Nicotine dependence (smoking)

For a lay person:

Nicotine dependence is an addiction to the nicotine in tobacco, which makes it hard to stop smoking even when you want to. When people try to quit they often get cravings, irritability, poor concentration, low mood and increased appetite. Stopping smoking at any age greatly lowers the risk of heart disease, lung disease and many cancers.

For a trained medical person:

Nicotine acts on nicotinic acetylcholine receptors to drive dopamine release in reward pathways, producing tolerance, dependence and a withdrawal syndrome that peaks in the first weeks after cessation. Assessment covers smoking history, heaviness of dependence (for example time to first cigarette) and readiness to quit. First-line treatment combines behavioural support with pharmacotherapy: combination nicotine replacement therapy, varenicline or bupropion, with e-cigarettes used as a quit aid in some health systems.

In Chinese medicine:

Liu and Tseng's textbook gives Chinese herbal formulas for this condition without a full pattern differentiation. Treatment still follows the pattern a patient presents with, not the Western diagnosis alone.

When to get help: Ask a doctor, pharmacist or stop-smoking service for help to quit, as support and medication greatly improve the chances of success. Seek medical advice if you develop low mood or thoughts of self-harm while quitting, and note that stopping smoking can change the levels of some medicines, such as clozapine and theophylline, so these may need review.