your mind off nicotine withdrawal symptoms and benefit your health.
• Spend time with friends who don’t smoke: Inform everyone around you that you’re quitting so they can support and cheer you on.
• Keep your hands occupied: Use a stress ball or fidget toy to keep your hands busy.
• Use a straw, toothpick or cinnamon stick: These items can replicate the feeling of something touching your lips and mouth. Gum chewing helps keep your mouth active, too.
• Beat your temptations: Write down rational responses to internal voices that falsely tell you using nicotine products is OK.

How long does it take to cure nicotine dependence?

Symptoms of nicotine withdrawal can last from a few days to several weeks. Every day your symptoms will improve a little more. When your withdrawal symptoms go away, your body is no longer dependent on nicotine.

How can I reduce my risk of nicotine dependence?

The best way to prevent nicotine dependence is to avoid it. Don’t use any products containing nicotine, including e-cigarettes. Using nicotine just one time can start the process of nicotine dependence. If you can, avoid putting yourself in situations where you might be tempted to use nicotine.

Outlook / Prognosis

What can i expect if i have tobacco use disorder.

If you have tobacco use disorder, you need a constant supply of the substance in your body. When nicotine fades out of your bloodstream, you’ll experience unpleasant withdrawal symptoms. Having a nicotine dependence also creates a higher tolerance for the substance over time, meaning you’ll need larger amounts of nicotine to feel the effects.

How long does nicotine dependence last?

You can have tobacco use disorder for as long as you keep using nicotine. For some people, it can last a lifetime. Quitting nicotine is the only way to successfully cure tobacco use disorder, and you must make a conscious effort to quit.

What is the outlook for beating nicotine dependence?

Breaking nicotine dependence is hard but doable. It might not happen on your first try, but 3 in 5 adults who ever smoked have quit. It takes consistency and perseverance, but it’s possible.

When you stop using nicotine products, you benefit almost immediately. For example, your heart rate and blood pressure return to normal during the first 20 minutes after quitting. Over time, you’ll:

• Have better breathing and be able to exercise more effectively.
• Experience improved sense of smell and taste.
• Lower your risk of disease, including certain cancers and heart disease, to typical levels.
• Have healthier teeth and gums.
• Save hundreds or thousands of dollars.

A note from Cleveland Clinic

Nicotine is one of the most addictive substances in the world. Using nicotine a handful of times can quickly turn into dependence, and this harmful drug can have long-lasting effects on your body. To beat tobacco use disorder, healthcare providers recommend a combination of medications and behavioral treatments to reduce withdrawal symptoms. If you have tobacco use disorder, talk to your provider about quitting. With their support, your journey to a nicotine-free life is around the corner.

Last reviewed on 11/30/2022.

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Nicotine addiction.

Allen Widysanto ; Felton E. Combest ; Aayush Dhakal ; Abdolreza Saadabadi .

Affiliations

Last Update: August 8, 2023 .

• Continuing Education Activity

Nicotine addiction is a complex disorder with no easy cure. Habitual use of tobacco and tobacco products continues to be a significant contributor to health problems worldwide, which in part may be related to the increasing affordability of tobacco and nicotine products as well as marketing strategies that increasingly utilize social media to reach consumers. This activity reviews the evaluation and management of nicotine addiction and the role of the interprofessional team in caring for affected patients.

• Describe the typical clinical presentation of a patient with nicotine addiction.
• Describe the etiologic factors associated with the development of nicotine addiction.
• Review management strategies for nicotine addiction.
• Explain the importance of enhancing care coordination amongst the interprofessional team to improve outcomes for patients with nicotine addiction.
• Introduction

The habitual use of tobacco and tobacco products continues to be a significant contributor to health problems worldwide. The increasing affordability of tobacco and nicotine products has been a contributing factor as well as marketing strategies that increasingly use social media to reach consumers globally. Smoking and chewing tobacco remain the main source of nicotine exposure in humans. Nicotine addiction remains one of the easiest addictions to fall into, can develop rapidly and one of the toughest addictions to get rid of. Once addicted, people take tobacco products to deliver the desired dose of nicotine as body demands and there is individual variation regarding the intervals between the dose and the rate of delivery. It is associated with significant morbidity and mortality worldwide. So nicotine addiction is a subject of great public health concern. [1] [2] [3]

