Nicotine addiction

Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of ​​enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

More about the experts All content is checked by medical journalists.

Nicotine addiction is not easy to overcome. The physical dependency is over after days or at the latest a few weeks. But psychological addiction remains in the head for a long time. If you can't get rid of cigarettes and the like on your own, you should seek help: Nicotine replacement preparations help you overcome physical withdrawal. But psychological coping strategies are even more important. Read all the important information about nicotine addiction here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F17

Brief overview

• Description: physical and psychological dependence on nicotine effects
• Symptoms: strong desire for nicotine, loss of control, continued consumption despite the harmful consequences, withdrawal symptoms (e.g. restlessness and irritability)
• Causes: conditioning of the reward center in the brain, stress, possibly genetic response to nicotine
• Diagnosis: Criteria include strong desire, high consumption, difficulties in giving up nicotine when smoking is prohibited, and reaching for a cigarette in the morning quickly
• Treatment: motivational treatment, behavioral support, nicotine replacement therapy
• Forecast: high risk of relapse without professional support, high motivation crucial for success

Nicotine addiction: description

For decades, advertising has presented smokers as attractive, free and cosmopolitan people. Despite intensive efforts to educate people, this image is still in many minds today. In fact, most tobacco users are simply addicted to nicotine. The chemical from the tobacco plant affects both the body and the psyche of the smoker. Cigarettes can have a calming, but also invigorating effect. The risk of smoking becoming an addiction is great.

Tobacco consumption is then no longer a choice, but arises from an internal compulsion. By then, at the latest, the enjoyment will be over. If those affected try to reduce their consumption or to stop completely, a struggle with themselves begins. Even the best resolutions cannot be kept because the desire is too strong. This conflict creates stress. The process of reaching for the cigarette is automated and is intended to reduce the pressure. Addiction is a vicious circle that can often only be broken with outside help.

Nicotine addiction: passive smoking

The smoke is not only dangerous for smoking itself. People who passively inhale the smoke can also be harmed. It is particularly dangerous when women smoke during pregnancy. This increases the risk of premature birth, newborns are often lighter at birth and more likely to suffer from sudden infant death syndrome. Nicotine also enters the baby's body through breast milk. The more a mother smokes, the higher the concentration in breast milk. Children who are passively exposed to smoke are also harmed. They suffer more often than other children from respiratory diseases, pneumonia and also otitis media.

Nicotine Addiction: How Many Are Affected?

About 29 percent of adults in Germany smoke. That's about 20 million people. Around 31 percent of men use a cigarette, and around 26 percent of women.

Among adolescents between 12 and 17 years of age, the number of smokers has decreased significantly since 2001: at that time it was still 28 percent. According to the last surveys in 2014, it has now fallen to just under 10 percent. Boys smoked slightly more often than girls (11 versus 9 percent).

Still, nicotine addiction remains a common addiction. Smokers shorten their lifespan by consuming tobacco by around ten years. Around 140,000 people die in Germany every year as a result of smoking.

Most of the tobacco consumed in this country is in cigarettes - with or without a filter, made up from the box or twisted or stuffed yourself. Cigarillos, cigars, pipes, snuff and chewing tobacco and water pipes play a subordinate role.

Nicotine Addiction: Toxic Haze

Raw tobacco is made from the dried leaves of the tobacco plant. The plant can only be consumed - as smoking, chewing or snuff - after industrial processing. Tobacco smoke contains more than 4,000 ingredients. The main active ingredient is nicotine. Depending on the origin of the plants and the preparation of the tobacco, the smoker, snuff or chewer gets different amounts of the toxic chemical compound. In addition to nicotine, there are numerous other chemicals and heavy metals in tobacco smoke, such as hydrogen cyanide, benzene, formaldehyde, hydrazine, vinyl chloride, cadmium, lead, nickel, chromium, aluminum and carbon monoxide. More than 40 of these substances have been shown to be carcinogenic.

