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Nicotine and tobacco

Tobacco and nicotine 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, incidence, and risk factors

Tobacco is a plant grown for its leaves, which are smoked, chewed, or sniffed for a variety of effects.

  • Tobacco contains a chemical called nicotine. Nicotine is an addictive substance.
  • Tobacco also contains more than 19 known chemicals that can cause cancer. As a group, these are called "tar." More than 4,000 other chemicals can be found in tobacco.

Millions of people in the United States have successfully 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. Nicotine in smokeless tobacco 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:

  • Decreases the appetite (for this reason, the fear of weight gain affects some people's willingness to stop smoking).
  • Boosts mood and may even relieve minor depression. Many people will feel a sense of well-being.
  • Increases activity of your intestines
  • Creates more saliva and phlegm.
  • Increases heart rate by around 10 to 20 beats per minute.
  • Increases blood pressure by 5 to 10 mmHg.
  • May cause sweating, nausea, and diarrhea.
  • Stimulates memory and alertness. People who use tobacco often depend on it to help them accomplish certain tasks and perform well.

You may notice symptoms of nicotine withdrawal within 2 - 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 will peak about 2 - 3 days later. Common symptoms include:

  • An intense craving for nicotine
  • Anxiety
  • Depression
  • Drowsiness or trouble sleeping, as well as 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 cut down on the number of cigarettes smoked.

Treatment

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

There are also resources to help you. Family members, friends, and co-workers may be supportive. Quitting tobacco is difficult if you are acting 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 to quit 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. Such 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. Such products include special gum, inhalers, throat lozenges, nasal spray, or skin patch. The goal is to relieve cravings for nicotine and ease your withdrawal symptoms.

Your health care provider can prescribe medicines to help you quit  and prevent you from starting again. These medications help with the craving for tobacco and the withdrawal symptoms

Expectations (prognosis)

People who are trying to quit smoking often become discouraged when they don't succeed at first. Research shows that the mor etimes you try, the more likely you are to succeed -- so don't give up! If you aren't successful the first time you try to quit, look at what worked or didn't work, think of new ways to quit smoking, and try again. Many attempts are often needed to finally break the habit.

Complications

There are many more reasons to quit using tobacco. Knowing the serious health risks may help motivate you to quit. When used over a long period, tobacco and related chemicals such as tar and nicotine can increase your risk of many health problems.  

Calling your health care provider

See your health care provider if you wish to stop smoking, or have already done so and are having withdrawal symptoms. Your doctor can help recommend treatments. Some are only available by prescription.

References

George TP. Nicotine and tobacco.In: Goldman L, Schafer AI, eds.Cecil Medicine. 24th ed.Philadelphia,PA: Saunders Elsevier; 2011:chap 31.

Burke MV, Ebbert JO, Hays JT. Treatment of tobacco dependence. Mayo Clin Proc. 2008;83:479-483.

Hays JT, Ebbert JO, Sood A. Treating tobacco dependence in light of the 2008 US Department of Health and Human Services clinical practice guideline. Mayo Clin Proc. 2009;84:730-735.

Updated: 12/10/2012

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.


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