Nicotine is a plant alkaloid, found in the tobacco plant. The main source of nicotine is tobacco. Two major sources of nicotine are Large leaf tobacco plants( Nicotiana tabacum ) and small leaf tobacco plants ( Nicotiana rustica ). The main means of administration are smoking pipes/cigars, chewing, and also snorting fine powders. It is also being used as a pharmacological means of cessation of smoke. Tobacco control has been a priority of almost every county in the world.  There are many alternate nicotine preparations like nicotine patches, nicotine gums, e-cigarettes, and inhalational agents available. These products have been promoted and marketed as exceptional alternatives and remedies. Major causes of nicotine addiction include lack of enforcement of smoking bans, lack of proper knowledge and education on the topic (mostly in underdeveloped countries), lack of motivation to quit smoking, inadequate training among mental health professionals, and inadequate treatments. [4]

• Epidemiology

The prevalence of nicotine addiction can be directly estimated from tobacco consumption which is interlinked. World Health Organization estimates that there are around 1.27 billion tobacco users in the world. In 2017, the Center for Disease Control estimates that 19.3% of the US population over 18 years old use some kind of tobacco products. About 14% of the population use cigarettes and the remaining 5% use cigars, smokeless tobacco or pipes, and electronic cigarettes. Around 24.8% of men and around 14.2% of women smoke cigarettes. According to the age group, the smoker population represent 18.3% of adults aged 18-24 years old, 22.5% of adults aged 25-44 years old, 21.3% of adults aged 45-64 years old, and 11% of adults 65 and older. At present, newer products like nicotine gums, patches, e-cigarettes, and inhalational agents constitute around 1% of total nicotine consumption worldwide and are showing a growing trend in most countries.

Tobacco use accounts for more than 5 million deaths worldwide each year. On average, around 435,000 people in the United States(US) suffer death prematurely from smoking-related diseases each year. Overall, smoking causes 1 out of 5 deaths. There is a 50% chance that a lifelong smoker will probably die prematurely from complications of smoking. The deaths due to tobacco consumption are reported to be twice the number of deaths due to alcohol and narcotic drugs combined. Most of the deaths due to tobacco use occur in low or middle-income countries. Cigarette smoking is a leading cause of preventable diseases and premature deaths in the United States along with other countries. [5] [6] [7] [8] [9]

• Pathophysiology

Nicotine is an amine found in tobacco and tobacco products. It is the addictive agent which confers a much lower risk than other elements of tobacco, but it is not completely benign. When tobacco smoke is inhaled, nicotine rapidly enters the bloodstream through the pulmonary circulation. Inhaled nicotine escapes the first pass intestinal and liver metabolism. Nicotine readily crosses the blood-brain barrier which then promptly diffuses into the brain tissue. The process is said to take only 2 to 8 seconds from the time of inhalation. Nicotine is a selective binder to nicotinic cholinergic receptors (nAChRs) in the brain and other tissues. The half-life of nicotine in the human body is estimated to be around 2 hours from the time of consumption.

Brain imaging studies have demonstrated that nicotine acutely increases activity in the prefrontal cortex, thalamus, and visual system consistent with activation of corticobasal ganglia and thalamic brain circuits. Nicotine which stimulates nAChRs produces the release of neurotransmitters, predominantly dopamine but also norepinephrine, acetylcholine, serotonin, GABA, glutamate, and endorphins. These neurotransmitters cause the various responses and behaviors after nicotine intake. When there is repeated exposure to nicotine, tolerance develops to some of the physiological effects of nicotine. Nicotine is a sympathomimetic drug that causes the release of catecholamines and increases heart rate, cardiac contractility, constricts cutaneous and coronary blood vessels and increases blood pressure. 

Nicotine undergoes metabolism in the liver, primarily by the liver enzyme CYP2A6, and converts nicotine to cotinine. Cotinine is a metabolite that can be used as a marker for exposure to nicotine. There are broad individual and racial variations in the rate of nicotine metabolism due to genetic polymorphism in CYP2A6. Thus the metabolism of nicotine is faster in Caucasians than Asians and Africans. Sex hormones also significantly affect CYP2A6 activity, and females metabolize nicotine faster than males. [10] [11]

• Histopathology

In animals, nicotine can inhibit apoptosis, resulting in the impaired killing of malignant cells. Nicotine also has promoted angiogenesis in animals, which could lead to more significant tumor invasion and metastases.

