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Nicotine is the substance in cigarettes that smokers become dependent on. Thus, nicotine dependence is essentially dependence on cigarettes. About 70% of smokers have acknowledged that they desire to quit smoking but are unable to do so. Of people who quit, 90% do so on their own, but only about 3 to 4% successfully quit in any given year.
Symptoms and
Complications
Nicotine, when obtained through smoking, generally produces few noticeable effects. Some people experience flushing. Nicotine withdrawal may result in many unpleasant symptoms, including craving for nicotine, irritability, anxiety, poor concentration, restlessness, headaches, drowsiness, and stomach upset. Many people gain weight while trying to stop smoking. Withdrawal is most troublesome in severely dependent people.
Treatment
Most smokers who quit do so for health or economic reasons. Behavior modification is a common method used in helping people to quit smoking. A behavior modification regimen may be established with the help of a professional, although other sources include the Internet and the package inserts in nicotine replacement products. Behavior modification deals with changing the habit patterns that are cues to smoking during the person's normal activities of daily living. These cues may be phone conversations, coffee breaks, meals, sexual activity, boredom, or traffic problems or other frustrations. People who recognize smoking cues may modify the cues (for example, taking a walk in place of a coffee break) or substitute oral activity (for example, sucking on candy or chewing on a toothpick or on chewing gum).
Quitting smoking abruptly (cold turkey) is generally preferable to tapering off. Selection of a quit date is very helpful. The quit date may be random or on a special occasion (for example, a holiday or anniversary). A stressful time, such as when a deadline (for example, tax deadline) needs to be met, is not a good time to try to quit.
Substituting a non-smoked version of nicotine for some period of time helps many people break the habit of smoking. Many over-the-counter and prescription nicotine-replacement products are available, including nicotine chewing gum, a nicotine patch, nicotine nasal spray, and a nicotine inhaler.
Bupropion can be combined with a nicotine-replacement product. Together, they have a higher success rate. The results of both drugs are best when used in conjunction with a behavior modification program.
Weight gain is a concern, particularly among women. Nicotine suppresses appetite and slightly increases the rate at which calories are burned. Exercise helps prevent weight gain and may also reduce the craving for nicotine.
A person with significant problems with depression who attempts to quit smoking should receive counseling. Bupropion is an antidepressant, making it particularly useful for people who are depressed or at risk of depression.
Many people dependent on nicotine relapse after the first attempt at quitting smoking. In fact, five to seven failures commonly precede success. The more often a person makes a serious attempt to quit smoking, the more likely the person ultimately will succeed.
Last full review/revision February 2003
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