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Smoking or nicotine dependence

What is smoking or nicotine dependence??

Nicotine dependence is caused by a substance called nicotine, a drug that is part of tobacco composition. Nicotine causes cerebral changes, which create a momentary pleasure. It is precisely this short-term pleasure that makes people want to smoke cigarette after cigarette. Smoking dependence or nicotine addiction is known to be a significant public health problem and a global epidemic, with over one billion people smoking daily worldwide. Besides, women are more affected than men.

In Romania, for example, in the last 20 years, the number of people who smoke almost doubled. Moreover, over 55% of them are between 15 and 34 years old.

Nicotine use usually begins at an early age, in adolescence, 95% of those who continue to smoke at the age of 20 become permanent daily smokers.

Smoking produces an addiction 6-8 times greater than alcohol and equal to cocaine addiction. 95-100% of smokers become addicted to nicotine.

Smoking dependence is one of the most difficult to remove types of addiction and is associated with reliance on certain dangerous drugs such as heroin or cocaine.

Once installed, it is challenging for people to quit.

Unfortunately, although the addictive substance is nicotine, along with it, smokers inhale a lot of other toxic substances. Over 8000 chemicals or “smoke compounds” were identified in cigarette smoke.

What are the causes?

Why do we become dependents on tobacco?  By inhaling tobacco smoke, nicotine reaches the lungs, then releases it quickly into the bloodstream and thus reaches the brain within seconds of drawing a puff.

Once in the brain, nicotine increases the release of neurotransmitters such as dopamine, which regulates mood and behaviour.

Dopamine is thus released into the “reward centre” of the brain, causing good mood and feelings of pleasure.

Experiencing these effects causes smoking to be so addictive.

Smoking dependence involves not only the physical effects but also the behavioural, and these behavioural associations with smoking can act as triggers of the “smoking craving.”

Here are some examples: morning coffee, breaks at work, after eating, when you drink alcohol, when you meet with friends when you talk on the phone or drive a car, in stressful situations, when you sense the smell of cigarettes.

To overcome the smoking addiction, you have to be aware of these triggers and develop a plan to cope with the behaviours and activities you associate with smoking.

Dependenta de fumat

Smoking dependence – groups of smokers

  • Those with strictly behavioural dependence, who smoke about five cigarettes per day and who can quit smoking without problems;
  • Those with behavioural and mental addiction, who smoke 20 or more cigarettes per day;
  • Those with behavioural, psychological and physical dependence who regularly smoke over 20 cigarettes per day;
  • Passive smoking, also known as environmental tobacco smoke (ETS), is a combination of the smoke produced by the burning end of the cigarette and the smoke exhaled by the smokers.

According to, the “average lethal dose” of nicotine is 50 mg/kg body. One cigarette contains 2,2 mg of nicotine.

If, for example, we take a person of 60 kg body weight, the lethal amount of nicotine (enough to kill that person) is 3g (grams), respectively 1363 cigarettes.

Smoking dependence – risk factors

Any person who smokes or uses other forms of tobacco risks to become dependent, and the factors that influence the appearance of this dependence are:

Genetic factors: The probability that you will start smoking and keep this habit may be partially inherited. Genetic factors can influence how receptors on the surface of nerve cells in the brain respond to high doses of nicotine in cigarettes.

Influence of family and close friends. Children who have smoker parents are likely to become like them. Children who have friends or colleagues who smoke will also try a few cigarettes. Also, movies or the internet can influence young people to smoke.

Age Most people start smoking since childhood or adolescence. The younger you are when you start smoking, the higher your chances of becoming a smoker as an adult.

Depression or other mental illnesses. Many studies show an association between depression and smoking. People who are depressed, schizophrenic, have PTSD, or have other forms of psychiatric disorders are more likely to become smokers.

Substance use. People who abuse alcohol and drugs become smokers much easier.