• Toxicokinetics

Animal studies have found nicotine exposure to increase behavioral control of conditioned stimuli, which may contribute to the compulsive smoking behavior. Although conditioning is an important element of nicotine addiction, conditioning primarily develops because of the pharmacological actions of the drug with behaviors.

• History and Physical

Intake of nicotine from tobacco smoke or products produces stimulation and a decrease in a feeling of stress and anxiety. Thus smokers modulate their consumption to experience arousal and mood control day. Smoking may improve concentration, reaction time, and performance in specific areas. But when there is a cessation of smoking, there is the appearance of nicotine withdrawal symptoms. Withdrawal symptoms may manifest as irritability, mood depression, anxiety, inability to socialize, increased appetite or desire to eat, and sleeplessness. If nicotine withdrawal is left untreated in habitual tobacco users, it may produce symptoms with similar intensity as psychiatric disorders.

The relative decrease in dopamine release following longstanding nicotine exposure is a possible explanation for many of the mood disturbances as well as tobacco craving experienced by smokers for a long time even after they have stopped smoking. The habituation to cigarette smoking is partly maintained because of conditioning. People habitually smoke cigarettes in specific situations such as after a meal, with a cup of coffee or an alcoholic drink, or in the company of friends who smoke.

Nicotine is metabolized to cotinine and then to trans-3'-hydroxycotinine or nornicotine and other chemicals such as anabasine. Both of these metabolites can be detected in urine and blood. With a long half-life of 16 hours. These tests can be used to test compliance with withdrawal therapy or nicotine toxicity. Another method to assess nicotine is COa level. This method is related to cotinine. Some questionnaires can measure nicotine dependence such as the Fagerstrom Test for Nicotine Dependence, Wisconsin Inventory of Smoking Dependence and Motives, and Smokeless Tobacco Dependence Scale.  [12] [13] [14]

• Treatment / Management

The three types of medication are used for smoking cessation are as follows:

Nicotine Replacement Products

These include products such skin patches or gum. Often nicotine replacement products are not used correctly. It has been recommended that the bite and park technique is used rather than chewing the gum. [2] [6] [15]

Nicotine Replacement Medications 

Bupropion and, most recently, varenicline has been shown to be effective for smoking cessation. Nortriptyline and Clonidine are considered as the second-line drugs. Nicotine replacement medications are believed to facilitate smoking cessation in several ways: (1) Their primary action is by the relief of withdrawal symptoms when a person stops tobacco use. (2) The second mechanism of benefit is positive reinforcement particularly for the arousal and stress-relieving effect. (3) The third possible mechanism of benefit is related to the ability of nicotine medication to desensitize nicotine receptors.

Bupropion:   initially marketed as an antidepressant; increases brain levels of dopamine and norepinephrine, simulating the effect of nicotine on these neurotransmitters. 

Varenicline:   an analog of cysteine, a naturally occurring plant alkaloid; has a strong binding affinity for nAChR.

Rimonabant: a cannabinoid receptor antagonist which is effective as an aid for smoking cessation.It is believed to contribute to reinforcing effects of nicotine action.

Two other medications of interest: 

Mecamylamine: a noncompetitive antagonist of nicotinic cholinergic receptors; blocks nicotinic effect as well as reinforcement 

lobeline: an alkaloid which is a nicotine receptor agonist; satisfies the nicotine receptor.

Phase 1 and phase 2 clinical trials are studying the effect of a nicotine vaccine that produces antibodies that bind to nicotine to prevent it from acting on nicotine receptors.

Genome-wide association studies that are exploring the possibility of using gene clusters such as the  CHNRA5 and CYP2A6 genes that are involved with nicotine metabolism and its conversion continue as a surrogate marker for response to therapy of nicotine replacement.

