Nicotine addiction and tobacco smoking have been a leading cause of death worldwide for a long time. The time between the first cigarette and the number of cigarettes smoked daily are the strongest predictors of nicotine addiction. Nicotine addiction can be prevented through patient education and nicotine and non-nicotine substitute therapy.

Takeaways from the conference:

  • Smoking tobacco is a significant health issue in the world.
  • Stopping smoking starts with the willingness to quit.
  • Tobacco smoking has far more negative health effects than positive ones, both in the short- and long term.

Nicotine addiction is diagnosed as a tobacco use disorder.

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) now calls nicotine addiction tobacco use disorder.

There are eleven possible criteria, of which two must have been present in the past 12 months.

  • Tobacco is consumed in more significant quantities or for more extended periods.
  • A persistent desire or ineffective attempts to reduce or control usage.
  • How much time is spent on activities required to obtain or use tobacco?
  • Craving is a strong desire to smoke tobacco.
  • Regular tobacco use results in failure to meet significant roles at work, school or home.
  • Continued tobacco use despite persistent or recurrent interpersonal or social problems (e.g. arguments with others over tobacco use).
  • Due to tobacco use, significant social, occupational or recreational activities are reduced or eliminated.
  • Tobacco use in physically dangerous situations (e.g., smoking in bed).
  • Continued tobacco use despite knowledge of persistent or recurrent psychological or physical problems likely to be caused or exacerbated by tobacco.
  • Tolerance is defined as the need to use a significantly increased amount of tobacco to achieve desired effects, or the effect is markedly reduced with the continued use of the tobacco.
  • Withdrawal is manifested either by the typical withdrawal syndrome or the use of tobacco to alleviate or avoid withdrawal symptoms.

Nicotine addiction: effects

Every smoker knows some of the effects. This includes increased heart rate, blood pressure, and decreased appetite, often leading to weight loss. Quitting smoking may lead to weight loss, decreased heart rate, and an improved sense of taste and scent, which can result in a better appetite.

The psychological and behavioural effects of nicotine addiction may be even more powerful. Smokers can be identified by their general appearances, such as tar-stained teeth and premature skin aging. Smokers will often do whatever it takes to hide their need to smoke.

Nicotine can cause smokers to become more alert and dependent and even exhibit frantic behaviour, including irritability and speech acceleration. Smokers believe they smoke in order to calm themselves down or soothe their agitation. Smoking tobacco can cause anxiety and depression.

Nicotine does not produce abnormal thoughts or perceptions such as delusions. Nicotine does not alter memory or judgment. But it can disrupt social interactions if others don’t want to be around a smoker.

How does nicotine work scientifically?

Nicotine works through the reward centre of our brain. The neuroanatomic complex involved is called the mesolimbic dopamine system, which covers a large brain area, including the basal forebrain. Addictive behaviours are controlled in an area called the nucleus accumbens that releases dopamine.

Other factors promote nicotine dependence through the enzyme monoamine oxidase inhibitor enzyme. This enzyme aids in the metabolism of catecholamines, such as dopamine itself.

The neurobiology of nicotine addiction is complex. Nicotine has a profound effect on brain chemistry. Nicotine use results in more efficient processing of information and reduction of fatigue. It can also work as a sedative, reducing anxiety and inducing euphoria. These benefits are outweighed by various health risks, including cardiovascular, lung, and kidney disease and cancer, to name a few.

The average cigarette delivers 1.2 to 2.9 mg of nicotine. A typical one-pack-a-day smoker absorbs 20 to 40 mg of nicotine per day, raising their blood plasma level quickly, but withdrawal symptoms can occur almost immediately within a few hours.

Smoking has known associations with depression, insomnia, and post-traumatic stress disorder. Interestingly, roughly one-third of current military service members smoke cigarettes.

Health impact of smoking

Smoking has a significant impact on health worldwide. Most of the leading causes of death are significantly impacted by those who smoke, reducing lifespans in almost every society. If the pattern of smoking all over the globe doesn’t change, more than eight million people will die from diseases related to tobacco use by 2030. In 2020, 12.5% of U.S. adults (31 million) smoked cigarettes.

The adverse effects of smoking tobacco are vast. Tobacco smoking accounts for over 85% of deaths due to lung cancer. Tobacco contributes to head and neck cancer and bladder and uterine cervical cancer. Tobacco increases the risk of heart attacks, stroke, lung disease, kidney disease, and many other health problems.

Second and third-hand smoke has significant health effects as well. Many nonsmokers exposed to tobacco smoke also have increased health risks, including risks of developing cancers and pulmonary diseases.


Many people quit smoking on their own. Some smokers use nicotine or non-nicotine replacements, behavioural counsels, and natural therapies such as acupuncture and other means to stop smoking.

Patients interested in Web-based smoking cessation programs may find the following sources helpful:

  • “Freedom from Smoking,” available from the American Lung Association.
  • The Tobacco Control Research Branch of the National Cancer Institute.
  • The Smoking Quitline of the National Cancer Institute (NCI) makes smoking cessation counsellors available to answer smoking-related questions in English or Spanish by telephone or confidential online chat.
  • The American Cancer Society website provides educational materials and can direct interested individuals to a community-based smoking cessation program called FreshStart.
  • Nicotine Anonymous is a fellowship-based program structured along the same lines as Alcoholics Anonymous.

Nicotine addiction has far-reaching adverse health risks. Tobacco smoking continues to decrease but still represents a global problem. There are many ways to stop smoking. The first step is wanting to quit.


By Lara Parker

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