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In some people, using any amount of tobacco can quickly lead to nicotine dependence. Symptoms that you may be addicted include:

• You can't stop smoking. You've made one or more serious, but unsuccessful, attempts to stop.
• You experience withdrawal symptoms when you try to stop. Your attempts at stopping have caused physical and mood-related symptoms, such as strong cravings, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration or anger, increased hunger, insomnia, and constipation or diarrhea.
• You keep smoking despite health problems. Even though you've developed problems with your lungs or your heart, you haven't stopped or can't stop.
• You give up social or recreational activities in order to smoke. You may stop going to smoke-free restaurants or stop socializing with certain family members or friends because you can't smoke in these situations.

When to see a doctor
If you've tried to stop smoking but haven't succeeded, talk to your health care provider about medications to help you quit. Look for a stop-smoking counselor, who can help you create a treatment plan that works for you. Most people who try to stop on their own don't succeed. You're more likely to stop for good if you follow a treatment plan that addresses both the physical and the psychological aspects of tobacco dependence.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Nicotine is the chemical in tobacco that keeps you smoking. It can be as addictive as cocaine. It increases the release of brain chemicals called neurotransmitters, which help regulate mood and behavior. One of these neurotransmitters is dopamine, which makes you feel good. Getting that dopamine boost is part of the addiction process.

Tobacco dependence involves psychological as well as physical factors. Behaviors and cues that you may associate with smoking include:

• Certain times of the day, such as with morning coffee or during breaks at work
• After a meal
• Drinking alcohol
• Certain places or friends
• Talking on the phone
• Stressful situations or when you're feeling down
• The smell of a cigarette
• Driving your car

To overcome your dependence on tobacco, you need to deal with the behaviors and routines that you associate with smoking.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Anyone who smokes is at risk of becoming dependent on tobacco and nicotine. Most people begin smoking during childhood or adolescence.

The younger you begin smoking, the greater the chance that you'll become a heavy smoker as an adult. Children with two parents who smoke are twice as likely to become smokers. Children with friends who smoke also are more likely to try cigarettes.

Other factors that influence nicotine dependence include:

• Genetics. The genes you inherit play a role in some aspects of nicotine dependence. For example, the likelihood that you will start smoking and keep smoking may be partly inherited. Some people experiment with smoking and don't experience pleasure, so they never become smokers. Other people develop dependence very quickly. Some "social smokers" can smoke just once in a while, and yet another group of smokers can stop smoking with no withdrawal symptoms. These differences can be explained by genetic factors that influence how receptors on the surface of your brain's nerve cells respond to nicotine.
• Depression, other mental illness and substance abuse. People who have depression, schizophrenia and other forms of mental illness are more likely to be smokers. Smoking may be a form of self-medication for these disorders. People who abuse alcohol and illicit drugs also are more likely to be smokers.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

When you inhale tobacco smoke, you ingest numerous chemicals that reach most of your body's vital organs. Tobacco smoke contains more than 60 known cancer-causing chemicals and more than 4,800 other harmful substances.

Smoking harms almost every organ of your body. More than half the people who keep smoking will die because of it. The negative health effects include:

• Lung cancer and other lung diseases. Smoking causes nearly nine out 10 of lung cancer cases, as well as other lung diseases, such as emphysema and chronic bronchitis. Smoking also makes asthma worse.
• Heart and circulatory system problems. Smoking increases your risk of dying of cardiovascular disease, including heart attack and stroke. Smoking 15 cigarettes a day doubles your heart attack risk. Even smoking just one to four cigarettes daily increases your risk of heart disease. If you have cardiovascular illness or heart failure, smoking worsens your condition. However, stopping smoking reduces your risk of having a heart attack by 50 percent in the first year.
• Other cancers. Smoking is a major cause of cancers of the esophagus, larynx, throat (pharynx) and mouth and also is related to cancer of the bladder, pancreas, kidney, cervix, stomach, and some leukemias.
• Physical appearance. The chemicals in tobacco smoke can change the structure of your skin, causing premature aging and wrinkles. Smoking also yellows your teeth, fingers and fingernails.
• Infertility and impotence. Smoking increases the risk of infertility in women and the chance of impotence in men.
• Pregnancy and newborn complications. Mothers who smoke while pregnant face a higher risk of miscarriage, preterm delivery, decreased birth weight and sudden infant death syndrome (SIDS) in their newborn. Low birth weight babies are more likely to die or have learning and physical problems.
• Cold, flu and other illnesses. Smokers are more prone to respiratory infections, such as colds, flu and bronchitis, than are nonsmokers.
• Diabetes. Smoking increases insulin resistance, which can set the stage for the development of type 2 diabetes. If you have diabetes, smoking can speed the progress of complications such as kidney disease.
• Impaired senses. Smoking deadens your senses of taste and smell, so food isn't as appetizing as it once was.
• Risks to your family. Spouses and partners of smokers have a higher risk of lung cancer and heart disease, compared with people who don't live with a smoker. If you smoke, your children will be more prone to sudden infant death syndrome, asthma, ear infections and colds.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