• Differential Diagnosis
• Alpha 1-Antitrypsin (AAT) deficiency
• Angina pectoris
• Chronic obstructive pulmonary disease(COPD)
• Histiocytosis X
• Idiopathic pneumothorax
• Low birth weight
• Non-small cell lung cancer
• Obstructive sleep apnea
• Respiratory bronchitis
• Small cell lung cancer

The adverse reproductive effects of nicotine are predominantly fetal neuroteratogenic effect. Smoking has been associated with retardation of fetal growth. Evidence shows that smoking is causative for premature births, stillbirths, placental abruption, and sudden infant death syndrome. The incidence of spontaneous abortions, ectopic pregnancies, and placenta previa in women smokers is increasing. Behavioral disorders have been observed among infants born to mothers who smoke during pregnancy. Smoking is recognized as a significant risk factor for poor maternal-fetal outcomes.

• Complications
• Lung cancer
• Peripheral vascular disease
• COPD/Emphysema
• Head and neck cancer
• Stained teeth
• Deterrence and Patient Education

Clinicians have an opportunity to impact treatment outcomes significantly by incorporating patient education on the critical issues of nicotine addiction. Individualized psychosocial or community-based interventions can help to reduce the use of medications.

• Pearls and Other Issues

Substantial evidence supports combining both psychosocial and pharmacological interventions for the best results.The best outcomes are when medications are combined with behavioral therapy and community-based interventions.

• Enhancing Healthcare Team Outcomes

Nicotine addiction is a complex disorder with no easy cure. Millions of people throughout the globe would like to discontinue smoking but cannot. Many people try to quit smoking and are successful for a few weeks or months but relapse rates are very high. There is no one magical treatment to curing nicotine addiction but evidence suggests that an interprofessional approach that encourages changes in lifestyle may have better outcomes. The nurse is in the prime position to educate the patient at discharge. The pharmacist can educate outpatients on the adverse effects of smoking. The social worker should encourage the patient to change lifestyle, join a support group and keep away from people who smoke. The pharmacist may recommend nicotine substitutes but at the same time should encourage a healthy diet, starting a new hobby and participating in an exercise program.  Some individuals may benefit from cognitive behavior therapy. Finally physicians should continually enforce the importance of nicotine cessation and remind the patient that it adversely affects health. [16] [17] [18] [Level 5]

Nicotine addiction affects millions of people all over the globe and has a very high morbidity and mortality. Besides causing cancers, increasing the risk of adverse cardiac events and stroke, it also results in premature birth, spontaneous abortions and peripheral vascular disease. The costs to healthcare from the adverse health affects as a result of nicotine are enormous. Stopping nicotine addiction is another industry that has evolved over the past decade with very poor success rates. Most nicotine addicts cease smoking more to good luck rather than any bona fide remedy. All healthcare workers should try and educate the patients on the harm of nicotine; until then the healthcare costs will continue to increase. [19] [20] [21] [Level 5]

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Disclosure: Allen Widysanto declares no relevant financial relationships with ineligible companies.

Disclosure: Felton Combest declares no relevant financial relationships with ineligible companies.

Disclosure: Aayush Dhakal declares no relevant financial relationships with ineligible companies.

Disclosure: Abdolreza Saadabadi declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Widysanto A, Combest FE, Dhakal A, et al. Nicotine Addiction. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Tobacco, Nicotine, and E-Cigarettes Research Report Is nicotine addictive?

Yes. Most smokers use tobacco regularly because they are addicted to nicotine. Addiction is characterized by compulsive drug-seeking and use, even in the face of negative health consequences. The majority of smokers would like to stop smoking, and each year about half try to quit permanently. Yet, only about 6 percent of smokers are able to quit in a given year. 25 Most smokers will need to make multiple attempts before they are able to quit permanently. 22 Medications including varenicline, and some antidepressants (e.g. bupropion), and nicotine-replacement therapy, can help in many cases (see " What are treatments for tobacco dependence? "). 26

A transient surge of endorphins in the reward circuits of the brain causes a slight, brief euphoria when nicotine is administered. This surge is much briefer than the "high" associated with other drugs. However, like other drugs of abuse, nicotine increases levels of the neurotransmitter dopamine in these reward circuits, 20,21,27 which reinforces the behavior of taking the drug. Repeated exposure alters these circuits' sensitivity to dopamine and leads to changes in other brain circuits involved in learning, stress, and self-control. For many tobacco users, the long-term brain changes induced by continued nicotine exposure result in addiction, which involves withdrawal symptoms when not smoking, and difficulty adhering to the resolution to quit. 28,29

