Nicotine Dependence
Nicotine (tobacco use) dependence is a pattern of compulsive tobacco or nicotine use, defined per DSM-5 and treated per the 2021 USPSTF recommendation on tobacco cessation.
Symptoms
Strong cravings, using more tobacco than intended, unsuccessful attempts to quit, and withdrawal symptoms (irritability, restlessness, difficulty concentrating, increased appetite) when not using.
Causes and risk
Nicotine's effects on brain reward circuits drive both tolerance and physical dependence; genetics, age of first use, and mental illness (including depression and other substance use) all raise risk.
How it is evaluated
Assessment combines a history of use pattern and quit attempts with tools like the Heaviness of Smoking Index; carbon monoxide testing can objectively confirm recent use.
Treatment
All adults should be offered behavioral counseling plus FDA-approved pharmacotherapy, per the USPSTF -- varenicline is the most effective single agent, and combination nicotine replacement therapy outperforms a single form of NRT alone. Mood changes and rare reports of suicidality warrant monitoring on these medications.
When to seek care
Nicotine ingestion in a child (from vaping liquid, gum, or patches) is a medical emergency -- call Poison Control or 911 immediately. Any new or worsening mood symptoms or thoughts of self-harm while on cessation medication should be reported to your prescriber right away.