What Is Nicotine Dependence?

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Nicotine is a highly addictive substance that is found in all tobacco products. People who use tobacco products are at high risk for developing nicotine dependence (formerly known as nicotine addiction), which is a lack of control over the need for nicotine.

According to the 2020 National Survey on Drug Use and Health, over 23 million people aged 12 and over reported dependence on nicotine. Tobacco products contain thousands of harmful chemicals that can affect every organ in the body and lead to serious illness and death.

This article discusses the symptoms associated with nicotine dependence, how it's diagnosed and treated, and coping strategies for people working to overcome it.

Cropped Hand Of Woman Holding Cigarette

Oliver Helbig / Getty Images

Types of Nicotine Dependence

Nicotine exerts its effects by binding to receptors located in the brain. It also increases the concentration of a neurotransmitter (brain chemical) called dopamine. These interactions eventually lead to behavioral change reinforcement and development of nicotine dependence.

The way the body responds to nicotine is consistent, but there are different types of nicotine products, all of which can lead to nicotine dependence.

Nicotine Products

Products that contain nicotine include:

  • Cigarettes
  • Cigars
  • Vaping devices
  • Hookahs
  • Chewing tobacco
  • Snuff
  • Dip
  • Snus

Nicotine Dependence Symptoms

The combination of the feel-good sensation paired with the reward response creates the craving for nicotine. The delay or absence of the effects of nicotine lead to the uncomfortable symptoms associated with nicotine dependence.

Typical symptoms of nicotine dependence include:

  • Having urges or cravings to smoke
  • Feeling irritable, grouchy, or upset
  • Feeling jumpy or restless
  • Having difficulty concentrating
  • Having difficulty sleeping
  • Feeling hungry (or experiencing weight gain)
  • Feeling anxious, sad, or depressed

Over time, people can become increasingly dependent on nicotine. The more dependent a person becomes on the substance, the more difficult it can be to stop because of the negative feelings associated with not having nicotine.

Severe nicotine dependence is associated with the following symptoms:

  • Smoking more than one pack a day
  • Smoking within minutes of waking up
  • Smoking while sick
  • Waking up at night to smoke
  • Smoking to ease symptoms of withdrawal


Exposure to nicotine, especially among youth, is the primary cause of nicotine dependence. The Centers for Disease Control and Prevention (CDC) reports that nine out of 10 adults who smoke cigarettes daily first tried smoking before the age of 18.

One 2012 study that looked at nicotine dependence symptoms among adolescent smokers over the course of four years found that symptoms of nicotine dependence began before these individuals had established regular smoking patterns. The same study also found that people who smoked cigarettes one to three times per month, and only one cigarette per day, still reported symptoms associated with nicotine dependence.

What some people might consider a small or infrequent exposure to nicotine, can still lead to nicotine dependence.


In order to diagnose nicotine dependence and decide on the most appropriate treatment option, your healthcare provider will likely ask you a series of questions, often known as the Fagerstrom Test for Nicotine Dependence (FTND).

The FTND is a short questionnaire, consisting of only six questions, to help your provider understand how much you're smoking and your urge to smoke. Responses to each question are scored from 0 to 3. When the questionnaire is complete, your provider will add up your responses, and the total will help them determine your dependence on nicotine.


There is no amount of exposure to tobacco that is safe, so for nicotine dependence, treatment means quitting. Talking with a healthcare provider can help you determine which treatment option is best for you.

Smoking cessation and overcoming dependence on nicotine is a very personal experience, and there is no one-size-fits-all solution. Some people choose to use a behavioral approach by implementing strategies that fit with their lifestyle and personality, while others prefer the use of medication.

There is no right or wrong way; there is simply the way that works best for each individual. The National Institute on Drug Abuse outlines available treatment options, as summarized below.

Behavioral Treatments

  • Cognitive behavioral therapy (CBT): Conducted by licensed professionals who help patients learn to identify triggers and develop coping strategies
  • Motivational interviewing: Uses counselors or coaches who talk to patients about the challenges of quitting and help foster motivation to overcome those challenges
  • Mindfulness: Involves patients learning strategies to reframe thoughts and tolerate negative emotions
  • Telephone support and quit helplines: Typically a free resource staffed by tobacco-cessation counselors who offer information and support
  • Text messaging, web-based services, and social media support: Technology-based support that can help increase access to care


  • Nicotine replacement therapy (NRT): Available without a prescription and comes in different forms, such as patches, gums, lozenges, and sprays
  • Wellbutrin (bupropion): Prescription medication, originally used as an antidepressant, that is as effective as NRT
  • Tyrvaya (varenicline): Prescription medication that helps to reduce cravings
  • Medication combinations: A combination of NRT and prescription treatment options
  • Other antidepressants: Certain antidepressants that have been found to be effective in treating nicotine dependence


Coping with the symptoms of nicotine dependence can be challenging and uncomfortable. Here are some ways to manage cravings:

  • Try NRT or talk to your healthcare provider about medications.
  • Avoid behaviors or situations that trigger your desire to use tobacco products.
  • Keep your mouth busy by chewing on things like sugar-free gum.
  • Remind yourself that the craving will pass.
  • Start a mindfulness practice or learn breathing techniques.


Nicotine dependence affects a significant portion of the population. It doesn't require a lot of exposure to nicotine or frequent use to develop a dependence on it. The symptoms of nicotine dependence can be uncomfortable, including strong urges, restlessness, irritability, anxiety, difficulty sleeping, and more.

Quitting tobacco can seem daunting but it is essential to preventing further damage to your health. There are treatment options available to those ready to take steps toward reducing and eliminating the use of nicotine.

A Word From Verywell

Whatever your reason might be for exploring options to overcome nicotine dependence, there is a strategy or treatment option that will work for you. The process will likely be unpleasant and uncomfortable, but with the right strategy and support system, it is possible to eliminate nicotine from your life and enjoy the health benefits of being free from nicotine.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  5. Centers for Disease Control and Prevention. 7 common withdrawal symptoms.

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  10. National Institute on Drug Abuse. What are treatments for tobacco dependence?.

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  12. National Cancer Institute. Handling nicotine withdrawal and triggers when you decide to quit tobacco.

By Teresa Maalouf, MPH
Teresa Maalouf is a public health professional with six years of experience in the field. She has worked in research, tobacco treatment, and infectious disease surveillance. Teresa is focused on presenting evidence-based health information in a way that is clear and approachable.