The pharmacokinetic properties of nicotine, or the way it is processed by the body, contribute to its addictiveness. 24 When cigarette smoke enters the lungs, nicotine is absorbed rapidly in the blood and delivered quickly to the brain, so that nicotine levels peak within 10 seconds of inhalation. But the acute effects of nicotine also dissipate quickly, along with the associated feelings of reward; this rapid cycle causes the smoker to continue dosing to maintain the drug's pleasurable effects and prevent withdrawal symptoms. 30

Withdrawal occurs as a result of dependence, when the body becomes used to having the drug in the system. Being without nicotine for too long can cause a regular user to experience irritability, craving, depression, anxiety, cognitive and attention deficits, sleep disturbances, and increased appetite. These withdrawal symptoms may begin within a few hours after the last cigarette, quickly driving people back to tobacco use.

When a person quits smoking, withdrawal symptoms peak within the first few days of the last cigarette smoked and usually subside within a few weeks. 31 For some people, however, symptoms may persist for months, and the severity of withdrawal symptoms appears to be influenced by a person's genes. 30,31

In addition to its pleasurable effects, nicotine also temporarily boosts aspects of cognition, such as the ability to sustain attention and hold information in memory. However, long-term smoking is associated with cognitive decline and risk of Alzheimer's Disease, suggesting that short-term nicotine-related enhancement does not outweigh long-term consequences for cognitive functioning. 32 In addition, people in withdrawal from nicotine experience neurocognitive deficits such as problems with attention or memory. 33 These neurocognitive withdrawal symptoms are increasingly recognized as a contributor to continued smoking. 34 A small research study also suggested that withdrawal may impair sleep for severely dependent smokers, and that this may additionally contribute to relapse. 35

In addition to the drug's impact on multiple neurotransmitters and their receptors, 30 many behavioral factors can affect the severity of withdrawal symptoms. For many people who smoke, the feel, smell, and sight of a cigarette and the ritual of obtaining, handling, lighting, and smoking the cigarette are all associated with the pleasurable effects of smoking and can make withdrawal or craving worse. 36 Learning processes in the brain associate these cues with nicotine-induced dopamine surges in the reward system 21 —similar to what occurs with other drug addictions. Nicotine replacement therapies such as gum, patches, and inhalers, and other medications approved for the treatment of nicotine addiction may help alleviate the physiological aspects of withdrawal 37–39 (see " What are treatments for tobacco dependence? "); however, cravings often persist because of the power of these cues. Behavioral therapies can help smokers identify environmental triggers of craving so they can use strategies to avoid these triggers and manage the feelings that arise when triggers cannot be. 40,41

Are there other chemicals that may contribute to tobacco addiction?

Research is showing that nicotine may not be the only ingredient in tobacco that affects its addictive potential.

Animal research has also shown that acetaldehyde, another chemical in tobacco smoke created by the burning of sugars added as sweeteners, dramatically increases the reinforcing properties of nicotine and may also contribute to tobacco addiction. 43

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Should be recognised as the central problem of smoking

• John Moxham , professor of respiratory medicine
• Guy's, King's, and St Thomas's School of Medicine, King's College Hospital, London SE5 9PJ

News p 397 Reviews p 454

Last week the Royal College of Physicians of London published its latest report on smoking, 1 the sixth since 1962. It reminds us that almost 40 years after the first report smoking cigarettes remains the single largest cause of premature disability and death in the United Kingdom. Moreover, smoking prevalence has stabilised at one in four of the adult population, with much higher levels in deprived sections of society. This greatest of all health problems refuses to go away. What is new is the report's emphasis on nicotine as an addictive substance and the actions that should flow from that recognition.

The central theme of the report, refined across 200 pages of lucid, carefully researched text, is that cigarette smoking should be understood first and foremost as a manifestation of nicotine addiction. Nicotine is as addictive as “hard” drugs such as heroin. Smokers usually start the habit as children, are addicted to nicotine by the time they are adults, and thereafter the choice to stop becomes an illusion. Thus, although two thirds of smokers want to quit, and about a third try each year, only 2% succeed.

