# Nicotine dependence

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Chronic disease

Medical condition

Nicotine dependence Other names Nicotine addiction; tobacco dependence; tobacco use disorder; cigarette dependence Video of medical explanation of nicotine dependence and its health effects Complications Health effects of tobacco Prognosis 10-year shorter lifespan[notes 1] Prevalence 1.2 billion tobacco users globally (2022)[2] Deaths 8 million per year (2023)[3]

**Nicotine dependence**[notes 2] is a state of [substance dependence](/source/Substance_dependence) on [nicotine](/source/Nicotine).[4] It is a [chronic](/source/Chronic_condition), relapsing disease characterized by a [compulsive](/source/Compulsive_behavior) craving to use the drug despite social consequences, loss of control over drug intake, and the emergence of [withdrawal symptoms](/source/Withdrawal_symptoms).[8] [Tolerance](/source/Drug_tolerance) is another component of drug dependence.[9] Nicotine dependence develops over time as an individual continues to use nicotine.[9] While [cigarettes](/source/Cigarette) are the most commonly used [tobacco product](/source/Tobacco_product), all forms of tobacco use—including [smokeless tobacco](/source/Smokeless_tobacco) and [e-cigarette](/source/E-cigarette) use—can cause dependence.[3][10] Nicotine dependence is a serious [public health](/source/Public_health) problem because it leads to continued tobacco use and the [associated negative health effects](/source/Health_effects_of_tobacco). Tobacco use is one of the leading [preventable causes of death](/source/Preventable_causes_of_death) worldwide, causing more than 8 million deaths per year and killing half of its users who do not quit.[3][11] Current smokers are estimated to die an average of 10 years earlier than non-smokers.[1]

According to the [World Health Organization](/source/World_Health_Organization), "Greater nicotine dependence has been shown to be associated with lower motivation to quit, difficulty in trying to quit, and failure to quit, as well as with smoking the first cigarette earlier in the day and smoking more cigarettes per day."[12] The WHO estimates that there were 1.24 billion tobacco users globally in 2022[\[update\]](https://en.wikipedia.org/w/index.php?title=Nicotine_dependence&action=edit), with the number projected to decline to 1.20 billion in 2025.[2] Of the 34 million smokers in the United States in 2018, 74.6% smoked every day, indicating the potential for some level of nicotine dependence.[13] There is an increased incidence of nicotine dependence in individuals with [psychiatric disorders](/source/Psychiatric_disorders), such as [anxiety disorders](/source/Anxiety_disorders) and [substance use disorders](/source/Substance_use_disorders).[14][15]

Various methods exist for measuring nicotine dependence.[6] Common assessment scales for cigarette smokers include the [Fagerström Test for Nicotine Dependence](/source/Fagerstr%C3%B6m_Test_for_Nicotine_Dependence), the *[Diagnostic and Statistical Manual of Mental Disorders](/source/Diagnostic_and_Statistical_Manual_of_Mental_Disorders)* criteria, the Cigarette Dependence Scale, the Nicotine Dependence Syndrome Scale, and the Wisconsin Inventory of Smoking Dependence Motives.[6]

[Nicotine](/source/Nicotine) is a [parasympathomimetic](/source/Parasympathomimetic) [stimulant](/source/Stimulant)[16] that binds to [nicotinic acetylcholine receptors](/source/Nicotinic_acetylcholine_receptor) in the brain.[17] [Neuroplasticity](/source/Neuroplasticity) within the brain's [reward system](/source/Reward_system), including an increase in the number of nicotine receptors, occurs as a result of long-term nicotine use and leads to nicotine dependence.[4] In contrast, the effect of nicotine on human brain structure (e.g., [gray matter](/source/Gray_matter) and [white matter](/source/White_matter)) is less clear.[18] Genetic risk factors contribute to the development of dependence.[19] For instance, [genetic markers](/source/Genetic_marker) for specific types of nicotinic receptors (the α5–α3–β4 nicotinic receptors) have been linked to an increased risk of dependence.[19] Evidence-based treatments—including medications such as [nicotine replacement therapy](/source/Nicotine_replacement_therapy), [bupropion](/source/Bupropion), [varenicline](/source/Varenicline), or [cytisine](/source/Cytisine), and [behavioral counseling](/source/Behaviour_therapy)—can double or triple a smoker's chances of successfully [quitting](/source/Quitting_smoking).[20]

## Definition

A [National Institute on Drug Abuse](/source/National_Institute_on_Drug_Abuse) video entitled *Anyone Can Become Addicted to Drugs*.[21]

Nicotine dependence is defined as a neurobiological adaptation to repeated drug exposure that is manifested by highly controlled or compulsive use, the development of tolerance, experiencing withdrawal symptoms upon cessation including cravings, and an inability to quit despite harmful effects.[9] Nicotine dependence has also been conceptualized as a chronic, relapsing disease.[20] A 1988 [Surgeon General](/source/Surgeon_General_of_the_United_States) report states, "Tolerance" is another aspect of drug addiction [dependence] whereby a given dose of a drug produces less effect or increasing doses are required to achieve a specified intensity of response. Physical dependence on the drug can also occur, and is characterized by a withdrawal syndrome that usually accompanies drug abstinence. After cessation of drug use, there is a strong tendency to relapse."[9]

Nicotine dependence leads to heavy smoking and causes severe [withdrawal symptoms](/source/Withdrawal_symptom) and relapse back to smoking.[9] Nicotine dependence develops over time as a person continues to use [nicotine](/source/Nicotine).[9] Teenagers do not have to be daily or long-term smokers to show [withdrawal symptoms](/source/Nicotine_withdrawal).[22] Relapse should not frustrate the nicotine user from trying to quit again.[20] A 2015 review found "Avoiding withdrawal symptoms is one of the causes of continued smoking or relapses during attempts at cessation, and the severity and duration of nicotine withdrawal symptoms predict relapse."[23] Symptoms of nicotine dependence include irritability, anger, impatience, and problems in concentrating.[24]

## Diagnosis

There are different ways of measuring nicotine dependence.[6] The five common [dependence](/source/Substance_dependence) assessment scales are the [Fagerström Test for Nicotine Dependence](/source/Fagerstr%C3%B6m_Test_for_Nicotine_Dependence), the *[Diagnostic and Statistical Manual of Mental Disorders](/source/Diagnostic_and_Statistical_Manual_of_Mental_Disorders)*, the Cigarette Dependence Scale, the Nicotine Dependence Syndrome Scale, and the Wisconsin Inventory of Smoking Dependence Motives.[6]

