What to Know About Nicotine Use

Nicotine, a stimulant found in tobacco plants, is one of the most heavily used drugs in the United States—and it's just as addictive as cocaine or heroin, according to the surgeon general. Nicotine products are regulated by the Federal Drug Administration (FDA). While nicotine is legal, as of 2019, it is illegal to sell or distribute nicotine-containing products to people under 21.

Fewer people over the age of 18 are smoking today than ever before, but smoking still remains the most preventable cause of death in the United States accounting for 480,000 deaths annually. Estimates from the Centers for Disease Control and Prevention (CDC) for 2018 indicate that 13.7% of the U.S. adult population smoke cigarettes.

Also Known As: Nicotine products include cigarettes (also known as "smokes"), pipes, cigars (sometimes referred to as "stogies"), chewing tobacco (also known as "dip" or "chew"), snuff, hookahs, and e-cigarettes (also known as "e-cigs" and "vapes").

Drug Class: Nicotine is classified as a stimulant.

Common Side Effects: Nicotine is known to cause decreased appetite, heightened mood, increased heart rate and blood pressure, nausea, diarrhea, better memory, and increased alertness.

What Does Nicotine Do?

When a person inhales cigarette smoke, the nicotine in the smoke is rapidly absorbed into the blood and starts affecting the brain within 10 seconds. Once there, nicotine triggers a number of chemical reactions that create temporary feelings of pleasure and concentration. But these sensations are short-lived, subsiding within minutes.

These chemical reactions include the release of catecholamines such as adrenaline, the "fight or flight" hormone. Physically, adrenaline increases heart rate and blood pressure. When this occurs, the person may experience rapid, shallow breathing and the feeling of a racing heartbeat. Adrenaline also tells the body to dump excess glucose into the bloodstream.

Nicotine also curbs appetite and may contribute to weight loss in complex ways.

What the Experts Say

To date, there have been studies showing positive effects of nicotine, including decreased tension and increased thinking, as well as the stimulant's potential in warding off cognitive decline into Alzheimer's, delaying the progression of Parkinson's disease, and as a therapeutic approach for ADHD and schizophrenia.

Still, health professionals continue to warn about the dangers of nicotine, especially when used by adolescents whose brains are still developing (until age 25).

While cigarette smoking is on the decline, vaping and e-cigarettes are on the rise. The American Academy of Pediatrics (AAP) warns that "e-cigarettes are threatening to addict a new generation to nicotine."

Off-Label and Approved Uses

Nicotine replacement therapy (NRT) was the first pharmacological treatment approved by the FDA for smoking cessation. In fact, studies show that using the nicotine patch can double the rate of a person's smoking cessation success, especially when combined with support.

There are a variety of available NRT products, including:

• Nicotine gum
• Nicotine inhaler
• Nicotine lozenges
• Nicotine nasal spray
• Nicotine patch
  

Common Side Effects

Nicotine causes a range of effects on both the body and mind, including:

• Decreased appetite
• Diarrhea
• Gastrointestinal distress
• Heightened mood
• Improved memory and alertness
• Increased blood pressure
• Increased heart rate
• Increased production of saliva and phlegm
• Nausea
  
• Sweating

Signs of Use

If your loved one is smoking cigarettes, you’ll likely be able to smell it on them. Detecting vaping can be a bit more difficult, but there are still some signs of use:

• Devices: E-cigarettes or "vape pens" can look like a thumb drive, pen, or stylus with holes on each end.
• Drinking more liquids: The vaporized liquid in e-cigs contains propylene glycol, which attracts and holds water molecules from the mouth, causing constant dry mouth.
• Irritability: This is a classic sign of nicotine withdrawal.
• Nosebleeds: Vaping can dry out the nasal passages and cause nose bleeds.
• Sweet smells: Vapor juice is often flavored, so if you suddenly catch a whiff of fruit punch or bubble gum and there’s no candy around, it could be a red flag.
  

Tolerance, Dependence, and Withdrawal

Nicotine is extremely addictive, and when used regularly, your body and mind learn to expect a certain amount of nicotine each day, and if it doesn't get it, withdrawal symptoms can be intense. You can quickly build a tolerance to nicotine, needing more to reach the desired effect. This is one reason why it's so hard (but not impossible) to quit smoking.

How Long Does Nicotine Stay in Your System?

Nicotine (in the form of a cigarette, pipe, or e-cigarette smoke) is mostly absorbed into the body through the lungs as well as the membranes in the mouth and throat. It can also be absorbed in your gastrointestinal tract (via chewing tobacco, nicotine gum, and lozenges) or your skin if you use a nicotine patch.

Nicotine is mainly metabolized in the liver and is excreted via urine through the kidneys as well as in feces. How long it stays in your system depends on many factors, including your age and weight; the type of nicotine product; frequency of use; and your hydration and physical activity levels.