The modern cigarette, developed and …

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What Is Nicotine?

Commonly Used Recreational Drug

• How It Works

Potential Benefits

Frequently asked questions.

Nicotine is an addictive organic compound found in tobacco plants. It’s the chemical that makes smoking cigarettes, chewing tobacco, and vaping so hard to quit.

Nicotine is associated with many health risks and problems. Tobacco is linked to cancer of the mouth, throat, and lungs. Smoking cigarettes causes emphysema and chronic obstructive pulmonary disease (COPD).

Quitting smoking or chewing tobacco can lead to nicotine withdrawal symptoms. Nicotine replacement therapy like gum, lozenges, and patches are used to help people quit smoking, chewing, and vaping.

This article discusses nicotine, how it is used, and the risks associated with tobacco. It also explains how nicotine replacement therapy can help you to quit smoking and chewing tobacco.

Nicotine is a plant alkaloid, which means that it's a naturally occurring chemical that contains nitrogen. It's also a highly addictive stimulant. Nicotine is most popularly known for its use in cigarettes and tobacco products, but it has some other uses.

Although nicotine is predominantly found in tobacco plants, it’s also present in tomatoes, eggplants, potatoes, and green pepper plants. And while they all belong to the nightshade family, the quantities of nicotine in these other plants are much lower than in tobacco plants. 

How Nicotine Works

There are certain proteins in our bodies referred to as receptors. These receptors only receive specific neurotransmitters or chemicals. The receptors that nicotine binds to are called nicotinic-cholinergic receptors. Nicotine is an agonist, which means that when it binds to receptors, it brings about a biological response.

Nicotinic-cholinergic receptors are found in many places in the body, including the brain, neuromuscular junctions (areas of chemical communication between nerves and muscles), the inner part of the adrenal gland , and ganglia (groups of nerve cells).

Nicotine‘s stimulating abilities come from the fact that when it binds to receptors, neurotransmitters (messenger chemicals) like dopamine, acetylcholine , beta-endorphin, norepinephrine , serotonin, and ACTH are released in the body.

Some of these neurotransmitters—like dopamine, beta-endorphin, and serotonin—regulate pleasure, mood, emotion, and pain relief. The dopamine release, for instance, is what causes one to feel pleasure after smoking a cigarette. 

Other neurotransmitters like acetylcholine control physiological responses like heart contractions and muscle movements. This is why a person’s heart rate might speed up, arteries constrict, or their blood pressure becomes elevated right after nicotine is consumed.

Nicotine has uses as a recreational drug, as a treatment for tobacco addiction, and as a pesticide.

Recreational

Nicotine is used as a recreational drug because of its mood-altering and pleasure-inducing effects. Nicotine use is very prevalent. Nearly 40 million adults in the U.S smoke cigarettes.  

Yet while cigarettes are the most common medium through which nicotine is consumed recreationally, there are other nicotine products like  e-cigarettes , chewing tobacco, cigars, snuff, and pipe tobacco.

Continuous use of nicotine leads to long-term changes in the brain. The repeated dopamine release from nicotine consumption teaches the brain to keep using nicotine, and this leads to addiction.

Nicotine use and addiction can cause many illnesses, disabilities, and even death. Over 8 million people die worldwide every year as a direct result of tobacco use. Overcoming nicotine addiction is difficult. Only about 6% of smokers are successfully able to quit every year.

As of Dec. 20, 2019, the  new legal age limit is 21 years old  for  purchasing cigarettes, cigars, or any other tobacco products  (including hookah tobacco) in the U.S.

Nicotine is used to help treat addiction to or dependence on smoking cigarettes. Quitting smoking abruptly can cause one to experience many severe effects and cravings called withdrawal symptoms. Products that deliver low doses of nicotine are sometimes used to ease quitting and manage withdrawal symptoms.

This form of treatment is called nicotine replacement therapy (NRT) . NRT products contain less nicotine than cigarettes and do not contain many harmful chemicals typically found in cigarettes. 

Nicotine replacement can come in the form of patches, gum, lozenges, inhalers, and nasal sprays. Heavy smokers may be medically directed to use a combination of NRT products. When used consistently, NRT increases a person's chances of successfully smoking by 50% to 70%.