The Fagerström Test for Nicotine Dependence focuses on measuring physical dependence which is defined "as a state produced by chronic drug administration, which is revealed by the occurrence of signs of physiological dysfunction when the drug is withdrawn; further, this dysfunction can be reversed by the administration of drug".[6] The long use of Fagerström Test for Nicotine Dependence is supported by the existence of significant preexisting research, and its conciseness.[6]

The 4th edition of the [American Psychiatric Association](/source/American_Psychiatric_Association) [Diagnostic and Statistical Manual of Mental Disorder (DSM-IV)](/source/Diagnostic_and_Statistical_Manual_of_Mental_Disorders#DSM-IV_(1994)) had a nicotine dependence diagnosis which was defined as "...a cluster of cognitive, behavioral, and physiological symptoms..."[6] In the updated *[DSM-5](/source/DSM-5)* there is no nicotine dependence diagnosis, but rather Tobacco Use Disorder, which is defined as, "A problematic pattern of tobacco use leading to clinically significant impairment or distress, as manifested by at least 2 of the following [11 symptoms], occurring within a 12-month period."[25]

The Cigarette Dependence Scale was developed "to index dependence outcomes and not dependence mechanisms".[6] The Nicotine Dependence Syndrome Scale, "a 19-item self-report measure, was developed as a multidimensional scale to assess nicotine dependence".[6] The Wisconsin Inventory of Smoking Dependence Motives "is a 68-item measure developed to assess dependence as a motivational state".[6]

## Mechanisms

Traditional cigarettes are the most common delivery device for nicotine.[26] However, [electronic cigarettes](/source/Electronic_cigarette) are becoming more popular.[27] Nicotine can also be delivered via other tobacco products such as chewing tobacco, snus, pipe tobacco, hookah, all of which can produce nicotine dependence.[28]

### Biomolecular

Dopamine

Pre-existing cognitive and mood disorders may influence the development and maintenance of nicotine dependence.[29] Nicotine is a [parasympathomimetic](/source/Parasympathomimetic) [stimulant](/source/Stimulant)[16] that binds to and activates [nicotinic acetylcholine receptors](/source/Nicotinic_acetylcholine_receptor) in the brain,[17] which subsequently causes the release of [dopamine](/source/Dopamine) and other [neurotransmitters](/source/Neurotransmitter), such as [norepinephrine](/source/Norepinephrine), [acetylcholine](/source/Acetylcholine), [serotonin](/source/Serotonin), [gamma-aminobutyric acid](/source/Gamma-aminobutyric_acid), [glutamate](/source/Glutamate), [endorphins](/source/Endorphin),[30] and several [neuropeptides](/source/Neuropeptide).[31] Repeated exposure to nicotine can cause an increase in the number of nicotinic receptors, which is believed to be a result of receptor [desensitization](/source/Desensitization_(medicine)) and subsequent receptor [upregulation](/source/Upregulation).[30] This upregulation or increase in the number of nicotinic receptors significantly alters the functioning of the brain [reward system](/source/Reward_system).[32] With constant use of nicotine, [tolerance](/source/Drug_tolerance) occurs at least partially as a result of the development of new nicotinic acetylcholine receptors in the brain.[30] After several months of nicotine abstinence, the number of receptors go back to normal.[17] Nicotine also stimulates nicotinic acetylcholine receptors in the [adrenal medulla](/source/Adrenal_medulla), resulting in increased levels of adrenaline and [beta-endorphin](/source/Beta-endorphin).[30] Nicotine alters neural responses of the [amygdala](/source/Amygdala). [33] Its physiological effects stem from the stimulation of nicotinic acetylcholine receptors, which are located throughout the [central](/source/Central_nervous_system) and [peripheral nervous systems](/source/Peripheral_nervous_system).[34] Chronic nicotinic acetylcholine receptor activation from repeated nicotine exposure can induce strong effects on the brain, including changes in the brain's physiology, that result from the stimulation of regions of the brain associated with reward, pleasure, and anxiety.[35] These complex effects of nicotine on the brain are still not well understood.[35]

When these receptors are not occupied by nicotine, they are believed to produce withdrawal symptoms.[36] These symptoms can include cravings for nicotine, anger, irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger, weight gain, and difficulty concentrating.[37]

[Neuroplasticity](/source/Neuroplasticity) within the brain's reward system occurs as a result of long-term nicotine use, leading to nicotine dependence.[4] There are genetic risk factors for developing dependence.[19] For instance, genetic markers for a specific type of nicotinic receptor (the α5-α3-β4 nicotine receptors) have been linked to increased risk for dependence.[19][38] The most well-known hereditary influence related to nicotine dependence is a mutation at rs16969968 in the nicotinic acetylcholine receptor *[CHRNA5](/source/CHRNA5)*, resulting in an amino acid alteration from aspartic acid to asparagine.[39] The [single-nucleotide polymorphisms](/source/Single-nucleotide_polymorphism) (SNPs) rs6474413 and rs10958726 in *CHRNB3* are highly correlated with nicotine dependence.[40] Many other known variants within the *CHRNB3–CHRNA6* nicotinic acetylcholine receptors are also correlated with nicotine dependence in certain ethnic groups.[40] There is a relationship between *CHRNA5*-*CHRNA3*-*CHRNB4* nicotinic acetylcholine receptors and complete smoking cessation.[41] Increasing evidence indicates that the genetic variant *CHRNA5* predicts the response to smoking cessation medicine.[41]

### Psychosocial

In addition to the specific neurological changes in nicotinic receptors, there are other changes that occur as dependence develops.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*] Through various conditioning mechanisms ([operant](/source/Operant_conditioning) and [cue/classical](/source/Classical_conditioning)), smoking comes to be associated with different mood and cognitive states as well as external contexts and cues.[32]

## Treatment

There are treatments for nicotine dependence, although the majority of the evidence focuses on treatments for cigarette smokers rather than people who use other forms of tobacco (e.g., [chew](/source/Chewing_tobacco), [snus](/source/Snus), [pipes](/source/Pipe_tobacco), [hookah](/source/Hookah), e-cigarettes).[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*] [Evidence-based medicine](/source/Evidence-based_medicine) can double or triple a smoker's chances of quitting successfully.[20] Mental health conditions, especially Major depressive disorder, may also impact the success of attempts to quit smoking.[42]

