Smoking is an addiction. Tobacco contains nicotine, a drug that is addictive. The nicotine, therefore, makes it very difficult (although not impossible) to quit. In fact, since the U.S. Surgeon General's 1964 report on the dangers of smoking, millions of Americans have quit.


Still, approximately 440,000 deaths occur in the U.S. each year from smoking-related illnesses; this represents almost 1 out of every 5 deaths. The reason for these deaths is that smoking greatly increases the risk of getting lung cancer, heart attack, chronic lung disease, stroke, and many other cancers. Moreover, smoking is perhaps the most preventable cause of breathing (respiratory) diseases within the USA.


Smoking harms not just the smoker, but also family members, coworkers, and others who breathe the smoker's cigarette smoke, called secondhand smoke or passive smoke. Among infants up to 18 months of age, secondhand smoke is associated with as many as 300,000 cases of chronic bronchitis and pneumonia each year.


In addition, secondhand smoke from a parent's cigarette increases a child's chances for middle ear problems, causes coughing and wheezing, worsens asthma, and increases an infant's risk of dying from sudden infant death syndrome (SIDS).


Smoking is also harmful to the unborn fetus. If a pregnant woman smokes, her fetus is at an increased risk of miscarriage, early delivery (prematurity), stillbirth, infant death, and low birth weight. In fact, it has been estimated that if all women quit smoking during pregnancy, about 4,000 new babies would not die each year.


Exposure to passive smoke can also cause cancer. Research has shown that non-smokers who reside with a smoker have a 24% increase in risk for developing lung cancer when compared with other non-smokers. An estimated 3,000 lung cancer deaths occur each year in the U.S. that are attributable to passive smoking.


Secondhand smoke also increases the risk of stroke and heart disease. If both parents smoke, a teenager is more than twice as likely to smoke as a teenager whose parents are both non smokers. Even in households where only one parent smokes, young people are more likely to start smoking.


Some of the most common symptoms of nicotine dependence are listed below.


  • Inability to stop smoking.
  • Experiencing strong withdrawal symptoms when you try to stop smoking.
  1. Strong withdrawal symptoms include: craving for tobacco, anxiety, irritability, restlessness, difficulty concentrating, headache, drowsiness, stomach upset, constipation and diarrhea.
  • You keep smoking despite health problems.
  • You give up social or recreational activities that don't allow you to smoke.


Complications of Nicotine Dependence


Nicotine dependence can affect several parts of your body.


Common complications of nicotine dependence are:



The Centers for Disease Control and Prevention estimates that 46 million people in the United States (18 years of age and older) smoke cigarettes. Smoking is more common in men than women and appears to be prevalent across a variety of different ethnic groups. The highest percentage of smokers is in the 25 to 44-year old age group. 


Despite the prevalence of smoking, the factors that lead a person to start smoking are difficult to understand. In many cases, smoking is started at a young age due to peer pressure, tobacco advertising, or a concept that smoking is an acceptable behavior. Many people who start smoking have a family member or close friend who smokes.


Once started, cigarette smoking and chewing tobacco are difficult to stop. It is a well-known fact that smoking and chewing tobacco are behaviors that can become addictions due to the presence of nicotine and other chemicals generated from smoking.


Like many other addictive substances, these chemicals trigger a series of biochemical reactions and pleasant sensations to which you can quickly become accustomed. Regular tobacco users eventually develop a need to experience these sensations in order to feel normal, which makes quitting a difficult challenge.


What are the risk factors for smoking?


Although there does not appear to be a specific trigger that causes a person to start smoking or chewing tobacco, there are several risk factors associated with smoking.


Risk factors include:

  • Behavioral problems such as aggression.
  • Family member who smokes.
  • Lack of education past high school.
  • Low self-esteem.
  • Poor financial or social status.
  • Poor school or academic performance.


Quitting smoking makes a difference right away in the way you feel. You can taste and smell food better. Your breath smells better. Your cough goes away. These benefits happen for men and women of all ages, even those who are older. They happen for healthy people as well as those who already have a disease or condition caused by smoking.


Even more importantly, in the long run, quitting smoking cuts the risk of lung cancer, many other cancers, heart disease, stroke, and other lung or breathing (respiratory) diseases (for example, chronic bronchitis, pneumonia, and emphysema). Moreover, ex-smokers have better health than current smokers. For example, ex-smokers have fewer days of illness, fewer health complaints, and less frequent bouts with chronic bronchitis and pneumonia than current smokers.


Finally, quitting smoking saves money. The average cost of a pack of cigarettes is approximately $4.50 to $5.00 a pack (depending on where you live). A smoker with a pack a day habit spends approximately $31.50 per week ($1,638 per year). 


What are the steps in quitting?


First, one can do certain things to get ready to quit. Then, there are other things to do on the day of quitting. Finally, one can do things to help oneself to remain abstinent.


Getting ready to quit smoking


  • Set a date for quitting. If possible, plan to have a friend quit smoking with you. 
  • Notice when and why you smoke. Try to find the things in your daily life that you often do while smoking (such as drinking your morning cup of coffee or driving a car). 
  • Change your smoking routines: Keep your cigarettes in a different place. Smoke with your other hand. Don't do anything else when you are smoking. Think about how you feel when you smoke. 
  • Smoke only in certain places, such as outdoors. 
  • When you want a cigarette, wait a few minutes. Try to think of something to do instead of smoking. For example, you might chew gum or drink a glass of water. 
  • Buy one pack of cigarettes at a time. Switch to a brand of cigarettes that you don't like.