Smoking dependence symptoms

For some people, using any amount of tobacco can quickly lead to smoking dependence. The signs that betray this dependence are:

You cannot stop smoking, although you have sincerely tried to quit several times.

You have a withdrawal crisis when you want to quit. Your attempts to stop have caused physical and mental reactions, such as strong appetite, anxiety, irritability, restlessness, difficulty concentrating, depressive state, frustration, anger, increased appetite, insomnia, digestive disorders.

You continue to smoke despite your health problems. Even if you know you have problems with your lungs, you cannot stop.

You quit social or fun activities for smoking.

 Smoking addiction can stop you from going, for example, to restaurants where you cannot smoke; you can stop socialize with some of your family members or friends because you cannot smoke in certain places or situations.

What complications may occur?

Cigarette smoke contains more than 60 known chemicals that cause cancer, as well as thousands of other harmful substances.

Even “natural” or herbal cigarettes contain chemicals that are harmful to health.
Smoking affects almost every organ of the body and the immune system. Nearly half of smokers will die from tobacco-related diseases.

The adverse effects of smoking dependence include:

Lung cancer and other lung diseases. – Smoking causes almost 9 out of 10 lung cancer cases. It also causes other lung diseases, such as pulmonary emphysema or chronic bronchitis. It aggravates asthma.

Other types of cancer. – Smoking is a significant cause of cancer of the esophagus, larynx, pharynx, and mouth.

It is also linked to bladder cancer, pancreas, kidney and cervix, even some leukemias. In general, smoking causes 30% of all cancer deaths.

Problems of the heart and circulatory system. – Smoking increases the risk of dying from heart disease and blood diseases, such as myocardial infarct and stroke.

Even smoking only up to four cigarettes per day increases the risk of heart disease.

Diabetes – Smoking increases insulin resistance, which can lead to the development of type 2 diabetes.

If you have diabetes, smoking can accelerate the progression of this complication, leading to kidney disease and eye problems.

Eye problems – Smoking can increase the risk of severe eye problems, such as cataracts and loss of vision through macular degeneration.

Infertility and impotence 

Pregnancy and newborns complications – Mothers who smoke during pregnancy have a higher risk of miscarriage, preterm birth, lower birth weight, and sudden infant death syndrome (SIDS).

Colds, flu, and other diseases – Smokers are more liable o respiratory infections, such as colds, flu, and bronchitis.

Weak senses – Smoking dampens the senses of taste and smell, so food is not as appealing.

Teeth and gum diseases – Smoking is associated with an increased risk of gingivitis and periodontitis.

Physical appearance – The chemicals in tobacco smoke can change the structure of the skin, causing premature aging and wrinkles. Smoking also yellows teeth, fingers, and nails.

Family risks – Spouses and non-smoking partners are at higher risk of lung cancer and heart disease compared to people who do not live with a smoker.

If you smoke, your children will be more liable to SIDS (sudden infant syndrome), asthma aggravation, ear infections, and colds.

How is it treated?

Most smokers have several attempts to quit smoking before achieving stable, long-term abstinence.

Nicotine disappears from the body within 72 hours after quitting smoking, and withdrawal symptoms usually get to a maximum within 2-3 days and disappear within one to 3 months.

It takes at least three months to change brain chemistry and return to normal.

It is more likely that someone will stop smoking if they follow a treatment plan that addresses both the physical and behavioural aspects of smoking dependence.

Using drugs and going to a counsellor, specially trained to help people quit smoking (a specialist in tobacco treatment), will significantly increase the chances of success.

Nicotine replacement therapies or drugs that do not contain nicotine are effective in treating nicotine dependence.

Using several medicines concurrently, such as a nicotine patch, along with nicotine gum, pills, a nasal spray, or an inhaler, can help achieve better results.

Clinical trials investigate nicotine vaccines.

These vaccines help the immune system develop antibodies to nicotine, antibodies that effectively block the effects of nicotine, and prevent relapse.

