Nicotine addiction

• STATUS: Legal in most of the world, but restricted by location of use and age of user worldwide

• SOURCE: Tobacco plant Nicotiana tabacum
• TRANSMISSION ROUTE: Inhalation, oral ingestion

DEFINITION: Unlike many damaging addictions (with the exception of alcohol), the smoking or chewing of tobacco is legal in most countries. Cigars, cigarettes (including e-cigarettes), and pipe and chewing tobacco contain many chemicals, but the addictive substance is nicotine, which creates a craving in many people that may be as difficult to break as addiction to heroin, cocaine, or other drugs.

History of Use

Nicotine was named for the tobacco plant Nicotiana tabacum, which itself was named for Jean Nicot de Villemain, a French ambassador, who imported the plant to Portugal in 1560 as a medicine. The colony of Jamestown, Virginia, began to cultivate tobacco on a large scale around 1616. Starting in 1617, exports rose from 20,000 pounds to 1.5 million by 1629.

What had been characterized as a detestable weed soon began to be used by the English, who were told that the tobacco would improve their health. The colonists abandoned other ventures to cultivate tobacco, drawing about 4,600 new colonists from Europe, who flooded onto lands that the Powhatan had used to grow food and hunt game over the subsequent decade.

The smoking or chewing of tobacco became popular for centuries. Until the 1950s, many university lecture halls were built with ashtrays. Indoor smoking was widely accepted. The newsroom of the New York Times, for example, was used by so many chain smokers in the 1930s that by the end of each workday, janitors swept away cigarette butts with push brooms.

The US surgeon general in 1963 issued a detailed report that associated the use of tobacco with many health problems, including heart disease, stroke, and cancer. Since then, even the inhalation of tobacco smoke from other people’s lungs (secondhand or passive smoking) has been associated with health risks.

Nicotine itself usually does not cause health risks. Most of the physical damage is caused by other substances, including tar and various chemicals. Gallup began collecting cigarette use data in 1944, and at the time, 41 percent of American adult respondents reported smoking cigarettes in the previous week. By the mid-2020s, that percentage was 11 percent. This decline was particularly sharp among respondents under thirty. In surveys conducted between 2001 and 2003, 35 percent of young adults reported smoking cigarettes in the past week, compared to only 6 percent of respondents in the same age group in the early 2020s. However, the use of e-cigarettes rose during that period, especially among youth and young adults.

According to Gallup research, between 2019 and 2024, the percentage of Americans who used e-cigarettes remained steady between 6 and 8 percent; however, use varied significantly by age. Among those surveyed, 18 percent of respondents aged eighteen to twenty-nine had used an e-cigarette in the past week, compared to only 1 percent of respondents aged sixty-five or older.

Effects and Potential Risks

The human body receives nicotine (and other addictive substances) through acetylcholine receptors in the brain, increasing the levels of neurotransmitters that regulate mood and behavior. The use of nicotine provides a shot of dopamine, a neurotransmitter that briefly produces a sense of euphoria and relaxation, rewarding continued use and thus reinforcing addiction. The use of nicotine also increases the flow of the stimulating hormone adrenaline (epinephrine). Nicotine also increases heart rate by about twenty beats per minute, elevating blood pressure and constricting arteries.

Burning tobacco smoke contains a minimum of seventy cancer-causing chemicals (carcinogens). According to the American Cancer Society, the smoking of tobacco plays a role in about 80 percent of lung cancer cases, as well as many cases of emphysema and chronic bronchitis; it also aggravates asthma. Inhalation of burning tobacco also provokes cancers of the esophagus, larynx, mouth, and throat (pharynx). It also negatively affects the stomach, pancreas, kidneys, bladder, cervix, and other parts of the body, and it can increase the risk of infertility and impotence. The Centers for Disease Control and Prevention (CDC) reported in the mid-2020s that, among adults who do not smoke, secondhand smoke alone killed some 34,000 Americans each year. Additionally, the CDC attributed 480,000 annual deaths to smoking and secondhand smoke, with over 16 million Americans living with a smoking-related disease.