What methods can help a person quit smoking?


Several methods are available to assist those who decide to quit smoking.


The main categories of methods are:

  • changing the behavior that is associated with smoking;
  • self-help literature;
  • nicotine replacement therapy;
  • prescription smoking cessation aids.


Each method actually offers several different options. Moreover, combinations of the methods usually are necessary, and no one combination will work for everyone. In fact, it may be necessary to try several different methods or combinations of methods before success is achieved.


Behavioral modification and self-help literature to quit smoking


Due to the addictive nature of nicotine, some form of behavioral modification is often necessary for successful cessation of smoking. Educational programs, hypnosis, and aversion therapy (learning how to avoid cigarettes) are a few options. Smokers may be counseled to avoid specific triggers or situations that lead to smoking.


For example, instead of awakening and grabbing a cigarette at the bedside or smoking immediately after a meal, people may be encouraged to replace the urge to smoke with another activity, such as, taking a walk or reading a book.


Numerous associations and societies, for example, the American Cancer Society, American Heart Association, and the American Lung Association, have developed brochures to help smokers quit smoking.


Nicotine replacement therapy to quit smoking


Nicotine replacement therapy (NRT) became available over the counter in the 1990's. The purpose of nicotine replacement therapy is to substitute another source of nicotine while cigarettes are discontinued. By this means, the habit of smoking is eliminated, even though the addiction to nicotine remains intact.


But at the same time, nicotine replacement therapy eliminates the symptoms of withdrawal that can trigger more smoking. In addition, behavioral counseling to change smoking-related behavior usually is necessary. Once cigarettes have been replaced during nicotine replacement therapy, the amount of nicotine is then gradually reduced.


Currently, there are different forms of nicotine replacement therapy available over-the-counter and include:

  • nicotine transdermal systems or patches (Nicoderm CQ and Nicotrol), 
  • nicotine polacrilex resin or gum (Nicorette),
  • nicotine lozenges (Commit).


The nicotine patch (Nicoderm CQ and Nicotrol) contains nicotine that is stored within a specially designed support or matrix. Once applied, the nicotine transdermal system steadily release nicotine that is absorbed across the skin and into the blood stream. The gum contains nicotine that is released slowly upon chewing and "parking".


Parking refers to the action of shifting the gum to one side of the cheek after chewing in order to speed the absorption of nicotine. Nicotine lozenges contain nicotine within a hard candy that allows for slow release of nicotine as the candy dissolves in the mouth. A program for slowly weaning users from nicotine replacement products is provided by each product's manufacturer.


The nicotine patch, Nicoderm CQ, is available in three strengths; 21, 14, and 7 mg. People are advised to begin with the 21 mg patch if they smoke more than 10 cigarettes per day or the 14 mg patch if they smoke less than 10 cigarettes per day. After six weeks of wearing the initial patch strength, the next lowest patch strength is worn for two weeks. If therapy was started with the 21 mg patch, an additional two weeks is required for the 7mg patch.


A maximum of eight or 10 weeks, depending upon the strength of the first patch used, is recommended for a successful quitting program. The Nicoderm CQ patch can be worn for 16 hours (from awakening until bedtime) or 24 hours if the urge to smoke is great upon awakening.


Nicotrol is available as a 15 mg patch, and should be worn no more than 16 hours per day. Nicotrol may be worn for up to six weeks.


The side effects commonly seen with patches are burning, itching, or redness at the site of the patch, headache, insomnia, nervousness, dizziness, cough, rash, joint aches, painful menstruation, and changes in taste.


The gum, Nicorette, is available in a variety of flavors in 2 strengths; 4 and 2 mg. Patients are advised to begin with the 4 mg piece of gum if they smoke more than 25 cigarettes per day or the 2 mg piece if they smoke fewer than 7 cigarettes per day. No more than 20 pieces of the 4 mg strength or 30 pieces of the 2 mg strength should be chewed in one day.


Initial weaning from treatment should begin after 2 to 3 months and be completed by 4 to 6 months. The most common side effects with Nicorette are aching jaws or soreness of the gums, changes in taste, abdominal (gastrointestinal) discomfort, hiccups, nausea, vomiting, and belching.


Commit nicotine lozenges are available in 2 or 4 mg doses. One dose consists of one lozenge, and no more than 20 doses should be consumed in one day. The manufacturers of Commit recommend choosing the proper dosage based upon when you usually have the first cigarette of your day. According to the manufacturer's instructions, if you smoke within 30 minutes of getting up in the morning, you should use the stronger 4 mg dose. If not, you should use the 2 mg lozenges.


Biting or chewing nicotine lozenges instead of allowing them to dissolve can lead to indigestion or heartburn. You should not eat or drink anything while the lozenge is in your mouth. The lozenges will last for about 20-30 minutes when allowed to dissolve in the mouth. The most commonly reported side effects with nicotine lozenges are indigestion, throat irritation, soreness of the teeth or gums, insomnia, nausea, hiccups, coughing, heartburn, headache, and flatulence.


How effective is nicotine replacement therapy?


Approximately 25% of patients successfully stop smoking with nicotine patch therapy. The success rate with nicotine gum is similar. There have not yet been studies to compare the effectiveness of nicotine lozenges to the patch or gum. The rate of success for nicotine replacement therapy increases 35% to 40% when intensive behavioral counseling is added.

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