There are no physical tests to determine the exact degree to which you're dependent on nicotine. Your doctor may assess the degree of your nicotine dependence by asking you questions or having you complete a questionnaire. The more cigarettes you smoke each day and the sooner you smoke after awakening, the more dependent you are. Knowing your degree of dependence can also help determine the correct dose of a nicotine replacement medication.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

If you've tried and failed to stop smoking on your own, you're not alone. You're more likely to succeed if you follow treatment that's been shown to be successful in scientific studies. Medications and counseling both work. Combining these approaches is even more effective.

Although it may be tough to break your tobacco dependence, the benefits are well worth the effort. If you stop smoking before you're 50, you can cut in half your risk of dying in the next 15 years, compared with those who continue smoking.

No matter what your age, your health will benefit if you stop smoking. Just 20 minutes after your last cigarette, your heart rate goes down. Twelve hours later, levels of carbon monoxide, a toxic gas, in your blood return to normal. Your lung function improves and your circulation starts to get better within three months. After a year, your risk of having a heart attack drops by half. And after five to 15 years, your stroke risk will be the same as that of a nonsmoker.

Medications
Several medications, including nicotine replacement therapy and non-nicotine medications, are effective in treating nicotine dependence. Any of these medications, combined with behavioral changes, can double your chances of quitting.

Using more than one medication — such as a nicotine patch along with a nicotine gum, lozenge, nasal spray or inhaler — may help you achieve better results than if you use a single medication.

If you've tried a medication on your own but haven't been successful in quitting, talk to your health care provider. He or she can help you move in the right direction by adjusting the dose of your medication, recommending a different medication or using a combination of medications.

Most people who want to stop smoking can benefit from a medication. But if you're pregnant or breast-feeding, you smoke fewer than 10 cigarettes a day or you're under age 18, talk to your doctor before taking any over-the-counter nicotine replacement products.

Nicotine replacement therapy
Nicotine replacement therapy gives you nicotine without the other harmful chemicals in tobacco smoke. Many people mistakenly believe that nicotine causes cancer, but that's not the case. Nicotine replacement medications, including patches, gums, lozenges, nasal sprays and inhalers, can help relieve difficult withdrawal symptoms and cravings. The best time to start using nicotine replacement is on the day you set to stop smoking.

Most nicotine replacement products are available over-the-counter:

• Nicotine patch (NicoDerm CQ, Habitrol, others). The patch delivers nicotine through your skin and into your bloodstream. You wear a new patch each day. The treatment period usually lasts for eight weeks or longer. Don't be in a hurry to stop using the patch, especially if you've stopped smoking or dramatically reduced your smoking. If you haven't been able to stop smoking completely after the two weeks or so of treatment, ask your doctor for help in adjusting the dose of the patch or adding another medication.
• Nicotine gum (Nicorette, Rite Aid). This is a gum-like resin that delivers nicotine to your blood through the lining of your mouth. It's available in a 2-milligram (mg) dose for regular smokers and a 4-mg dose for heavy smokers. You can use up to 20 pieces a day as needed.  Nicotine gum is often recommended to curb cravings. To use the gum correctly, chew it a few times until you feel a mild tingling or peppery taste, then park the gum between your cheek and gumline for several minutes. This "chewing and parking" allows nicotine to be gradually absorbed in your bloodstream. Avoid drinking carbonated or acidic drinks, such as coffee or juice, before or while using nicotine gums or lozenges.
• Nicotine lozenge (Commit). This is a tablet that dissolves in your mouth and, like nicotine gum, delivers nicotine through the lining of your mouth. The lozenges are available in 2- and 4-mg doses, for regular or heavier smokers. To use the lozenge, place it in your mouth between your gumline and cheek or under your tongue and allow it to dissolve. You'll start with one lozenge every one to two hours and gradually increase the time between treatments. The most common side effects are headache, diarrhea, hiccups, heartburn and nausea.