### Medication

There are eight major evidence-based medications for treating nicotine dependence: [bupropion](/source/Bupropion), [cytisine](/source/Cytisine) (not approved for use in some countries, including the US), [nicotine gum](/source/Nicotine_gum), [nicotine inhaler](/source/Nicotine_inhaler), [nicotine lozenge/mini-lozenge](/source/Nicotine_lozenge), [nicotine nasal spray](/source/Nicotine_nasal_spray), [nicotine patch](/source/Nicotine_patch), and [varenicline](/source/Varenicline).[43] These medications have been shown to significantly improve long-term (i.e., 6-months post-quit day) abstinence rates, especially when used in combination with psychosocial treatment.[20] The [nicotine replacement treatments](/source/Nicotine_replacement_therapy) (i.e., patch, lozenge, gum) are dosed based on how dependent a smoker is—people who smoke more cigarettes or who smoke earlier in the morning use higher doses of nicotine replacement treatments.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*] There is no consensus for remedies for tobacco use disorder among pregnant smokers who also use [alcohol](/source/Alcohol_(drug)) and stimulants.[7]

#### Vaccine

[TA-NIC](/source/TA-NIC) is a proprietary [vaccine](/source/Vaccine) in development similar to [TA-CD](/source/TA-CD) but being used to create human anti-nicotine [antibodies](/source/Antibody) in a person to destroy [nicotine](/source/Nicotine) in the human body so that it is no longer effective.[44]

### Psychosocial

Psychosocial interventions delivered in-person (individually or in a group) or over the phone (including mobile phone interventions) have been shown to effectively treat nicotine dependence.[43] These interventions focus on providing support for quitting and helping with smokers with problem-solving and developing healthy responses for coping with cravings, negative moods, and other situations that typically lead to relapse.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*] The combination of pharmacotherapy and psychosocial interventions has been shown to be especially effective.[20]

### Emerging Medical Treatment

A non-invasive, brain-based therapy called rTMS (repetitive transcranial magnetic stimulation) gained FDA approval in 2020 for treating nicotine addiction and aiding the quitting process.[45] Studies have found patients who undergo rTMS have reduced cigarette cravings and number of cigarettes smoked, as well as greater long term success with cessation.[46] While this therapy is relevantly new for treating nicotine additions, it has a longer history as a therapeutic treatment for Major depressive disorder, Obsessive-compulsive disorder, and migraines. Side effects of this therapy are relatively mild because of the noninvasive nature of the treatment.

## Epidemiology

First-time nicotine users develop a dependence about 32% of the time.[47] There are approximately 976 million smokers in the world.[48] Estimates are that half of smokers (and one-third of former smokers) are dependent based on DSM criteria, regardless of age, gender or country of origin, but this could be higher if different definitions of dependence were used.[49] Recent data suggest that, in the United States, the rates of daily smoking and the number of cigarettes smoked per day are declining, suggesting a reduction in population-wide dependence among current smokers.[50] However, there are different groups of people who are more likely to smoke than the average population, such as those with low education or low socio-economic status and those with mental illness.[50] There is also evidence that among smokers, some subgroups may be more dependent than other groups.[*[citation needed](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*] Men smoke at higher rates than do women and score higher on dependence indices; however, women may be less likely to be successful in [quitting](/source/Smoking_cessation), suggesting that women may be more dependent by that criterion.[50][51] There is an increased frequency of nicotine dependence in people with anxiety disorders.[14] 6% of smokers who want to quit smoking each year are successful at quitting.[52] Nicotine withdrawal is the main factor hindering smoking cessation.[53] A 2010 [World Health Organization](/source/World_Health_Organization) report states, "Greater nicotine dependence has been shown to be associated with lower motivation to quit, difficulty in trying to quit, and failure to quit, as well as with smoking the first cigarette earlier in the day and smoking more cigarettes per day."[54] E-cigarettes may result in starting nicotine dependence again.[55] Greater nicotine dependence may result from dual use of traditional cigarettes and e-cigarettes.[55] Like tobacco companies did in the last century, there is a possibility that e-cigarettes could result in a new form of dependency on nicotine across the world.[56]

## Concerns

Nicotine use and addiction.

Nicotine dependence results in substantial mortality, morbidity, and socio-economic impacts.[52] Nicotine dependence is a serious [public health](/source/Public_health) concern due to it being one of the leading causes of avoidable deaths worldwide.[52] The [medical community](/source/Medical_community) is concerned that e-cigarettes may escalate global nicotine dependence, particularly among adolescents who are attracted to many of the flavored e-cigarettes.[57] There is strong evidence that vaping induces symptoms of dependence in users.[58] Many organizations such the World Health Organization, [American Lung Association](/source/American_Lung_Association), and [Australian Medical Association](/source/Australian_Medical_Association) do not approve of vaping for quitting smoking in youth, making reference to concerns about their safety and the potential that experimenting with vaping may result in nicotine dependence and later tobacco use.[59]

## See also

- [Nicotine poisoning](/source/Nicotine_poisoning)

- [Nicotine withdrawal](/source/Nicotine_withdrawal)

## Notes

1. **[^](#cite_ref-2)** Current smokers are estimated to die an average of 10 years earlier than non-smokers.[1]

1. **[^](#cite_ref-9)** **Nicotine dependence**[4] is also variously known as **cigarette dependence**,[5] **tobacco dependence**,[6] or **tobacco use disorder**.[7]

## Bibliography

- Stratton, Kathleen; Kwan, Leslie Y.; Eaton, David L. (January 2018). [*Public Health Consequences of E-Cigarettes*](https://www.nap.edu/resource/24952/012318ecigaretteHighlights.pdf) (PDF). [National Academies of Sciences, Engineering, and Medicine](/source/National_Academies_of_Sciences%2C_Engineering%2C_and_Medicine). pp. 1–774. [doi](/source/Doi_(identifier)):[10.17226/24952](https://doi.org/10.17226%2F24952). [ISBN](/source/ISBN_(identifier)) [978-0-309-46834-3](https://en.wikipedia.org/wiki/Special:BookSources/978-0-309-46834-3). [PMID](/source/PMID_(identifier)) [29894118](https://pubmed.ncbi.nlm.nih.gov/29894118).

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1. **[^](#cite_ref-14)** ["WHO | Gender, women, and the tobacco epidemic"](https://web.archive.org/web/20140604233633/http://www.who.int/tobacco/publications/gender/women_tob_epidemic/en/). *WHO*. Archived from [the original](https://www.who.int/tobacco/publications/gender/women_tob_epidemic/en/) on June 4, 2014. Retrieved 2021-04-17.

1. **[^](#cite_ref-15)** Creamer, MeLisa R. (2019). ["Tobacco Product Use and Cessation Indicators Among Adults — United States, 2018"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855510). *MMWR. Morbidity and Mortality Weekly Report*. **68** (45): 1013–1019. [doi](/source/Doi_(identifier)):[10.15585/mmwr.mm6845a2](https://doi.org/10.15585%2Fmmwr.mm6845a2). [ISSN](/source/ISSN_(identifier)) [0149-2195](https://search.worldcat.org/issn/0149-2195). [PMC](/source/PMC_(identifier)) [6855510](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855510). [PMID](/source/PMID_(identifier)) [31725711](https://pubmed.ncbi.nlm.nih.gov/31725711).

