Learn about symptoms and causes of nicotine addiction, self help treatment options, medication and when to seek medical help.

What is Nicotine Addiction?

Nicotine is a chemical found in tobacco. It causes addiction to tobacco products, including cigarettes. When tobacco is smoked, nicotine is absorbed quickly into the bloodstream through the lungs and reaches the brain within seconds, where it produces feelings of alertness, pleasure and improved mood for a short period of time.

Addiction to nicotine can develop with regular use. When a person becomes addicted to nicotine, they will need to smoke more to feel the pleasurable effects. When they do not smoke for a long period of time, they will experience unpleasant withdrawal symptoms. Nicotine addiction is harmful to health as the use of nicotine-containing products increases the risk of heart disease, lung disease and certain cancers.

What are the possible causes of this condition?

Nicotine dependence happens when the body becomes used to the presence of nicotine and starts to rely on it to function normally. Addiction to nicotine can be affected by the following:

• Home Environment: Children who grow up with family members who smoke are more likely to start smoking themselves. Smoking at an early age will increase the risk of developing nicotine addiction later in life. 
• Social Influence: People may start using nicotine-containing products to fit in with their friends who are also users or because they want to be accepted by their friends.
• Cope With Stress: Some people use smoking to cope with stress or to relax. This turns into a habit when certain feelings or situations trigger the urge to smoke.
• Accessibility: When cigarettes and other nicotine-containing products are easy to get, this can lead to development of nicotine addiction as more people may try them. 

What are the symptoms of Nicotine Addiction?

• Cravings: A very strong urge to smoke or use other forms of nicotine-containing products.
• Tolerance: Needing more nicotine to feel the same pleasurable effects that they used to get.
• Withdrawal Symptoms: When trying to reduce or stop smoking, individuals may experience withdrawal symptoms such as feeling anxious, moody, irritable, unable to focus, difficulty sleeping and sometimes headaches or dizziness.

What can I do to treat Nicotine Addiction?

There are several methods to help you in stopping the use of nicotine-containing products.

You may stop by going cold turkey (i.e. choosing to completely stop the use of all nicotine-containing products), or by purposely planning the gradual reduction of the number of times you use your nicotine-containing product, until you stop altogether. Both of these methods often come with withdrawal symptoms.

To reduce withdrawal symptoms, you may use Nicotine Replacement Therapy (NRT). NRTs work by giving people a small, safe dose of nicotine without the harmful chemicals found in most nicotine-containing products. This will reduce withdrawal symptoms and cravings for nicotine, making it easier for you to stop. 

Below is a list of NRT products that are available at your local pharmacy. Talk to your pharmacist to find out which one is more suitable for you.

• Nicotine Gums 
  • Comes in 2mg or 4mg to let you choose the right strength based on your past nicotine usage.
  • Nicotine is absorbed quickly through the lining of your mouth.
  • Chewing can help with other withdrawal symptoms such as anxiety and stress.
• Nicotine Patches 
  • Controlled amounts of nicotine is absorbed through your skin into the bloodstream.
  • Convenient and discreet way to help stop smoking.
  • Available in different strength to let you choose the right strength based on your past nicotine usage.
• Nicotine Lozenges 
  • Dissolves in the mouth to release a dose of nicotine to reduce your urge to smoke.
  • Nicotine is absorbed quickly through the lining of your mouth.
• Nicotine Spray
  • Starts to relieve cravings from 30 seconds after use.
  • Suitable for individuals who want fast relief from cravings.
  • Nicotine is absorbed quickly through the lining of your mouth.

On top of NRTs, there are prescription medications, bupropion and varenicline, that can help to reduce nicotine cravings and withdrawal symptoms. Discuss these options with your doctor.

Finally, there are many counselling programmes that can help you with your quit journey. Quit counsellors can help you figure out what triggers make you want to use nicotine-containing products and how to handle these situations. They can also give you tips on how to resist cravings and what you can do to ensure a higher rate of success. An example of such a programme is the I-Quit programme provided by the Health Promotion Board.

When do I need to see a doctor?

Nicotine Replacement Therapy may not be suitable for everyone and there are certain situations where it may not be recommended. If you fall into any of the categories below, please speak to a healthcare professional before using any NRTs.

• You are pregnant, planning to become pregnant or breastfeeding. 
• You have an underlying heart condition.
• You recently had a heart attack or stroke.
• You have an ulcer in your stomach.
• You have any other medical conditions.
• You are taking any other medications.
• You are less than 18 years old.

What else can I do to manage this condition?

• Set a Quit date: Choose a specific date to quit. Having a clear goal in mind can help you prepare mentally for the change.
• Identify triggers: Look out for situations, emotions or activities that can trigger your urge to use nicotine-containing products. Common triggers include stress, social situations or certain times of the day. 
• Find ways to cope with triggers: Once you know what your triggers are, come up with other ways to cope with them. This may involve practising deep breathing exercises, going for a walk, or finding other healthy distractions.
• Avoid Triggers: Avoid situations that cause you to have a stronger urge to use nicotine-containing products, especially in the early stages of quitting.
• Seek Support: Let your friends, family and coworkers know that you are quitting and ask for their support. You may also join a support group or seek counselling to meet others who are going through the same situation.
• Reward yourself: Celebrate your successes along the journey, whether it is going a day without using nicotine-containing products, being nicotine-free for a week, or hitting other milestones. Treat yourself to something special as a reward for your hard work. 

Disclaimers

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

The content above is solely for informational purposes only and is not intended as a substitute for the advice provided by your physician, pharmacist or other healthcare professional. You should not use the information for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. Always speak with your physician, pharmacist or other healthcare professional before taking any medication or supplement, or adopting any treatment for a health problem.