Nicotine Addiction: Symptoms, Causes, Risks, Complications, Diagnosis and Withdrawal

nicotine addiction man with cigarette


Nicotine is an addictive substance with a large potential for abuse.The majority of smokers use tobacco on a regular basis because they are addicted to nicotine.
Addiction is characterized by drug seeking and abuse, which is compulsive, even with the knowledge of negative consequences for health. It has been well documented that smokers express the desire to quit or at least to reduce their consumption. Nearly 35 million smokers want to quit each year. Unfortunately, more than 85% of those who want to quit are able to do so. In addition, those who are able to stop smoking relapse within a week.

Research has shown the effects of nicotine on the brain, which produces a variety of effects. The greatest importance lies in its addictive potential. Findings show that nicotine is a potent activator of reward pathways in the brain, which regulates the person’s feeling of pleasure. A key chemical in mediating these reward pathways is dopamine, which increases in response to nicotine. The reaction is similar to the reactions to other drugs of abuse, and long-term brain changes occur due to nicotine. These long-term brain changes lead to addiction.


Nicotine addiction manifests in a variety of ways. Studies show that 3 out of 4 people who presently smoke are still smoking up to 40 years later. These people simply can’t quit smoking due to the addictive effects of nicotine. In fact, the Surgeon General has warned that the addictive effects of nicotine are the same as that of cocaine and heroin.

One of the symptoms of nicotine addiction is reaching for cigarettes first thing in the morning. After not taking nicotine for a long time while sleeping, and then reaching for it,
is a good indication of the severity of nicotine addiction. If the person smokes within five minutes of waking up, addiction to nicotine is strong. If the person smokes within 30 minutes, addiction is moderate and if it is 60 minutes or longer, the addiction is lower.

There are other signs of nicotine addiction, such as smoking more than 7 cigarettes a day, smoking even while sick, and going outside to smoke even when it’s raining or freezing. Irritability, angers, restlessness, depression, physical sensations that mimic a mild case of the flu, craving for cigarettes, and weight gain are other symptoms.


The cause of nicotine addiction lies in the brain pathways affected by nicotine.
Once tobacco smoke is inhaled, the body distills the nicotine found in smoke.
Smoke particles transport nicotine into the lungs, where rapid absorption occurs in the pulmonary venous circulation. The nicotine then transfers to the arterial circulation.
It moves rapidly from the lungs to the brain. Once in the brain, it binds to nicotinic cholinergic receptors. These are channels that normally bind acetylcholine.
Nicotine binds to the channel, paving the way for the entry of calcium and sodium.
Once calcium enters, neurotransmitters are released. Dopamine, a neurotransmitters, signals reward pathways in the brain, allowing for a pleasurable experience which reinforces the effects of nicotine.

Glutamate is another neurotransmitter that is released when nicotine is in the brain. Glutamate facilitates the release of dopamine. This binding also releases another neurotransmitter, GABA, which inhibits the release of dopamine. However, over time, this inhibition decreases, while glutamate action increases. Thus, responsiveness to nicotine increases, which also increases the response to nicotine.

When the responsiveness for nicotine increases, this leads to addiction as the person is sensitized to the effects of nicotine. Thus, the more cigarettes he smokes, the more pleasure he gets from nicotine.

Risk Factors

Nicotine addiction has several risk factors associated with it. One of the greatest risk factors is a history of tobacco use in any form. It is harder for people who have tried nicotine to quit. Genetic factors also seem to play a role in addiction. The reason behind this is that the response of the neurons, which are cells in the brain, to the release of dopamine is dependent partially on genetic factors. Some people may respond better to the release of dopamine compared to others, leading to an increased chance of addiction.

Environmental factors

also, play a role. Having parents or family members who smoke can increase the chances of a person developing an addiction. In addition to this, having a circle of peers who smoke will also encourage one’s smoking habits.

Age is another factor. Smoking at an earlier age increases the chances that a person will become a heavy smoker. This is presumably due to different factors, but may be linked to the sensitization of nicotine receptors in the brain.