1. ^ [***a***](#cite_ref-MoylanJacka2012_16-0) [***b***](#cite_ref-MoylanJacka2012_16-1) Moylan, Steven; [Jacka, Felice N](/source/Felice_Jacka); Pasco, Julie A; Berk, Michael (2012). ["Cigarette smoking, nicotine dependence and anxiety disorders: a systematic review of population-based, epidemiological studies"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523047). *BMC Medicine*. **10** (1): 123. [doi](/source/Doi_(identifier)):[10.1186/1741-7015-10-123](https://doi.org/10.1186%2F1741-7015-10-123). [ISSN](/source/ISSN_(identifier)) [1741-7015](https://search.worldcat.org/issn/1741-7015). [PMC](/source/PMC_(identifier)) [3523047](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523047). [PMID](/source/PMID_(identifier)) [23083451](https://pubmed.ncbi.nlm.nih.gov/23083451).

1. **[^](#cite_ref-17)** Airagnes, Guillaume; Sánchez-Rico, Marina; Deguilhem, Amélia; Blanco, Carlos; Olfson, Mark; Ouazana Vedrines, Charles; Lemogne, Cédric; Limosin, Frédéric; Hoertel, Nicolas (2024-09-11). ["Nicotine dependence and incident psychiatric disorders: prospective evidence from US national study"](https://www.nature.com/articles/s41380-024-02748-6). *Molecular Psychiatry*. **30** (3): 1080–1088. [doi](/source/Doi_(identifier)):[10.1038/s41380-024-02748-6](https://doi.org/10.1038%2Fs41380-024-02748-6). [ISSN](/source/ISSN_(identifier)) [1476-5578](https://search.worldcat.org/issn/1476-5578). [PMID](/source/PMID_(identifier)) [39261672](https://pubmed.ncbi.nlm.nih.gov/39261672).

1. ^ [***a***](#cite_ref-BeebeMyers2012_18-0) [***b***](#cite_ref-BeebeMyers2012_18-1) Richard Beebe; Jeff Myers (19 July 2012). [*Professional Paramedic, Volume I: Foundations of Paramedic Care*](https://books.google.com/books?id=bS8KAAAAQBAJ&pg=PA640). Cengage Learning. pp. 640–. [ISBN](/source/ISBN_(identifier)) [978-1-133-71465-1](https://en.wikipedia.org/wiki/Special:BookSources/978-1-133-71465-1).

1. ^ [***a***](#cite_ref-Bullen2014_19-0) [***b***](#cite_ref-Bullen2014_19-1) [***c***](#cite_ref-Bullen2014_19-2) Bullen, Christopher (2014). ["Electronic Cigarettes for Smoking Cessation"](http://qmro.qmul.ac.uk/xmlui/handle/123456789/16169). *Current Cardiology Reports*. **16** (11): 538. [doi](/source/Doi_(identifier)):[10.1007/s11886-014-0538-8](https://doi.org/10.1007%2Fs11886-014-0538-8). [ISSN](/source/ISSN_(identifier)) [1523-3782](https://search.worldcat.org/issn/1523-3782). [PMID](/source/PMID_(identifier)) [25303892](https://pubmed.ncbi.nlm.nih.gov/25303892). [S2CID](/source/S2CID_(identifier)) [2550483](https://api.semanticscholar.org/CorpusID:2550483).

1. **[^](#cite_ref-Hamp2019_20-0)** Hampton WH, Hanik I, Olson IR (2019). ["\[Substance Abuse and White Matter: Findings, Limitations, and Future of Diffusion Tensor Imaging Research\]"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440853). *Drug and Alcohol Dependence*. **197** (4): 288–298. [doi](/source/Doi_(identifier)):[10.1016/j.drugalcdep.2019.02.005](https://doi.org/10.1016%2Fj.drugalcdep.2019.02.005). [PMC](/source/PMC_(identifier)) [6440853](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440853). [PMID](/source/PMID_(identifier)) [30875650](https://pubmed.ncbi.nlm.nih.gov/30875650). Heavy nicotine use in the form of smoking tobacco has been linked to neuropathy (Brody, 2006), often manifesting as prefrontal gray matter atrophy (Gallinat et al., 2006; Zhang et al., 2011). Conversely, consumption of nicotine via smoking has been associated with higher white matter volume (Gazdzinski et al., 2005; Yu et al., 2011). Studies examining nicotine use via DTI have found similarly conflicting results. In chronic nicotine users, heavy consumption has been associated with lower FA (Lin et al., 2013) and higher FA (Paul et al., 2008), as well has both lower RD (Wang et al., 2017) and higher RD (Lin et al., 2013). The results of studies examining non-chronic, regular nicotine use are similarly split. Regular nicotine use has been associated with lower FA (Huang et al., 2013; Liao et al., 2011; Zhang et al., 2011) and higher FA (Hudkins et al., 2012; Wang et al., 2017). These seemingly conflicting nicotine results may be partly accounted for by the developmental stage in which it is consumed, with higher FA more commonly observed in younger nicotine users (Hudkins et al., 2012; Jacobsen et al., 2007). Alternatively, it maybe that the association between nicotine use and higher FA in adolescents is temporary, eventually leading to microstructural declines with chronic use. Future longitudinal studies could formally address this theory.

1. ^ [***a***](#cite_ref-Saccone2010_21-0) [***b***](#cite_ref-Saccone2010_21-1) [***c***](#cite_ref-Saccone2010_21-2) [***d***](#cite_ref-Saccone2010_21-3) Saccone, NL; Culverhouse, RC; Schwantes-An, TH; Cannon, DS; Chen, X; Cichon, S; Giegling, I; Han, S; Han, Y; Keskitalo-Vuokko, K; Kong, X; Landi, MT; Ma, JZ; Short, SE; Stephens, SH; Stevens, VL; Sun, L; Wang, Y; Wenzlaff, AS; Aggen, SH; Breslau, N; Broderick, P; Chatterjee, N; Chen, J; Heath, AC; Heliövaara, M; Hoft, NR; Hunter, DJ; Jensen, MK; Martin, NG; Montgomery, GW; Niu, T; Payne, TJ; Peltonen, L; Pergadia, ML; Rice, JP; Sherva, R; Spitz, MR; Sun, J; Wang, JC; Weiss, RB; Wheeler, W; Witt, SH; Yang, BZ; Caporaso, NE; Ehringer, MA; Eisen, T; Gapstur, SM; Gelernter, J; [Houlston, R](/source/Richard_Houlston); Kaprio, J; Kendler, KS; Kraft, P; Leppert, MF; Li, MD; Madden, PA; Nöthen, MM; Pillai, S; Rietschel, M; Rujescu, D; Schwartz, A; Amos, CI; Bierut, LJ (5 August 2010). ["Multiple independent loci at chromosome 15q25.1 affect smoking quantity: a meta-analysis and comparison with lung cancer and COPD"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916847). *[PLOS Genetics](/source/PLOS_Genetics)*. **6** (8) e1001053. [doi](/source/Doi_(identifier)):[10.1371/journal.pgen.1001053](https://doi.org/10.1371%2Fjournal.pgen.1001053). [PMC](/source/PMC_(identifier)) [2916847](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916847). [PMID](/source/PMID_(identifier)) [20700436](https://pubmed.ncbi.nlm.nih.gov/20700436).