These nicotine replacement products are available by prescription:

• Nicotine nasal spray (Nicotrol NS). The nicotine in this product, sprayed directly into each nostril, is absorbed through your nasal membranes into your blood vessels. The nasal spray delivers nicotine a bit quicker than gum, lozenges or the patch but not as rapidly as smoking a cigarette. It's usually prescribed for three-month periods for up to six months. Side effects may include nasal irritation.
• Nicotine inhaler (Nicotrol Inhaler). This device is shaped something like a cigarette holder. You puff on it, and it delivers nicotine vapor in your mouth. You absorb the nicotine through the lining in your mouth, where it then enters your bloodstream. Common side effects are mouth or throat irritation and occasional coughing.

Non-nicotine medications
Medications that don't contain nicotine include:

• Antidepressants. The antidepressant drug bupropion (Zyban, Wellbutrin) increases levels of dopamine and norepinephrine, brain chemicals that are also boosted by nicotine. Bupropion may be prescribed along with a nicotine patch. Bupropion has the advantage of helping to minimize weight gain after you quit smoking. Side effects may include sleep disturbance and dry mouth. If you have a history of seizures or serious head trauma, such as a skull fracture, you shouldn't take this drug. Another antidepressant that has been shown to help people stop smoking is nortriptyline (Pamelor).
• Varenicline (Chantix). This medication acts on the brain's nicotine receptors, decreasing withdrawal symptoms and reducing the feelings of pleasure you get from smoking. Potential side effects include nausea, headache, insomnia and strange dreams. Rarely, varenicline can cause serious psychiatric symptoms, such as depressed mood, agitation and suicidal thoughts.
• Clonidine (Catapres). This drug is approved for use in treating high blood pressure, but may be used as a second line medication for tobacco dependence if other medications haven't helped. Its usefulness is limited because of side effects such as drowsiness and sedation.
• Medications in development. Several nicotine vaccines are under investigation in clinical trials.  The vaccines cause the immune system to develop antibodies to nicotine. These antibodies then bind to nicotine as it enters the bloodstream and prevent the nicotine from reaching the brain, effectively blocking the effects of nicotine. The nicotine vaccine holds promise for preventing relapse among smokers who quit.

Counseling, support groups and smoking cessation programs
Research shows that combining medications with behavioral counseling provides the best chance for long-term success in abstaining from tobacco. Medications help you cope with withdrawal symptoms, while behavioral treatments help you develop the skills you need to stay away from tobacco over the long run. The more time you spend with a counselor, the better your treatment results will be.

Several types of counseling and support can help with stopping smoking:

• Telephone counseling. No matter where you live, you can take advantage of telephone counseling to help you give up tobacco. Two national help lines are the National Cancer Institute's 800-QUIT-NOW (800-784-8669) and the American Cancer Society's Quitline at 800-ACS-2345 (800-227-2345).
• Individual or group counseling program. Your doctor may recommend local support groups or a treatment program where counseling is provided by a tobacco treatment specialist. Counseling helps you learn techniques for quitting and provides support for the process. Many hospitals, health care plans, health care providers and employers offer treatment programs or have tobacco treatment specialists who are certified to provide treatment for tobacco dependence. Nicotine Anonymous groups provide support for people trying to quit.
• Internet-based programs. Several Web sites offer support and strategies for people who are trying to stop smoking. Text messaging services, including personalized reminders about a quit smoking plan, also may prove helpful.