New research has shown that if you combine drugs with psychotherapy sessions, there is a higher chance of long-term success in abstaining from smoking.

Medications help to overcome withdrawal symptoms, while psychotherapy sessions help to develop techniques to stay away from tobacco in the long term.

Also, several sites offer support and strategies that help people who want to quit smoking.

Text messages and services, including personalized reminders about an anti-smoking plan, can prove to be very useful.


Frequently used therapies for treating nicotine addiction

We combine different psycho-therapeutic solutions to map the exact source and the way of how each symptom manifests.

ID Therapy team innovatively combines the types of therapy, to shorten the path to the solution and to diagnose directly in the context.


Nicotine Dependence treatment can be done by:

Psychiatric treatment

Psychiatric treatment

The combination of psychotherapy and drug therapy is sometimes the ideal solution in addressing conditions such as depression, anxiety,...

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Treat nicotine dependence with Virtual Reality Therapy

Treat nicotine dependence with Virtual Reality Therapy

Virtual Reality Therapy for addiction contains 12 sessions with an addiction VR psychotherapist. Patients wishing to take control of...

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Cognitive Behavioral Therapy

Cognitive Behavioral Therapy

The way we interpret or think about a particular situation determines the feeling we have about that situation, which...

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Brief Strategic Therapy

Brief Strategic Therapy

There are personal therapies that last for years and treatments that have conclusive results in a maximum of 10...

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Solution Focused Brief Therapy

Solution Focused Brief Therapy

Solution Focused Brief Therapy is a collaborative therapy approach with direct patient participation and focuses on the goal.

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Integrative Therapy

Integrative Therapy

A more flexible and sophisticated approach than traditional psychotherapy, a progressive form of psychotherapy, customized ...

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There are many dependencies treatment possibilities, but the best mix between them is based on condition causes. Innovative psychotherapy by Virtual Reality exposure could be one of the best choices that your therapist could choose among all the other options to learn how to manage your cue physiology through Exposure at Virtual Reality

Virtual Reality Ps

Virtual reality therapy for nicotine dependence.

Patients who wish to take control of cigarettes use will be assisted by their therapist to develop new coping skills while being exposed to specific relevant virtual cigarettes-related cues. The patient is placed in different virtual environments (bar, restaurant, party, at home) where there are specific temptation-cue indicators to attract him to consume alcohol or nicotine. The patient is helped by the therapist to identify the physical and cognitive symptoms of the craving he is experiencing. He is also helped to develop new cognitive behaviours or strategies to avoid, distract attention from temptation-cue indicators, to speak alone, to change the thinking pattern. The therapist can place certain cigarettes brands preferred by the patient within these virtual environments. Also, the virtual bartender offers opportunities for the patient to engage in interactions and strengthen their abstinence or moderation skills. This therapy, based mainly on prevention, contains 12 sessions with a specially trained psychotherapist.

Thus, through exposure to virtual reality, the person benefits from cognitive learning, reinforcement of new behaviours, suppression of appetite in the presence of tempting-cue indicators related to cigarettes, and avoiding relapse and produces a series of positive changes in the brain metabolism.

ID Therapy Team

Dr Nadia Gorduza, Psichotherapist

Nadia Gorduza

Anxiety, Couple therapy, Depression, Fear of flight, Fear of public speaking, Insomnia, Panic attacks, Phobias, Psychological trauma, Stress
MD, EMBA Psychotherapist and founder ID Therapy
couple problems, phobias, anxiety, panic attacks
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Raina Saguna

Addiction-treatment, Alcohol dependence, Anxiety, Bipolar disorder, Depression, Eating Disorders, Insomnia, Panic attacks, Personality disorder treatment, Smoking dependence, Stress
Integrative Psychotherapist and Clinical Psychologist
addictions, anxiety, psychological trauma, depression, insomnia, stress, personality disorders
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