1. ^ [***a***](#cite_ref-Fiore2008_22-0) [***b***](#cite_ref-Fiore2008_22-1) [***c***](#cite_ref-Fiore2008_22-2) [***d***](#cite_ref-Fiore2008_22-3) [***e***](#cite_ref-Fiore2008_22-4) [***f***](#cite_ref-Fiore2008_22-5) Fiore, MC; Jaen, CR; Baker, TB; et al. (2008). [*Treating tobacco use and dependence: 2008 update*](https://web.archive.org/web/20160327225607/http://bphc.hrsa.gov/buckets/treatingtobacco.pdf) (PDF). Rockville, MD: U.S. Department of Health and Human Services, U.S. Public Health Service. Archived from [the original](https://bphc.hrsa.gov/buckets/treatingtobacco.pdf) (PDF) on 2016-03-27. Retrieved 2016-09-02.

1. **[^](#cite_ref-23)** ["Anyone Can Become Addicted to Drugs"](https://www.drugabuse.gov/related-topics/addiction-science). [National Institute on Drug Abuse](/source/National_Institute_on_Drug_Abuse). July 2015.

1. **[^](#cite_ref-CamengaKlein2016_24-0)** Camenga, Deepa R.; Klein, Jonathan D. (2016). ["Tobacco Use Disorders"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4920978). *Child and Adolescent Psychiatric Clinics of North America*. **25** (3): 445–460. [doi](/source/Doi_(identifier)):[10.1016/j.chc.2016.02.003](https://doi.org/10.1016%2Fj.chc.2016.02.003). [ISSN](/source/ISSN_(identifier)) [1056-4993](https://search.worldcat.org/issn/1056-4993). [PMC](/source/PMC_(identifier)) [4920978](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4920978). [PMID](/source/PMID_(identifier)) [27338966](https://pubmed.ncbi.nlm.nih.gov/27338966).

1. **[^](#cite_ref-PistilloClementi2015_25-0)** Pistillo, Francesco; Clementi, Francesco; Zoli, Michele; Gotti, Cecilia (2015). "Nicotinic, glutamatergic and dopaminergic synaptic transmission and plasticity in the mesocorticolimbic system: Focus on nicotine effects". *Progress in Neurobiology*. **124**: 1–27. [doi](/source/Doi_(identifier)):[10.1016/j.pneurobio.2014.10.002](https://doi.org/10.1016%2Fj.pneurobio.2014.10.002). [ISSN](/source/ISSN_(identifier)) [0301-0082](https://search.worldcat.org/issn/0301-0082). [PMID](/source/PMID_(identifier)) [25447802](https://pubmed.ncbi.nlm.nih.gov/25447802). [S2CID](/source/S2CID_(identifier)) [207407218](https://api.semanticscholar.org/CorpusID:207407218).

1. **[^](#cite_ref-Shaik2016_26-0)** Shaik, Sabiha Shaheen (2016). ["Tobacco Use Cessation and Prevention – A Review"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948554). *Journal of Clinical and Diagnostic Research*. **10** (5): ZE13-7. [doi](/source/Doi_(identifier)):[10.7860/JCDR/2016/19321.7803](https://doi.org/10.7860%2FJCDR%2F2016%2F19321.7803). [ISSN](/source/ISSN_(identifier)) [2249-782X](https://search.worldcat.org/issn/2249-782X). [PMC](/source/PMC_(identifier)) [4948554](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948554). [PMID](/source/PMID_(identifier)) [27437378](https://pubmed.ncbi.nlm.nih.gov/27437378).

1. **[^](#cite_ref-APA2013_27-0)** American Psychiatric Association (22 May 2013). [*Diagnostic and Statistical Manual of Mental Disorders (DSM-5®)*](https://books.google.com/books?id=-JivBAAAQBAJ). American Psychiatric Pub. p. 571. [ISBN](/source/ISBN_(identifier)) [978-0-89042-557-2](https://en.wikipedia.org/wiki/Special:BookSources/978-0-89042-557-2).

1. **[^](#cite_ref-28)** ["Exploring The Prevalence Of Smoking In The UK | News | Vaping Guides | IndeJuice (UK)"](https://indejuice.com/uk/vape-guides/news/exploring-the-prevalence-of-smoking-in-the-uk). *indejuice.com*. Retrieved 2021-05-08.

1. **[^](#cite_ref-Payne2016_29-0)** Payne, JD; Orellana-Barrios, M; Medrano-Juarez, R; Buscemi, D; Nugent, K (2016). ["Electronic cigarettes in the media"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900769). *Proc (Bayl Univ Med Cent)*. **29** (3): 280–3. [doi](/source/Doi_(identifier)):[10.1080/08998280.2016.11929436](https://doi.org/10.1080%2F08998280.2016.11929436). [PMC](/source/PMC_(identifier)) [4900769](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900769). [PMID](/source/PMID_(identifier)) [27365871](https://pubmed.ncbi.nlm.nih.gov/27365871).

1. **[^](#cite_ref-30)** Publishing, Harvard Health. ["Breaking free from nicotine dependence"](https://www.health.harvard.edu/newsletter_article/breaking-free-from-nicotine-dependence). *Harvard Health*. Retrieved 2021-05-08.

