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Nicotine and tobacco

  • Definition
    • The nicotine in tobacco can be addictive like alcohol, cocaine, and morphine.

  • Alternative Names
    • Withdrawal from nicotine; Smoking - nicotine addiction and withdrawal; Smokeless tobacco - nicotine addiction; Cigar smoking; Pipe smoking; Smokeless snuff; Tobacco use; Chewing tobacco; Nicotine addiction and tobacco

  • Causes
    • Tobacco is a plant grown for its leaves, which are smoked, chewed, or sniffed.

      • Tobacco contains a chemical called nicotine. Nicotine is an addictive substance.
      • Millions of people in the United States have been able to quit smoking. Although the number of cigarette smokers in the United States has dropped in recent years, the number of smokeless tobacco users has steadily increased. Smokeless tobacco products are either placed in the mouth, cheek, or lip and sucked or chewed on, or placed in the nasal passage. The nicotine in these products is absorbed at the same rate as smoking tobacco, and addiction is still very strong.

      Both smoking and smokeless tobacco use carry many health risks.

  • Symptoms
    • Nicotine use can have many different effects on the body. It can:

      • Decrease the appetite; fear of weight gain makes some people unwilling to stop smoking
      • Boost mood, give people a sense of well-being, and possibly even relieve minor depression
      • Increase activity in the intestines
      • Create more saliva and phlegm
      • Increase the heart rate by around 10 to 20 beats per minute
      • Increase blood pressure by 5 to 10 mm Hg
      • Possibly cause sweating, nausea, and diarrhea
      • Stimulate memory and alertness; people who use tobacco often depend on it to help them accomplish certain tasks and perform well

      Symptoms of nicotine withdrawal appear within 2 to 3 hours after you last use tobacco. People who smoked the longest or smoked a greater number of cigarettes each day are more likely to have withdrawal symptoms. For those who are quitting, symptoms peak about 2 to 3 days later. Common symptoms include:

      • Intense craving for nicotine
      • Anxiety
      • Depression
      • Drowsiness or trouble sleeping
      • Bad dreams and nightmares
      • Feeling tense, restless, or frustrated
      • Headaches
      • Increased appetite and weight gain
      • Problems concentrating

      You may notice some or all of these symptoms when switching from regular to low-nicotine cigarettes or reducing the number of cigarettes you smoke.

  • Treatment
    • It is hard to stop smoking or using smokeless tobacco, but anyone can do it. There are many ways to quit smoking.

      There are also resources to help you quit. Family members, friends, and co-workers may be supportive. Quitting tobacco is hard if you are trying to do it alone.

      To be successful, you must really want to quit. Most people who have quit smoking were unsuccessful at least once in the past. Try not to view past attempts as failures. See them as learning experiences.

      Most smokers find it hard to break all the habits they have created around smoking.

      A smoking cessation program may improve your chance for success. These programs are offered by hospitals, health departments, community centers, work sites, and national organizations.

      Nicotine replacement therapy may also be helpful. It involves the use of products that provide low doses of nicotine, but none of the toxins found in smoke. Nicotine replacement comes in the form of:

      • Gum
      • Inhalers
      • Throat lozenges
      • Nasal spray
      • Skin patches

      You can buy many types of nicotine replacement without a prescription. The goal is to relieve cravings for nicotine and ease your withdrawal symptoms.

      Health experts warn that e-cigarettes are not a replacement therapy for cigarette smoking. It is not known exactly how much nicotine is in e-cigarette cartridges, because information on labels is often wrong.

      Your health care provider can also prescribe other types of medicines to help you quit and prevent you from starting again.

  • Support Groups
    • Your provider can refer you to stop smoking programs. These are offered by hospitals, health departments, community centers, work sites, and national organizations.

  • Outlook (Prognosis)
    • People who are trying to quit smoking often become discouraged when they do not succeed at first. Research shows that the more times you try, the more likely you are to succeed. If you start smoking again after you have tried to quit, do not give up. Look at what worked or did not work, think of new ways to quit smoking, and try again.

  • Possible Complications
    • There are many more reasons to quit using tobacco. Knowing the serious health risks from tobacco may help motivate you to quit. Tobacco and related chemicals can increase your risk of serious health problems such as cancer, lung disease, and heart attack.

  • When to Contact a Medical Professional
    • See your provider if you wish to stop smoking, or have already done so and are having withdrawal symptoms. Your provider can help recommend treatments.

  • References
    • Benowitz NL, Brunetta PG. Smoking hazards and cessation. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 46.

      Rakel RE, Houston T. Nicotine addiction. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 49.

      Siu AL; U.S. Preventive Services Task Force. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: US Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2015;163(8):622-634. PMID: 26389730