(Two other prescription medications that have been found to help with nicotine addiction and dependence are Chantix (varenicline) and Zyban (bupropion). These drugs work by reducing cravings and do not contain nicotine.)

In the natural environment, nicotine protects tobacco plants from herbivores. Nicotine has been used as an insecticide for centuries, although its use this way has seriously dwindled.

In 2014, the Environmental Protection Agency banned nicotine pesticides from being sold commercially in the United States. Nicotine pesticides are also banned in countries under the European Union. 

Instead, chemicals called neonicotinoids are used in many pesticide products. Neonicotinoids are derived from nicotine and are chemically similar to nicotine. Aside from plant protection, they are also used for tick and flea control for pets. 

In 2018, the European Commission banned the outdoor use of neonicotinoids pesticide due to public health concerns and potential threats to bees. In the U.S., many pesticides containing neonicotinoids have been banned, and some restrictions apply to the use of others still permitted for the same reasons as the European ban.

Nicotine and tobacco products are legal for sale to adults over the age of 21 in the United States. Prior to December 2019, the minimum age of sale of tobacco products in the U.S was 18.  While laws and age restrictions vary, nicotine and tobacco products are legal in most other countries in the world.

There are many health risks and side effects associated with using nicotine. Some of the health risks include:

• Nicotine contributes to the development of emphysema —a type of chronic obstructive pulmonary disease— in smokers.
• It’s potentially carcinogenic. Chronic nicotine use is linked to lung , gastrointestinal, pancreatic, and breast cancer.
• Nicotine use is associated with peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). 
• Nicotine use increases the risk of hypertension and cardiovascular diseases.
• Nicotine use during pregnancy increases the likelihood of complications and adverse outcomes like miscarriages and stillbirth.
• Children exposed to nicotine in the womb are more predisposed to health problems throughout their lifetimes. These health problems affect their endocrine, reproductive, neurologic, respiratory, and cardiovascular systems.
• Nicotine use can cause cardiac arrhythmia —a cardiovascular condition characterized by an irregular heartbeat.

Some of the side effects of nicotine use are:

• Stomach pain
• Increased heart rate
• Nervousness

Although conclusive research is still unavailable, nicotine may have some health benefits when taken long-term. These benefits include protection against illnesses and diseases like:

• Alzheimer's disease
• Tourette's syndrome
• Parkinson's disease
• Ulcerative colitis

Nicotine may also help with weight loss.

A Word From Verywell

Nicotine is a highly addictive substance, and it’s advisable to avoid using it recreationally. If you’re trying to quit smoking and plan to use nicotine replacement therapy to ease the process, you should speak to your healthcare provider first. 

Common nicotine withdrawal symptoms include:  

• Cravings or urges to smoke, chew, or vape
• Difficulty concentrating
• Increased appetite 
• Irritability 
• Restlessness
• Weight gain

Nicotine has a reputation for relieving anxiety. Nicotine dependence is more common among people with ADHD, anxiety disorders, and depression. Research suggests nicotine may play a role in relieving symptoms of these mental illnesses.  

At the same time, nicotine withdrawal can cause anxiety, depression, and difficulty concentrating. The science isn’t clear on why people with mental health issues are more likely to use tobacco. It could be because it relieves symptoms or because withdrawal symptoms compound the underlying issues, making it harder to quit.

Nicotine byproducts can be detected in urine for up to four days. The test measures levels of cotinine, a nicotine metabolite. Cotinine levels are generally:

• Less than 10 nanograms per milliliter (ng/mL) in nonsmokers
• Between 11 ng/mL and 30 ng/mL in light smokers or those exposed to secondhand smoke
• Higher than 500 mg/mL in heavy smokers 

Yes, nicotine replacement therapy (NRT) is safe to use. NRT does not cause death or disease as tobacco products do. The dangers of smoking and chewing tobacco is associated with chemicals other than nicotine. There is no evidence that NRT can cause health problems.

Potential side effects of NRT include a rash from the nicotine patch or upset stomach, heartburn, and indigestion from nicotine gum or lozenges. 

Centers for Disease Control and Prevention. Data and statistics: Smoking & tobacco use .