1. **[^](#cite_ref-BessonForget2016_31-0)** Besson, Morgane; Forget, Benoît (2016). ["Cognitive Dysfunction, Affective States, and Vulnerability to Nicotine Addiction: A Multifactorial Perspective"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030478). *Frontiers in Psychiatry*. **7**: 160. [doi](/source/Doi_(identifier)):[10.3389/fpsyt.2016.00160](https://doi.org/10.3389%2Ffpsyt.2016.00160). [ISSN](/source/ISSN_(identifier)) [1664-0640](https://search.worldcat.org/issn/1664-0640). [PMC](/source/PMC_(identifier)) [5030478](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030478). [PMID](/source/PMID_(identifier)) [27708591](https://pubmed.ncbi.nlm.nih.gov/27708591).*This article incorporates [text](http://journal.frontiersin.org/article/10.3389/fpsyt.2016.00160/full) by Morgane Besson and Benoît Forget available under the [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/) license.*

1. ^ [***a***](#cite_ref-BMJ2014_32-0) [***b***](#cite_ref-BMJ2014_32-1) [***c***](#cite_ref-BMJ2014_32-2) [***d***](#cite_ref-BMJ2014_32-3) Drug Therapeutics, Bulletin (2014). "Republished: Nicotine and health". *BMJ*. **349** (nov26 9) 2014.7.0264rep. [doi](/source/Doi_(identifier)):[10.1136/bmj.2014.7.0264rep](https://doi.org/10.1136%2Fbmj.2014.7.0264rep). [ISSN](/source/ISSN_(identifier)) [1756-1833](https://search.worldcat.org/issn/1756-1833). [PMID](/source/PMID_(identifier)) [25428425](https://pubmed.ncbi.nlm.nih.gov/25428425). [S2CID](/source/S2CID_(identifier)) [45426626](https://api.semanticscholar.org/CorpusID:45426626).

1. **[^](#cite_ref-RahmanReitz2005_33-0)** Atta-ur- Rahman; Allen B. Reitz (1 January 2005). [*Frontiers in Medicinal Chemistry*](https://books.google.com/books?id=tCyDoIHToBQC&pg=PA279). Bentham Science Publishers. pp. 279–. [ISBN](/source/ISBN_(identifier)) [978-1-60805-205-9](https://en.wikipedia.org/wiki/Special:BookSources/978-1-60805-205-9).

1. ^ [***a***](#cite_ref-Martin-Soelch2013_34-0) [***b***](#cite_ref-Martin-Soelch2013_34-1) Martin-Soelch, Chantal (2013). ["Neuroadaptive Changes Associated with Smoking: Structural and Functional Neural Changes in Nicotine Dependence"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061825). *Brain Sciences*. **3** (1): 159–176. [doi](/source/Doi_(identifier)):[10.3390/brainsci3010159](https://doi.org/10.3390%2Fbrainsci3010159). [ISSN](/source/ISSN_(identifier)) [2076-3425](https://search.worldcat.org/issn/2076-3425). [PMC](/source/PMC_(identifier)) [4061825](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061825). [PMID](/source/PMID_(identifier)) [24961312](https://pubmed.ncbi.nlm.nih.gov/24961312).

1. **[^](#cite_ref-35)** Mihov, Yoan; [Hurlemann, Rene](/source/Rene_Hurlemann) (July 2012). ["Altered Amygdala Function in Nicotine Addiction: Insights from Human Neuroimaging Studies"](https://eric.ed.gov/?id=EJ976154). *[Neuropsychologia](/source/Neuropsychologia)*. **50** (8). [University of Bonn](/source/University_of_Bonn): [Education Resources Information Center](/source/Education_Resources_Information_Center), [Institute of Education Sciences](/source/Institute_of_Education_Sciences) - [United States Department of Education](/source/United_States_Department_of_Education). [doi](/source/Doi_(identifier)):[10.1016/j.neuropsychologia.2012.04.028](https://doi.org/10.1016%2Fj.neuropsychologia.2012.04.028). [PMID](/source/PMID_(identifier)) [22575084](https://pubmed.ncbi.nlm.nih.gov/22575084).

1. **[^](#cite_ref-SGUS2014_36-0)** Lushniak, Boris D.; Samet, Jonathan M.; Pechacek, Terry F.; Norman, Leslie A.; Taylor, Peter A. (2014). "Nicotine". [*The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General*](https://stacks.cdc.gov/view/cdc/21569/Share). [Surgeon General of the United States](/source/Surgeon_General_of_the_United_States). pp. 107–138. [PMID](/source/PMID_(identifier)) [24455788](https://pubmed.ncbi.nlm.nih.gov/24455788).

1. ^ [***a***](#cite_ref-Rowell2015_37-0) [***b***](#cite_ref-Rowell2015_37-1) Rowell, Temperance R; Tarran, Robert (2015). ["Will Chronic E-Cigarette Use Cause Lung Disease?"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4683316). *American Journal of Physiology. Lung Cellular and Molecular Physiology*. **309** (12): L1398–L1409. [doi](/source/Doi_(identifier)):[10.1152/ajplung.00272.2015](https://doi.org/10.1152%2Fajplung.00272.2015). [ISSN](/source/ISSN_(identifier)) [1040-0605](https://search.worldcat.org/issn/1040-0605). [PMC](/source/PMC_(identifier)) [4683316](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4683316). [PMID](/source/PMID_(identifier)) [26408554](https://pubmed.ncbi.nlm.nih.gov/26408554).

1. **[^](#cite_ref-Benowitz2010_38-0)** Benowitz, NL (17 June 2010). ["Nicotine addiction"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928221). *The New England Journal of Medicine*. **362** (24): 2295–303. [doi](/source/Doi_(identifier)):[10.1056/NEJMra0809890](https://doi.org/10.1056%2FNEJMra0809890). [PMC](/source/PMC_(identifier)) [2928221](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928221). [PMID](/source/PMID_(identifier)) [20554984](https://pubmed.ncbi.nlm.nih.gov/20554984).

1. **[^](#cite_ref-Martin2016_39-0)** ["Nicotine and Tobacco"](https://www.medlineplus.gov/ency/article/000953.htm). *Medline Plus*. 7 June 2016.

1. **[^](#cite_ref-40)** Ware, JJ; van den Bree, MB; Munafò, MR (2011). ["Association of the CHRNA5-A3-B4 gene cluster with heaviness of smoking: a meta-analysis"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223575). *Nicotine & Tobacco Research*. **13** (12): 1167–75. [doi](/source/Doi_(identifier)):[10.1093/ntr/ntr118](https://doi.org/10.1093%2Fntr%2Fntr118). [PMC](/source/PMC_(identifier)) [3223575](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223575). [PMID](/source/PMID_(identifier)) [22071378](https://pubmed.ncbi.nlm.nih.gov/22071378).

1. **[^](#cite_ref-YuMcClellan2016_41-0)** Yu, Cassie; McClellan, Jon (2016). "Genetics of Substance Use Disorders". *Child and Adolescent Psychiatric Clinics of North America*. **25** (3): 377–385. [doi](/source/Doi_(identifier)):[10.1016/j.chc.2016.02.002](https://doi.org/10.1016%2Fj.chc.2016.02.002). [ISSN](/source/ISSN_(identifier)) [1056-4993](https://search.worldcat.org/issn/1056-4993). [PMID](/source/PMID_(identifier)) [27338962](https://pubmed.ncbi.nlm.nih.gov/27338962).

