Nicotine Dependence

Nicotine dependence, or tobacco dependence, refers to the addiction to different tobacco products even when it cause significant distress. Addiction is specifically to nicotine, the primary component in tobacco products. It is one of the hardest addiction of all, and it is one of the leading causes of death. 

Dependence to nicotine causes a strong urge to use the drug or product despite the distress. People with this addiction tend to have increased tolerance to the products, and often give a higher priority to use them. Use of nicotine gives a pleasant feeling which leads to dependence. 

People with nicotine dependence have trouble controlling its use, while stopping or reducing the use leads to withdrawal symptoms. Nicotine addiction may lead to cardiovascular diseases, cancer, and chronic obstructive pulmonary disorder.

Symptoms of nicotine dependence may vary with the individual. Some individuals get addicted to the products rapidly when compared to others. The most common symptoms are:

• Tolerance – continued use of the same amount may have reduced effect over a period of time and there is a need to have increased dose or amount of the substance to produce the desired effect. 
• Withdrawal symptoms – reduced amount or attempt to stop results in characteristic withdrawal symptoms.
• Unsuccessful attempts to quit – efforts to reduce the amount or stop its use often is a failure.
• Higher priority for use – significant amount of time and effort is spent on obtaining and using nicotine products. As substance abuse progresses, lesser time will be spent on social, occupational, and even hobbies. 

Despite the health problems, people with nicotine dependence find it difficult to stop the usage. 

The cause of nicotine dependence is a combination of nicotine exposure, and preexisting biological tendencies.

Nicotine, the primary addictive component of tobacco, leads to the release of neurotransmitters that regulate mood. Dopamine is the main neurotransmitter released by nicotine use. Dopamine enhances pleasure feeling, called as dopamine rush, and makes nicotine addictive. 

Addiction is influenced by many psychological and physical factors like: 

• After eating – the urge to smoke increases after a good meal.
• Alcohol – most patients prefer to have a smoke along with alcohol.
• Some places – there is a strong desire to smoke at certain places like pub, car park, or bar. The location may vary with individual.
• Stress – stressful, or exciting moments increase the desire to smoke.
• Tobacco smell – smell of smoking triggers the desire further.
• Driving – driving on their own often influences smoking. 

Some people prefer to smoke at certain times of the day like with coffee, early morning, or before going to bed. Identifying and breaking these routines or factors are important in controlling the disorder. 

The most common risk factors for nicotine dependence are peer influence, age, mental illness, and genetics. People who have other types of substance use disorder like alcohol use disorder also have increased chances of developing nicotine dependence. 

Diagnosis of nicotine dependence is based on the responses given by the patient to queries regarding his/her habit of nicotine use. Doctor may seek information regarding tobacco use from family and friends as well. 

Diagnosis is based on American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). Extent of dependency is based on the number of products used per day. 

Dependence is more if the use starts soon after getting up in the morning. Treatment is based on the degree of dependence on the product.

Combination of psychological therapy and medications is the best way to treat nicotine dependence. 

Nicotine replacement therapy (NRT) helps to curb the urge to use products by releasing nicotine in lower doses into blood. This can be done using nicotine patch, nicotine gums, nicotine lozenge, nicotine inhaler, or a nicotine nasal spray. 

The type of NRT prescribed is based on degree of dependence and ease of use. Progressive reduction in the amount of product use also helps to give up dependence over a period of time. 

Non-nicotine medications are also recommended to control nicotine dependence. These medications increase the level of neurotransmitters like dopamine, or act on the brain’s receptors to give a pleasant feeling similar to that of nicotine. They are not addictive and help to reduce the usage of nicotine products. 

Some of the common non-nicotine medications include bupropion, varenicline, and nortriptyline. Combining medications with counselling and support help to quit the use of nicotine. 

Not smoking is the best way to prevent nicotine dependence. In most of the cases, people start the habit in their teenage. Talking to teenagers regarding the harmful effects is useful. 

Having a smoke-free environment in the society and community also helps to curb smoking in public, prevents the habit. Increased prices on tobacco products may also be of help.

A few alternative and homeopathic remedies exist for nicotine dependence.

Homeopathic remedies for nicotine dependence is based on the cause of smoking. Lycopodium, baryta, calcarea, mercurius, argentum nitricum, arsenic album, natrum mur, nux vomica, and aurum met are the common remedies prescribed. 

Many other alternative remedies like herbs and supplements, e-cigarettes, hypnosis, and nicotine lollipops are suggested, but lack scientific evidence.

Lifestyle modifications are necessary in order to cope with nicotine dependence.

Avoiding situations that force a person to take up the habit is ideal to control the habit. Developing healthy lifestyle with regular exercise, healthy eating habits, and avoiding cravings are equally important. 

Motivation and dedication to quit is important if under treatment for controlling nicotine dependence. For this, identifying the triggers of nicotine use helps. Seeking professional help creates a healthy environment to avoid cravings and quit smoking without affecting health.

There are several complications associated with nicotine dependence.

Nicotine use causes many health consequences in the long run. Cancer of lung, esophagus, throat, and mouth are the most common complications associated with tobacco product use. 

Cardiovascular diseases are also not rare with nicotine dependence. Some other common complications include: 

• Eye problems
• Diabetes
• Infertility
• Weak immune system
• Oral cavity diseases
• Complications in pregnancy
• Stroke