That said, the following are estimates for how long nicotine is detectable in your system:

• Saliva test: One to four days
• Blood test: Two to four days
• Urine test: Two to four days
• Hair follicle test: Up to 90 days
  

Many routine drug tests screen for nicotine.

Addiction

Nicotine is a highly addictive substance that's found in all tobacco products, including cigarettes, pipes, cigars, chewing tobacco, snuff, hookahs, e-cigarettes, and other vaping devices.

Nicotine activates the same reward pathways in the brain that other drugs such as cocaine or amphetamines do, although to a lesser degree. Research has shown that nicotine increases the level of dopamine in the brain, a neurotransmitter that is responsible for feelings of pleasure and well-being.

Withdrawal

As the level of nicotine in the blood drops, people may begin to feel edgy and agitated. The acute effects of nicotine wear off within minutes, so people who smoke must continue dosing themselves frequently throughout the day to maintain the pleasurable effects of nicotine and to prevent nicotine withdrawal, which causes a host of physical and psychological symptoms:

• Constipation, gas, stomach pain
• Cough
• Cravings to smoke
• Dry mouth
• Fatigue
• Headache
• Inability to concentrate
• Insomnia
• Irritability, crankiness
  
• Postnasal drip
  
• Sore throat
  
• Sore tongue and/or gums
  
• Tightness in the chest

Treatment for Addiction and Withdrawal

Overcoming nicotine addiction is hard, but it is very possible. To set yourself up for success, try to prepare yourself to stop using nicotine by choosing a quit day. Mark your quit day on your calendar, and from that point on, do your best to discontinue the use of any nicotine product (other than a nicotine replacement therapy product, if you're using one as a quit aid).

Therapy

Cognitive behavioral therapy (CBT) can be an effective treatment for people who are looking to quit using nicotine. During a CBT session, a therapist will help you understand your triggers for using nicotine products and teach you healthy coping mechanisms to turn to instead.

Motivational interviewing is another therapeutic technique during which a counselor will help you become more motivated or inspired to pursue your goal of quitting smoking. They will help you answer important questions, such as: What is getting in your way of quitting? How can you align your values with your actions?

In a mindfulness session, a counselor teaches you how to detach yourself from your cravings for nicotine. Mindfulness practices can help you learn to tolerate your cravings and triggers to smoke instead of giving in to them.

Medications

A doctor may recommend a prescription medication to quit smoking such as Chantix (varenicline) or Zyban (bupropion).

Chantix works by reducing the feeling of pleasure a person gets when they use nicotine. Both Chantix and Zyban can also help relieve the symptoms of nicotine withdrawal. Zyban can also help reduce nicotine cravings.

There are potential side effects of Chantix and Zyban including headache, nausea, mood changes, trouble sleeping, and seizures.

A doctor might also recommend nicotine replacement therapy (NRT) separately or in addition to another quit smoking medication. NRT administers small amounts of nicotine without the other toxins in cigarettes and other nicotine products. It can help reduce cravings during nicotine cessation and lessen nicotine withdrawal symptoms.

Lifestyle Changes

Let your friends and family know that you're quitting. By enlisting their support, you improve your chances of success. If you have friends or family who use nicotine, you might request that they don't use nicotine around you.

Try making a list of smoke-free social activities to engage in, such as going to the movies or to a museum. Know your triggers to use nicotine, and have a plan to avoid or cope with them. If you associate alcohol with cigarettes, for example, you might avoid drinking or going to bars until you can manage your cravings.

How to Get Help

Statistics show that only a small percentage (approximately 7%) of people who try to quit smoking without support are still smoke-free a year later. However, those with a quit program in place that includes education about nicotine addiction and a solid support group, do much better.

Whether you prefer to quit cold turkey or choose to use a quit aid to help you stop smoking, it's important to recognize that recovery from nicotine addiction is a process of gradual release over time.

Quitting nicotine doesn't happen overnight, but with perseverance, freedom from nicotine addiction is doable and will pay you back with benefits that go well beyond what you can probably imagine.

History of Nicotine

Nicotine is a substance found in the tobacco plant. Tobacco use likely began in the first century in Central America.

Native Americans would chew or smoke tobacco leaves. They used tobacco for religious rites of passage and medicinal cures for asthma, fever, depression, and more.

By the 1500s, Portuguese and Spanish sailors brought tobacco from the Americas to Europe. The French ambassador to Lisbon, Nicot de Villemain, introduced tobacco to the French court. His name would be used to create the name nicotine. In the 1600s, tobacco was cultivated in the present-day United States. By 1880, the first cigarette-rolling machine was invented.

Since the 1970s, there have been many landmark legislations in the United States to regulate smoking and educate people on the hazards of smoking. Still, the World Health Organization (WHO) reports that there are 1.3 billion people in the world who currently smoke tobacco.