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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

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

  • Tobacco contains 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 been able to 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. The nicotine in these products 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 (Fear of weight gain makes some people unwilling to stop smoking.)
  • Boosts mood and may even relieve minor depression (Many people will feel a sense of well-being.)
  • Increases activity of the 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.)

Symptoms of nicotine withdrawal appear 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:

  • Intense craving for nicotine
  • Anxiety
  • Depression
  • Drowsiness or trouble sleeping
  • 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 hard 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. These 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. Nicotine replacement comes in the form of gum, inhalers, throat lozenges, nasal spray, and skin patches. You can buy many types without a prescription. The goal is to relieve cravings for nicotine and ease your withdrawal symptoms.

Your health care provider can also prescribe other types of medicines to help you quit and prevent you from starting again.

Outlook (Prognosis)

People who are trying to quit smoking often become discouraged when they don't succeed at first. Research shows that the more times you try, the more likely you are to succeed. If you start smoking again after you have tried to quit, do not give up. Look at what worked or did not work, think of new ways to quit smoking, and try again.

Possible Complications

There are many more reasons to quit using tobacco. Knowing the serious health risks from tobacco may help motivate you to quit. Tobacco and related chemicals such as tar and nicotine can increase your risk of serious health problems such as cancer, lung disease, and heart attack.

When to Contact a Medical Professional

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

References

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

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.

Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2012;11:CD000146. DOI: 10.1002/14651858.CD000146.pub4.

U.S. Preventive Services Task Force. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women. U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2009;150:551-555.

Updated: 8/29/2013

Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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