Is Nicotine Addictive?

Tobacco Plants

Most smokers identify tobacco use as harmful and express a desire to reduce or stop using it, and nearly 35 million want to quit each year.

Yes. Most smokers use tobacco regularly because they are addicted to nicotine. Addiction is characterized by compulsive drug seeking and abuse, even in the face of negative health consequences. It is well documented that most smokers identify tobacco use as harmful and express a desire to reduce or stop using it, and nearly 35 million of them want to quit each year. Unfortunately, more than 85 percent of those who try to quit on their own relapse, most within a week.

Research has shown how nicotine acts on the brain to produce a number of effects. Of primary importance to its addictive nature are findings that nicotine activates reward pathways—the brain circuitry that regulates feelings of pleasure. A key brain chemical involved in mediating the desire to consume drugs is the neurotransmitter dopamine, and research has shown that nicotine increases levels of dopamine in the reward circuits. This reaction is similar to that seen with other drugs of abuse and is thought to underlie the pleasurable sensations experienced by many smokers. For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction.

Nicotine’s pharmacokinetic properties also enhance its abuse potential. Cigarette smoking produces a rapid distribution of nicotine to the brain, with drug levels peaking within 10 seconds of inhalation. However, the acute effects of nicotine dissipate quickly, as do the associated feelings of reward, which causes the smoker to continue dosing to maintain the drug’s pleasurable effects and prevent withdrawal.

Nicotine withdrawal symptoms include irritability, craving, depression, anxiety, cognitive and attention deficits, sleep disturbances, and increased appetite. These symptoms may begin within a few hours after the last cigarette, quickly driving people back to tobacco use. Symptoms peak within the first few days of smoking cessation and usually subside within a few weeks. For some people, however, symptoms may persist for months.

Although withdrawal is related to the pharmacological effects of nicotine, many behavioral factors can also affect the severity of withdrawal symptoms. For some people, the feel, smell, and sight of a cigarette and the ritual of obtaining, handling, lighting, and smoking the cigarette are all associated with the pleasurable effects of smoking and can make withdrawal or craving worse. Nicotine replacement therapies such as gum, patches, and inhalers may help alleviate the pharmacological aspects of withdrawal; however, cravings often persist. Behavioral therapies can help smokers identify environmental triggers of craving so they can employ strategies to prevent or circumvent these symptoms and urges.

Are There Other Chemicals That May Contribute to Tobacco Addiction?

Yes, research is showing that nicotine may not be the only ingredient in tobacco that affects its addictive potential. Using advanced neuroimaging technology, scientists can see the dramatic effect of cigarette smoking on the brain and are finding a marked decrease in the levels of monoamine oxidase (MAO), an important enzyme that is responsible for the breakdown of dopamine. This change is likely caused by some ingredient in tobacco smoke other than nicotine, because we know that nicotine itself does not dramatically alter MAO levels. The decrease in two forms of MAO (A and B) results in higher dopamine levels and may be another reason that smokers continue to smoke—to sustain the high dopamine levels that lead to the desire for repeated drug use.

Animal studies by NIDA-funded researchers have shown that acetaldehyde, another chemical found in tobacco smoke, dramatically increases the reinforcing properties of nicotine and may also contribute to tobacco addiction. The investigators further report that this effect is age-related: adolescent animals display far more sensitivity to this reinforcing effect, which suggests that the brains of adolescents may be more vulnerable to tobacco addiction.