Having any kind of mental illness is a factor in developing an addiction. Studies have shown that people with depression, bipolar disorder, and schizophrenia are heavier smokers compared to the general population. There are hypotheses surrounding this and one of them is that when nicotinic receptors are activated, a few seconds of clear thought occurs in these individuals. More schizophrenics smoke compared to the general population.

Finally, indulging in other addictions, such as illegal drugs and alcohol also increases the chances that a person will smoke and become addicted. These activities are conducive to smoking and are habits that are hard to overcome.


There are many complications associated with nicotine addiction.
Perhaps the most well-known is lung cancer. Lung cancer has been directly linked to smoking, and the risk increases with the number of sticks and the length of time that a person has been smoking. Mouth cancers are another complication, as well as heart disease, chronic obstructive pulmonary disease, and emphysema.

In addition, smokers are also more likely to acquire respiratory illnesses such as viral infections and may be at a higher risk for other types of cancers, such as bladder cancer. Asthma and allergies are also made worse by exposure to tobacco smoke. Aside from these, maternal and fetal exposure to tobacco smoke may occur in women who smoke while pregnant. These women are at a greater risk of miscarriage and premature delivery. Their children may weigh less than the average for their age.

A large proportion of those with mental illnesses smoke. Smoking is believed to be more common among those with mood and anxiety disorders. It is also more prevalent in those with substance abuse disorders. Alcohol abuse and other substance abused may lengthen the time to recovery and may affect the disability. Cigarette smoking further increases the metabolism of many medications, and these may occur to a clinically significant degree.


The diagnosis of nicotine addiction is dependent upon the criteria of substance abuse disorders in the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V).The core features of diagnostic methods include the compulsive and repeated self-administration of the substance, such as nicotine. Impaired control over the use of the substance is another criteria. This includes repeated attempts to stop using it and being aware of the harmful effects, but these attempts are usually unsuccessful. There is also an increased motivation to seek nicotine

because of the positive effects that it has on relaxation and mood. It may also stimulate thinking and thus the person seeks the substance compulsively. There are also other reasons that relate to the seeking of the drug, which includes social and mental pressures.

Aside from these, there is also a judgment of the greater value of the use of the drugs over other activities or reinforcers. There is also a manifestation of physical dependence, such as tolerance and withdrawal symptoms when nicotine is discontinued.
The diagnosis of nicotine addiction is based on these criteria, which make up the core features of a diagnosis of substance abuse disorder.

Nicotine Withdrawal

In those with nicotine dependence, abstaining from smoking produces the onset of distress. This is indicated by self-reported behavioral, physiological, and cognitive symptoms and by clinical signs. The symptoms of withdrawal include disturbances in mood, such as anger, irritability, anxiety, and depression. The behavioral symptoms include increased appetite, sleep disturbances, and restlessness. Cognitive effects also occur, which include difficulty in concentrating. Researchers believe that this constellation of symptoms is the cause of the difficulty in quitting.Thus, the primary management of craving and withdrawal symptoms is a first-line treatment strategy to maintain quitting. Typically, withdrawal symptoms appear a few hours after the last cigarette. These symptoms peak within a few days to a week. Then, symptoms disappear within

Thus, the primary management of craving and withdrawal symptoms is a first-line treatment strategy to maintain quitting. Typically, withdrawal symptoms appear a few hours after the last cigarette. These symptoms peak within a few days to a week.
Then, symptoms disappear within two to four weeks. However, substantial individual variability exists in the response to nicotine withdrawal. These individual responses may be clinically significant and substantial enough to warrant medical attention.

Individual withdrawal symptoms are often viewed as various manifestations of the underlying process. One approach suggests that the symptoms of nicotine withdrawal are caused by a tightly linked pattern, time course, relationship to relapse, neurobiological factors, and intensity. Another approach suggests that the smoker’s symptoms should be based on a scoring system of aggregating symptoms. The severity of withdrawal is strongly related to the scores for nicotine dependence.