Nicotine addiction: symptoms

According to the classification of mental disorders in the ICD-10, at least three of the following criteria must be met for a diagnosis of nicotine dependence over a period of one month or repeatedly within a year:

1. A strong craving or compulsion to consume tobacco.
2. Limited control over start, stop and amount of consumption.
3. Physical withdrawal symptoms occur when consumption is reduced.
4. Tolerance development: Consumption must be increased in order to achieve a constant effect.
5. Surrender or neglect of interests due to substance use.
6. Persistent tobacco consumption despite obviously harmful consequences.

As the body gets used to the nicotine, the person concerned must initially consume more and more in order to feel the same effect. Typical withdrawal symptoms are increased excitability and restlessness. Many smokers believe that nicotine reduces anxiety, but it actually makes it stronger in the long run. Further withdrawal symptoms are a reduced ability to concentrate, feelings of hunger as well as sleep disorders and anxiety.

Smoking: health consequences

While nicotine is responsible for its effects and addiction, the other chemicals in tobacco smoke are primarily harmful to health. The effects of smoking affect the health of the entire body. In many cases, tobacco consumption is even responsible for premature death.

The respiratory tract of a smoker is exposed to a massive amount of chemicals. The possible late effects of nicotine addiction therefore range from chronic bronchitis to lung cancer. Smoking also promotes arteriosclerosis (vascular calcification), which can cause serious circulatory disorders.

Smoking also increases blood pressure and thus promotes diseases of the heart and blood vessels. Dreaded long-term effects of nicotine addiction are coronary heart disease (CHD), myocardial infarction and circulatory disorders of the leg arteries ("smoker's leg"). Further consequences are diabetes (type 2 diabetes) as well as skin and tooth damage.

Last but not least, smoking also increases the risk of cancer. This is especially true for lung cancer, larynx cancer, esophageal cancer and oral cancer. Nicotine consumption also plays a role in the development of other malignant tumors, such as pancreatic cancer, kidney cancer, stomach cancer and leukemia. About 25 to 30 cancer deaths are attributable to smoking.

Nicotine Addiction: Causes and Risk Factors

Nicotine addiction arises from the influence of various psychological and biological factors. The nicotine creates both physical and psychological addiction.

Nicotine addiction: smoking as a learned behavior

Most of those affected started smoking in childhood or adolescence. Out of curiosity or through peer pressure, they take up cigarettes. Many also cover up their insecurities with cigarettes in hand.

The first cigarette doesn't make you feel good. The body reacts to the first doses of nicotine as if it were poisoned: with dizziness, increased salivation, heart pounding, headaches, nausea, vomiting or diarrhea and impaired consciousness. But many young people feel “cool” when they smoke and accept the initially unpleasant taste and side effects. The positive group feeling that arises from smoking together increases consumption socially.

Even in adulthood, cigarettes smoked together serve a social purpose. Smoking during work breaks and after eating links nicotine consumption with a feeling of relaxation and enjoyment. As soon as the connection between smoking and certain situations has been learned, reaching for a cigarette after eating or when going out occurs almost automatically.

Nicotine Addiction: Biological Factors

Nicotine addiction occurs when our natural reward system in the brain is manipulated. The reward system is vital. For example, it rewards us for eating when we are hungry. It also releases the messenger substance dopamine, which makes us feel good. When you consume nicotine, more dopamine is released. Picking up a cigarette is therefore just as rewarded as eating, drinking and sex. However, those who smoke regularly overwhelm the system. The previous amount of nicotine is no longer sufficient for a positive effect. This development of tolerance and the associated withdrawal symptoms characterize the physical dependence of nicotine addiction. The body increasingly demands more nicotine.

Nicotine has an effect on the psyche through the release of messenger substances. One speaks of a psychotropic effect. Nicotine increases alertness, supports memory and increases stress tolerance. At the same time, it lowers the level of aggression, relieves arousal and reduces the feeling of hunger. Depending on the general mood of the smoker, nicotine can have both a calming effect (for example in stressful situations) and a stimulating effect (for example when tired). The person is psychologically dependent when they believe they absolutely need the cigarette.

If there is a physical and psychological dependency, it is hardly possible for those affected to control the consumption. The unpleasant withdrawal symptoms of nicotine addiction, which occur as soon as nicotine levels decrease, determine when the next cigarette is smoked.