National Institute on Drug Abuse for Teens. Why is nicotine so addictive? .

World Health Organization. Tobacco.

National Institute on Drug Abuse. Is nicotine addictive? .

Federal Register. Nicotine; Product cancellation order .

European Commission. Neonicotinoids .

U.S. Environmental Protection Agency. EPA releases proposed interim decisions for neonicotinoids .

U.S. Food and Drug Administration. Selling tobacco products in retail stores .

Holbrook B. The effects of nicotine on human fetal development .  Birth Defects Research Part C: Embryo Today: Reviews . 2016;108(2):181-192. doi:10.1002/bdrc.21128

D'Alessandro A, Boeckelmann I, Hammwhöner M, Goette A. Nicotine, cigarette smoking and cardiac arrhythmia: an overview .  Eur J Prev Cardiol . 2011;19(3):297-305. doi:10.1177/1741826711411738

Harvard Health. Nicotine: It may have a good side .

Barreto GE, Iarkov A, Moran VE. Beneficial effects of nicotine, cotinine and its metabolites as potential agents for Parkinson's disease .  Front Aging Neurosci . 2015;6:340. doi:10.3389/fnagi.2014.00340

Lakhan SE, Kirchgessner A. Anti-inflammatory effects of nicotine in obesity and ulcerative colitis .  J Transl Med.  2011;9,129. doi:10.1186/1479-5876-9-129

Centers for Disease Control And Prevention. Tips from former smokers: 7 common withdrawal symptoms and what you can do about them .

Kutlu MG, Parikh V, Gould TJ. Nicotine addiction and psychiatric disorders . Int Rev Neurobiol . 2015;124:171-208. doi:10.1016/bs.irn.2015.08.004

University of Rochester Medical Center. Nicotine cotinine (urine) .

Chaturvedi P, Mishra A, Datta S, Sinukumar S, Joshi P, Garg A. Harmful effects of nicotine .  Indian Journal of Medical and Paediatric Oncology . 2015;36(1):24. doi:10.4103/0971-5851.151771

PubChem. Nicotine .

By Tolu Ajiboye Tolu Ajiboye is a health writer who works with medical, wellness, biotech, and other healthcare technology companies.

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June 24, 2024

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Q&A: Researcher discusses a prescription for quitting nicotine

by Karolinska Institutet

Researcher Tanja Tomson and her colleagues have developed a support tool for health care professionals whose patients want to quit nicotine. Tomson is an associate professor of Public Health who conducts research on tobacco cessation at the Department of Learning, Informatics, Management and Ethics (LIME) at Karolinska Institutet. In this interview, she answers questions about kicking the tobacco habit.

How does nicotine dependence work?

When smoking, nicotine reaches the brain within ten minutes, releasing dopamine that provides a nicotine kick. Snus (tobacco designed to be held between the upper lip and gum) users experience a longer delay before the nicotine reaches the brain, but the blood nicotine level remains elevated for an extended period. Over time, users need to increase their nicotine dose to maintain the desired effect. Feelings of anxiety and negativity can arise if nicotine is absent, leading to cravings.

How do you quit?

The best evidence supports using qualified counseling combined with nicotine replacement therapy , such as patches, gum, or prescription medications . The National Board of Health and Welfares guidelines also recommend this care for daily users. [The] reality is that many do not receive this care and are not even asked about their tobacco or nicotine use.

Why is this the case?

Studies indicate that doctors often lack time, and to some extent, knowledge.

What is your research about?

We have developed a concept called Tobaksavvänjning på Recept, TOR, inspired by FAR, Physical Activity on Prescription. This is a novel approach enabling offering qualified advice and nicotine medication. Patients receive at least ten minutes of tobacco counseling, a written prescription for tobacco cessation , and follow-up on at least one occasion. The treatment plan is discussed with the patient, ensuring individual tailor-made treatment.

How effective is it?

We have examined the setup in a RCT study where 18 primary health care (PHC) centers in socioeconomically vulnerable areas were included. At eight PHC we trained staff in smoking cessation and introduced TOR. The remaining ten centers, which formed a control group , followed standard procedures. With TOR, 35% of those who wanted to quit remained smoke-free six months after the treatment. In the centers following standard practices, the corresponding figure was 13%.

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