Nicotine Use Disorder

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KEY POINTS

• Nicotine use disorder is a pattern of using nicotine that leads to serious personal, family, and health problems. Nicotine is a chemical in cigarettes, pipe tobacco, cigars, and smokeless (chewing) tobacco. It is both a stimulant, which increases energy, and a sedative, which calms you down.
• Nicotine use disorder can be treated. You must stop all use of tobacco, including smoking cigarettes, cigars, or pipes, and chewing tobacco. Your healthcare provider might prescribe medicine to help reduce your cravings for nicotine or to decrease the positive feelings caused by nicotine. Joining an organized quit-smoking program while you are using medicines can help you quit.
• The best way to help yourself is to see your healthcare provider and make plans to quit smoking.

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What is nicotine use disorder?

Nicotine is a chemical in cigarettes, pipe tobacco, cigars, and smokeless (chewing) tobacco. It is both a stimulant, which increases energy, and a sedative, which calms you down.

Nicotine use disorder is a pattern of using nicotine that leads to serious personal, family, and health problems. The more of these statements that apply to you, the more severe your nicotine use disorder is.

1. You use more or use nicotine for longer than you planned.
2. You want to cut down or quit, but are not able to do so.
3. You spend a lot of time and energy getting nicotine, using nicotine, and getting over the effects.
4. You crave nicotine so much that you have trouble thinking about anything else.
5. You have problems at work or school, or stop taking care of people who depend on you.
6. You have relationship problems because you don’t keep your promises, or you argue or get violent with other people.
7. You stop doing things that used to matter to you, such as sports, hobbies, or spending time with friends or family, because of your nicotine use.
8. You use nicotine even when it is dangerous, such as while driving or operating machinery.
9. You keep using nicotine even though you know that it is hurting your physical or mental health.
10. You need to use more and more of the drug, or use it more often to get the same effects. This is called tolerance.
11. You have withdrawal symptoms when you stop using.

Nicotine use disorder may also be called drug abuse, substance abuse, dependence, or addiction. Nicotine is very addicting and smoking cigarettes is dangerous to you and the people who are around you when you smoke. Every time you smoke, poisonous chemicals go into the air. Each year, many nonsmokers die from lung cancer because they breathed secondhand smoke.

What is the cause?

The brain makes chemicals that affect thoughts, emotions, and actions. Nicotine changes the balance of these chemicals in your brain. When you use nicotine regularly, your brain starts to get used to it. As a result you don't feel right unless you use nicotine. When you stop using nicotine suddenly, the balance of chemicals in your brain changes, which causes the symptoms of withdrawal.

You may enjoy the ritual of handling, lighting, and smoking cigarettes. If you try to quit, not having these rituals to follow may make withdrawal symptoms and cravings worse.

You have a higher risk of becoming dependent on nicotine if you:

• Have a family history of tobacco, drug, or alcohol abuse
• Have abused tobacco, alcohol, or drugs in the past
• Are easily frustrated, have trouble dealing with stress, or feel like you aren’t good enough
• Are regularly around people who use tobacco, alcohol, or drugs
• Have a mental health problem

What are the symptoms?

The symptoms of nicotine use disorder depend on how much and how often you use nicotine. The symptoms can be mild to severe, such as:

• Fast heartbeat
• Smelling like smoke and having bad breath
• Trouble breathing when doing activities such as walking up stairs
• Sinus congestion and constant cough
• Trouble sleeping
• Getting frequent colds or other infections

You may also have symptoms of new or worse health problems caused by long-term smoking, such as:

• COPD or lung cancer
• Cancer of the mouth, throat, bladder, kidney, and stomach
• Heart disease
• Kidney failure
• Stroke

Pregnant women who smoke are at higher risk of miscarriage, premature delivery, and having a baby with low birth weight. The symptoms of nicotine withdrawal can be mild to severe. You may have some of these symptoms when you stop using nicotine:

• Restlessness and irritability
• Depression or anxiety
• Trouble paying attention
• Trouble sleeping
• Increased appetite
• Headaches
• Cravings for tobacco

The symptoms of withdrawal may be very strong, especially during the first 72 hours after you stop using tobacco. After the first 2 or 3 days the symptoms improve.

How is it diagnosed?

Your healthcare provider will ask how much and how often you smoke. Be honest about your smoking. Your provider needs this information to give you the right treatment. He will also ask about your symptoms and medical history and examine you. You may have blood or urine tests.

How is it treated?

Nicotine use disorder can be treated. You must stop all use of tobacco, including smoking cigarettes, cigars, or pipes, and chewing tobacco.

Your healthcare provider may recommend nicotine replacements that can almost double your chances of quitting for good. You can buy nicotine gum, patches, or lozenges without a prescription. Your provider can prescribe nicotine inhalers or nasal sprays. Nicotine replacement therapy lets you slowly decrease the amount of nicotine in your system over time. Using nicotine replacement as you quit tobacco may reduce cravings and ease physical symptoms. The dose of nicotine is slowly decreased over several weeks or months.

Electronic cigarettes, also called e-cigs, are battery-operated devices that look like a cigarette or cigar. They make a smokeless vapor that the user inhales. The vapor contains many chemicals, and often contains nicotine. E-cigs are not a good way to quit smoking because:

• They have not been proven to be safe. Some of the chemicals are harmful. E-cigs affect lungs and breathing in some of the same ways that tobacco cigarettes do.
• There is no proof that e-cigs help with quitting smoking. E-cigs deliver nicotine in a way that can continue nicotine and smoking addiction.

Your healthcare provider might prescribe medicine that doesn’t contain nicotine to help reduce your cravings for nicotine or to decrease the positive feelings caused by nicotine.

You are more likely to succeed if you work to change your behavior as well as take medicine. You may want to join self-help groups such as Nicotine Anonymous or organized quit-smoking programs, or try individual therapy. Cognitive-behavioral therapy (CBT) helps you look at your thoughts, beliefs, and actions, and understand which ones cause problems for you. Then you learn to change unhealthy ways of thinking and acting.

Hypnosis and acupuncture may help you to quit smoking. However, you still need to learn to live without nicotine in your daily life.

How can I take care of myself?

There are things you can do you help yourself quit smoking:

• Make a plan:
  • Set a date for when you plan to quit and tell your family and friends. Some people gradually use less tobacco in the days leading up to their quit date. Others use the same amount of tobacco right up to their quit date.
  • It may also help to chew sugarless gum or eat hard candy, beef jerky, or sunflower seeds when you feel like smoking or chewing tobacco.
  • Throw out all your tobacco products and anything that you use with your tobacco, such as lighters and ashtrays.
  • Think about all the reasons you do not want to use tobacco. For example, you may hate the smell and the cost. You can write these reasons down and review them whenever you feel tempted to use tobacco.
  • Make a list of the situations, places, or emotions that make you more likely to use tobacco. These things are called triggers. Being aware of these triggers can help you avoid them or be ready for them. For example, if you always use tobacco after an argument with your partner, make a plan to take a walk the next time you have an argument.
• Get support. Talk with family and friends. Join a stop-smoking support group or class.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. Don’t use alcohol or drugs. Exercise according to your healthcare provider's instructions.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that you take.
• Contact your healthcare provider for a prescription medicine that can help you quit. Ask about using nicotine gum or patches.
• Keep trying. Many people try more than once to quit smoking before they finally succeed. Don't give up. You can quit and quit for good. Get help and try again.