Remember, it's common to "relapse." But your goal is no smoking at all — even light or occasional smoking is dangerous. You can learn from past quitting experiences, and you'll be stronger during your next attempt.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

When you stop smoking, you'll likely experience some unpleasant or stressful symptoms of nicotine withdrawal. Medications will markedly reduce the difficulty of withdrawal. Even so, it's important to have a plan for managing withdrawal symptoms.

Withdrawal symptoms are usually the most intense during the first week after you stop smoking. They may continue for several weeks, with declining intensity. Although most nicotine withdrawal symptoms pass within a month, you may occasionally experience a strong urge to smoke months after stopping. Triggers or cues that were associated with your smoking can provoke these urges or cravings.

Here are some things you can do to manage withdrawal symptoms:

• Exercise regularly. Regular physical activity has been found to help people stop smoking.  Exercise also helps offset potential weight gain following smoking cessation.
• Wait out cravings. Cravings or urges usually last less than five minutes. Wash the dishes, go for a walk or have a healthy snack, such as carrots, an apple or sunflower seeds. Pursue a hobby that keeps your hands busy.
• Identify rationalizations. If you find yourself thinking, "I'll just smoke one to get through this tough time" or "Just one won't hurt," recognize it as a message that can derail your plan. Review your reasons for quitting, and replace that thought with something positive to support your stopping.
• Talk to a support person if you're feeling anxious or depressed or need encouragement to get through a difficult craving.
• Avoid high-risk situations. Know your triggers, and stay away from people, places and situations that tempt you to smoke.
• Be realistic about the energy and time it takes to stop smoking. Adjust your schedule to a lighter workload. Take time to do something fun or simply relax.
• Eat regular meals, including plenty of fruits and vegetables, and drink more water.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

How can you stay motivated to maintain abstinence from smoking? Start by thinking about the mixed feelings you may have about smoking. Then make a list of your reasons for quitting.

Stopping smoking is a positive change for many reasons. Think of short-term benefits, such as breathing easier, saving money and having better smelling clothes. Long-term benefits include a lower risk of disease, increased chances for a longer life and a healthier environment for your family. Use these reasons to build your motivation. Look at your list often, especially when you feel your motivation is lagging.

To stay smoke-free over the long haul, consider these tips:

• Identify your major smoking triggers and challenges. This will help you solve problems and have a plan to deal with high-risk situations.
• Seek support. Seek the social support you need to stay quit. Ask your family, friends and co-workers for support and encouragement. Let them know what you find most helpful.
• Practice positive self-talk. Think of one or two phrases to use repeatedly for encouragement, such as "I am grateful to be smoke-free."
• Set smoke-free boundaries. If there's another smoker in your household, set boundaries by making your home and car smoke-free.
• Regularly review the benefits you're getting from quitting. Look at your list again. Add up how much money you've saved. Ask your family members for their observations.
• Avoid alcohol. Drinking is a high-risk situation. Avoid drinking situations until you are confident you can remain smoke-free.
• Reward yourself. Buy a magazine, go to a park, meet a friend for lunch, take a class.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

The best way to prevent tobacco dependence is to not smoke in the first place. The best way to prevent your children from smoking is to not smoke yourself. If you're a parent who smokes, the younger your children are when you quit, the less likely they are to become smokers themselves. Even if you don't smoke, here are some things you might try as a parent:

• Promote smoke-free environments. Support legislation to make all workplaces smoke-free. Encourage smoke-free public places, including restaurants or other places where your teen may work.
• Support legislation to increase taxes on tobacco products. Higher prices discourage teens from starting to smoke. Higher prices on tobacco products, coupled with smoke-free workplace laws, are the most effective public health policies to reduce smoking in adults and prevent young people from ever starting.
• Talk with your teenagers. Ask whether their friends smoke. Most teenagers smoke their first cigarette with a friend who already smokes.
• Learn what your children think about smoking. Ask them to read this article so that you can discuss it together.
• Help your children explore personal feelings. Use nonjudgmental questions and rehearse with them how they could handle tough situations regarding peer pressure and smoking.
• Note the social repercussions. Remind your teenager that smoking gives you bad breath and makes your hair and clothes smell.
• Work with your schools. Become active in community stop-smoking programs.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.