The use of tobacco at a young age increases the likelihood of serious addiction. Dependence becomes slightly more intense each time the drug is used. Thus, while going without the drug is easier for younger people, the addiction becomes more trenchant with age. Going without nicotine causes withdrawal symptoms (such as irritability and anxiety) that vary in intensity and duration among different people.

Other symptoms of nicotine withdrawal include difficulty concentrating, restlessness, a depressed mood, frustration, anger, hunger, occasional insomnia, and constipation or diarrhea. The use of tobacco even after the onset of serious health problems is a sign of serious addiction. Some people continue using tobacco even after lung cancer surgery, and some people defend their “freedom” to be addicted.

Although nicotine addiction is physiological, it also involves psychological cues. The desire experienced by people who smoke to raise their nicotine levels is often associated with daily rituals, including a cup of morning coffee, free time between work tasks, or an evening over drinks at a familiar bar. Meeting with friends (especially those who smoke) can also intensify the urge. Smoking can also be associated with specific sites, or a ride in a familiar automobile. Psychological stress can raise anxiety levels and increase the desire to smoke. Smelling burning tobacco also may increase a person’s desire to use the substance.

People with schizophrenia, depression, or other mental health conditions are more likely to smoke tobacco than the general population. Individuals with alcohol use disorder and other substance use disorders also use tobacco at higher rates. Products meant to aid in quitting smoking are a billion-dollar global industry. Gums, patches, and mints are commonly used as nicotine replacements for those trying to quit smoking, but studies show mixed results for their efficacy in supporting long-term success. Products like Zyn nicotine pouches gained popularity in the 2020s, with various types, including spit-free, tobacco-free, smokeless, and even nicotine-free pouches, designed and advertised to help people quit using tobacco and nicotine. However, no tobacco or nicotine product is risk-free or completely safe, according to the CDC and the American Lung Association.

Many states have passed laws that ban smoking in public venues in an effort to decrease exposure to secondhand smoke. By the mid-2020s, twenty-eight states and Washington, DC had enacted smoke-free legislation. Additionally, hundreds of cities and counties across the country also enacted such legislation.

Bibliography

Benowitz, Neal L., editor. Nicotine Safety and Toxicity. Oxford UP, 1998.

Bock, Gregory, and Jamie Goode, editors. Understanding Nicotine and Tobacco Addiction. Wiley, 2006.

Braymiller, Jessica, and Stephanie T. Lanza. Epidemiology of Nicotine Use among Adolescents and Young Adults in the United States: Findings from the PATH Study. Pennsylvania State University, 2019, etda.libraries.psu.edu/catalog/16946jlb982. Accessed 18 Nov. 2025.

"Cigarette Smoking." US Centers for Disease Control and Prevention, 17 Sept. 2024, www.cdc.gov/tobacco/about/index.html. Accessed 18 Nov. 2025.

"Current Cigarette Smoking among Adults in the United States." US Centers for Disease Control and Prevention, 17 Sept. 2024, www.cdc.gov/tobacco/php/data-statistics/adult-data-cigarettes/index.html. Accessed 18 Nov. 2025.

"Health Risks of Smoking Tobacco." American Cancer Society, 19 Nov. 2024, www.cancer.org/healthy/stay-away-from-tobacco/health-risks-of-tobacco/health-risks-of-smoking-tobacco.html. Accessed 18 Nov. 2025.

Jones, Jeffrey M. "Cigarette Smoking Rate in U.S. Ties 80-Year Low." Gallup, 13 Aug. 2024, news.gallup.com/poll/648521/cigarette-smoking-rate-ties-year-low.aspx. Accessed 18 Nov. 2025.

Kozlowski, Lynn T., et al. Cigarettes, Nicotine, and Health: A Biobehavioral Approach. Sage, 2001.

"U.S. State and Local Issues: Smoke-Free Laws." Campaign for Tobacco-Free Kids, 7 July 2025, www.tobaccofreekids.org/what-we-do/us/smoke-free-laws. Accessed 18 Nov. 2025.