1. ^ [***a***](#cite_ref-WenYang2016_42-0) [***b***](#cite_ref-WenYang2016_42-1) Wen, L; Yang, Z; Cui, W; Li, M D (2016). ["Crucial roles of the CHRNB3–CHRNA6 gene cluster on chromosome 8 in nicotine dependence: update and subjects for future research"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931601). *Translational Psychiatry*. **6** (6): e843. [doi](/source/Doi_(identifier)):[10.1038/tp.2016.103](https://doi.org/10.1038%2Ftp.2016.103). [ISSN](/source/ISSN_(identifier)) [2158-3188](https://search.worldcat.org/issn/2158-3188). [PMC](/source/PMC_(identifier)) [4931601](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931601). [PMID](/source/PMID_(identifier)) [27327258](https://pubmed.ncbi.nlm.nih.gov/27327258).

1. ^ [***a***](#cite_ref-ChenHorton2016_43-0) [***b***](#cite_ref-ChenHorton2016_43-1) Chen, Li-Shiun; Horton, Amy; Bierut, Laura (2018). ["Pathways to precision medicine in smoking cessation treatments"](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5115988). *Neuroscience Letters*. **669**: 83–92. [doi](/source/Doi_(identifier)):[10.1016/j.neulet.2016.05.033](https://doi.org/10.1016%2Fj.neulet.2016.05.033). [ISSN](/source/ISSN_(identifier)) [0304-3940](https://search.worldcat.org/issn/0304-3940). [PMC](/source/PMC_(identifier)) [5115988](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5115988). [PMID](/source/PMID_(identifier)) [27208830](https://pubmed.ncbi.nlm.nih.gov/27208830).

1. **[^](#cite_ref-44)** Kaprio, J., Kinnunen, T. H., Korhonen, T., Latvala, A., Ranjit, A., Depressive symptoms predict smoking cessation in a 20-year longitudinal study of adult twins, Addictive Behaviors, 2020 [https://doi.org/10.1016/j.addbeh.2020.106427](https://doi.org/10.1016/j.addbeh.2020.106427)

1. ^ [***a***](#cite_ref-Hartmann-Boyce2013_45-0) [***b***](#cite_ref-Hartmann-Boyce2013_45-1) Hartmann-Boyce, J; Stead, LF; Cahill, K; Lancaster, T (October 2013). "Efficacy of interventions to combat tobacco addiction: Cochrane update of 2012 reviews". *Addiction*. **108** (10): 1711–21. [doi](/source/Doi_(identifier)):[10.1111/add.12291](https://doi.org/10.1111%2Fadd.12291). [PMID](/source/PMID_(identifier)) [23834141](https://pubmed.ncbi.nlm.nih.gov/23834141).

1. **[^](#cite_ref-46)** ["CelticPharma: TA-NIC Nicotine Dependence"](https://web.archive.org/web/20091206100218/http://www.celticpharma.com/theportfolio/ta-nic.html). Archived from [the original](http://www.celticpharma.com/theportfolio/ta-nic.html) on 2009-12-06. Retrieved 2009-10-27.

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## External links

Wikimedia Commons has media related to [Nicotine dependence](https://commons.wikimedia.org/wiki/Category:Nicotine_dependence).

- [Fagerstrom Test of Nicotine Dependence (Heatherton et al., 1991)](http://cde.drugabuse.gov/instrument/d7c0b0f5-b865-e4de-e040-bb89ad43202b)

- [Heaviness of Smoking Index (Heatherton et al., 1989)](http://www.livingwellseontario.ca/livingwell/assets/File/Webinars/Heaviness%20of%20Smoking%20Scale.pdf) [Archived](https://web.archive.org/web/20170202010417/http://www.livingwellseontario.ca/livingwell/assets/File/Webinars/Heaviness%20of%20Smoking%20Scale.pdf) 2017-02-02 at the [Wayback Machine](/source/Wayback_Machine)

- [Diagnostic and Statistical Manual of Mental Disorders V (DSM-V)](http://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596)

- [Tobacco Dependence Screener (Kawakami et al., 1999)](http://growyourwellness.com/sites/default/files/attachments/2014/07/KawakamiArticle_TDSquestionnaire.pdf) [Archived](https://web.archive.org/web/20160927183545/http://growyourwellness.com/sites/default/files/attachments/2014/07/KawakamiArticle_TDSquestionnaire.pdf) 2016-09-27 at the [Wayback Machine](/source/Wayback_Machine)

- [Nicotine Dependence Syndrome Scale (NDSS; Shiffman, Waters & Hickcox, 2004)](https://web.archive.org/web/20160821101829/http://ntr.oxfordjournals.org/content/6/2/327.full.pdf+html)

- [Cigarette Dependence Scale (Etter et al., 2003)](http://www.nature.com/npp/journal/v28/n2/full/1300030a.html)

- [Wisconsin Inventory of Smoking Dependence Motives (Piper et al., 2004)](http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.546.8124&rep=rep1&type=pdf)

v t e Drugs used in treatment of drug dependence (N07B) Nicotine dependence Bupropion Cytisine Lobeline Mecamylamine Therapeutic nicotine Varenicline AATooltip Adrenergic agonist (Clonidine) Alcohol dependence AD inhibitor Disulfiram Acamprosate Calcium carbimide Hydrogen cyanamide General anesthetics Nitrous oxide Opioid antagonists Naltrexone Nalmefene Topiramate AATooltip Adrenergic agonist (Clonidine) Baclofen Phenibut Opioid dependence AATooltip Adrenergic agonist (Clonidine Lofexidine) Ibogaine Opioids Buprenorphine (+naloxone) Diamorphine (heroin) Levacetylmethadol Methadone Dihydrocodeine Dihydroetorphine Hydromorphone (extended-release) Morphine (extended-release) Opioid antagonists (Naltrexone Nalmefene) Benzodiazepine dependence AATooltip Adrenergic agonist (Clonidine) Benzodiazepines (Diazepam Lorazepam Chlordiazepoxide Oxazepam) Barbiturates (Phenobarbital)