Nicotine addiction: examinations and diagnosis

If you suspect tobacco addiction, you can first see your family doctor. In order to diagnose nicotine addiction, they will ask questions about your tobacco consumption. The Fagerström questionnaire, with which the severity of nicotine addiction can be recorded, is very well established. The Fagerströmtest contains the following questions, among others:

• How many cigarettes do you smoke a day?
• Having trouble not smoking when in places where smoking is prohibited?
• How soon after waking up do you smoke your first cigarette?

The doctor will also check your physical health to see if nicotine addiction has caused any sequelae. If necessary, these must be dealt with.

If there is severe nicotine addiction, the doctor will recommend therapeutic treatment. If the person concerned is motivated, less intensive aid measures can also be effective. The doctor will inform you about the various offers for smoking cessation in the case of nicotine addiction.

Nicotine addiction: treatment

There are various options for treating nicotine addiction, from nicotine patches to psychotherapy. However, tobacco addiction is not yet considered a disease, but rather self-harming behavior. The health insurances do not cover any costs for the treatment of nicotine addiction. If the experts have their way, nicotine addiction should be treated like any other addiction disease. Many doctors therefore demand that smoking cessation in the case of nicotine addiction is paid for by health insurance companies.

Nicotine addiction: motivational treatment and brief interventions

A brief intervention to treat nicotine addiction usually takes place at a doctor's or in addiction counseling centers. For this purpose, smoking behavior is first recorded and then the motivation to quit is explored. The smoker is supported in giving up nicotine through short motivational conversations. Telephone counseling and self-help groups also offer effective help in combating nicotine addiction.

Nicotine Addiction: Therapeutic Treatment

For smoking cessation, behavioral group and individual interventions have proven to be particularly effective. In behavior therapy, the behavior of the person affected is analyzed and alternative behaviors are developed. For example, the therapist will ask what conditions and situations induce the person concerned to smoke. There is often a connection with stress, which is supposed to be reduced by the cigarette. The therapist helps the patient find other ways to deal with stress. Relaxation techniques and strengthening the social network play an important role in this.

Nicotine addiction: nicotine replacement therapy

Another way of giving up smoking is to use nicotine patches, chewing gum, inhalers or sprays. They provide the body with a certain amount of nicotine. The nicotine patch releases nicotine continuously. Depending on the previous consumption, a high dose of nicotine is started and this is slowly reduced. The nicotine patch initially maintains the nicotine level in the body so that the withdrawal symptoms do not set in so strongly.

Nicotine chewing gum and nicotine mouth sprays do not work continuously, but slightly delayed after ingestion. Nicotine nasal sprays mimic the effects of the cigarette best, but for this reason they are more addictive.

The physical dependence of nicotine addiction is over after about two weeks. However, the psychological dependence persists and needs treatment to prevent relapse. How long the craving persists varies greatly. In many cases, however, nicotine replacement therapy is an effective method to support a permanent cessation of tobacco.

Nicotine Addiction: Further Measures

If you are starting to quit smoking, you should come up with a plan for structuring the day. Distracting activities are an important support. Exercise, in particular, makes abstinence easier. On the one hand, those affected feel an improvement in their condition and breathing becomes easier. On the other hand, exercise triggers the release of messenger substances that create a feeling of happiness. Friends and family can also make an important contribution. People around you should be informed about quitting smoking so that they can support the person concerned.

Nicotine addiction: course and prognosis

The earlier you start smoking, the higher the risk of becoming dependent and suffering long-term damage. Young people who take up a cigarette very early also usually consume alcohol and drugs. It is therefore important to protect children and adolescents in particular from nicotine. As a good role model, adults can have a positive influence on younger generations.

An important prerequisite for the success of smoking cessation is the motivation of the person concerned. After a longer period of abstinence, the risk of relapse decreases. Nevertheless, vigilance is still necessary even after years. Certain smells or situations can bring back memories of the good feeling with the cigarette. The decision against nicotine addiction must therefore be made again and again.

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