v t e Reinforcement disorders: addiction and dependence Addiction Drug Alcohol Amphetamine Cocaine Methamphetamine Methylphenidate Nicotine Opioid Behavioral Financial Gambling Shopping Palatable food Sex-related Intercourse Pornography Internet-related Internet addiction disorder Internet sex addiction Video game addiction Digital media addictions Cellular mechanisms Transcriptional ΔFosB c-Fos Cdk5 CREB GluR2 NF-κB Epigenetic G9a G9a-like protein HDAC1 HDAC2 HDAC3 HDAC4 HDAC5 HDAC9 HDAC10 SIRT1 SIRT2 ... Dependence Concepts Adverse childhood experiences Physical dependence Psychological dependence Withdrawal Disorders Drugs Alcoholism Amphetamine Barbiturate Benzodiazepine Caffeine Cannabis Cocaine Nicotine Opioid Non-drug stimuli Tanning dependence Treatment and management Detoxification Alcohol detoxification Drug detoxification Behavioral therapies Cognitive behavioral therapy Relapse prevention Contingency management Community reinforcement approach and family training Motivational enhancement therapy Motivational interviewing Motivational therapy Physical exercise Treatment programs Drug rehab Residential treatment center Heroin-assisted treatment Intensive outpatient program Methadone maintenance Smoking cessation Nicotine replacement therapy Tobacco cessation clinics in India Twelve-step program Support groups Addiction recovery groups List of twelve-step groups Harm reduction Category:Harm reduction Drug checking Reagent testing Low-threshold treatment programs Managed alcohol program Moderation Management Needle exchange program Responsible drug use Stimulant maintenance Supervised injection site Tobacco harm reduction See also Addiction medicine Allen Carr Category:Addiction Category:Vaccines against drugs Discrimination against drug addicts Dopamine dysregulation syndrome Cognitive control Inhibitory control Motivational salience Incentive salience Sober companion Category

v t e Psychoactive substance-related disorders General SID Substance intoxication / Drug overdose Substance-induced psychosis Withdrawal: Neonatal withdrawal Post-acute-withdrawal syndrome (PAWS) SUD Substance abuse / Substance-related disorders Physical dependence / Psychological dependence / Substance dependence Combined substance use SUD Polysubstance dependence SID Combined drug intoxication (CDI) Alcohol SID Cardiovascular diseases Alcoholic cardiomyopathy (ACM) Alcohol flush reaction (AFR) Gastrointestinal diseases Alcoholic liver disease (ALD): Alcoholic hepatitis Zieve's syndrome Auto-brewery syndrome (ABS) Endocrine diseases Alcoholic ketoacidosis (AKA) Nervous system diseases Alcohol-related dementia (ARD) Alcohol intoxication Hangover Neurological disorders Alcoholic hallucinosis Alcoholic polyneuropathy Alcohol-related brain damage (ARBD) Alcohol withdrawal syndrome (AWS): Alcoholic hallucinosis Delirium tremens (DTs) Fetal alcohol spectrum disorder (FASD) Korsakoff syndrome (KS) Marchiafava–Bignami disease (MBD) Positional alcohol nystagmus (PAN) Wernicke–Korsakoff syndrome (WKS) Wernicke encephalopathy (WE) Respiratory tract diseases Alcohol-induced respiratory reactions Alcoholic lung disease SUD Alcoholism (alcohol use disorder (AUD)) Binge drinking Caffeine SID Caffeine-induced anxiety disorder Caffeine-induced psychosis Caffeine-induced sleep disorder Caffeinism Caffeine withdrawal SUD Caffeine dependence Cannabis SID Cannabis arteritis Cannabinoid hyperemesis syndrome (CHS) SUD Cannabis use disorder (CUD) Synthetic cannabinoid use disorder Cocaine SID Cocaine intoxication Prenatal cocaine exposure (PCE) SUD Cocaine dependence Hallucinogen SID Acute intoxication from hallucinogens (bad trip) Hallucinogen persisting perception disorder (HPPD) Nicotine SID Nicotine poisoning Green Tobacco Sickness (GTS) Nicotine withdrawal SUD Nicotine dependence Opioids SID Opioid overdose Opioid withdrawal Opioid-induced hyperalgesia (OIH) Opioid-induced endocrinopathy (OIE) Opioid-induced constipation (OIC) SUD Opioid use disorder (OUD) Sedative / hypnotic SID Kindling (sedative–hypnotic withdrawal) benzodiazepine: SID Benzodiazepine overdose Benzodiazepine withdrawal SUD Benzodiazepine use disorder (BUD) Benzodiazepine dependence barbiturate: SID Barbiturate overdose SUD Barbiturate dependence Stimulants SID Stimulant psychosis amphetamine: SUD Amphetamine dependence Volatile solvent SID Sudden sniffing death syndrome (SSDS) Toluene toxicity Inhalant withdrawal SUD Chronic solvent-induced encephalopathy Inhalant abuse Related Anabolic-androgenic steroids SUD Anabolic-androgenic steroids abuse Cannabis Amotivational syndrome Chocolate Chocoholic Cocaine Cocaine-induced midline destructive lesions Levamisole induced necrosis syndrome Methamphetamine Meth mouth

v t e Cigarettes Types Fashion Fire-safe Flavored Kretek Lights Menthol Beedi Components Tobacco Rolling paper Filter Cigarette tube Additives Peripherals Case Holder Lighter Pack Receptacles Ashtray Vending machine Culture Cigarette card Loosie Smoking in association football Smoking fetishism Tobacco smoking Youth College students In art Skull of a Skeleton with Burning Cigarette Health issues Asthma Chain smoking Coronary artery disease Gangrene Lung cancer Nicotine consumption and weight loss Nicotine dependence Nicotine replacement therapy Nicotine withdrawal Smoking cessation Nicotine poisoning Passive smoking Third-hand smoke Pregnancy Schizophrenia and smoking Sidestream smoke Tobacco harm reduction Related products Candy cigarette Cigar Cigarillo Herbal cigarette Heated tobacco product Composition List Snus Electronic cigarette Nicotine pouch Tobacco industry Cultivation of tobacco Tobacco advertising Disinformation playbook "Big Tobacco" By country Argentina Egypt Malawi Pakistan Philippines Switzerland United States Tobacco control Advertising ban European Directive Illicit trade Legal smoking age Master Settlement Agreement Plain packaging Smoking bans list private vehicles Taxation Tobacco politics Warning messages WHO Framework Convention on Tobacco Control MPOWER Protocol to Eliminate Illicit Trade Lists Cigarette brands Cigarette smoke carcinogens Countries by tobacco consumption Rolling papers Smoking bans Category Commons Smoking Electronic cigarettes

Classification D ICD-10: F17.2 ICD-10-CM: F17.2 ICD-9-CM: 305.1 OMIM: 188890 SNOMED CT: 56294008

Authority control databases: National Czech Republic

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Adapted from the Wikipedia article [Nicotine dependence](https://en.wikipedia.org/wiki/Nicotine_dependence) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Nicotine_dependence?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.