Nicotine and You


Smoking and tobacco use has been known as a very unhealthy habit. A lot of smear campaigns to demotivate its use were done by Malaysia’s Ministry of Health but the country still has 5.3 million people who are tobacco users. The main problem is nicotine dependence and addiction. Therefore, in order to help reduce numbers of smokers the discussion should shift to understand what nicotine dependence is and why nicotine replacement therapy is the forefront method of fighting it.

How does nicotine work?

Nicotine is a chemical substance with psychoactive function of stimulant and depressant. It is the main substance in cigarettes that affects the brain of a smoker. One cigarette nowadays can be packed with 6 to 28 mg of brain altering nicotine. It alters the brain within seconds of each sip of smoke and causes a surge of epinephrine hormones, a powerful stimulant and beta-endorphins which inhibits pain. Ultimately, giving them the mood boost and pleasure that they need.

This ‘kick’ allows smokers to go about their day with a sense of fleeting energy. This is because a few hours after the first smoke, their mood starts to drop, they will start to feel fatigue and they will require another shot. Directly leading them to a vicious cycle of nicotine addiction and dependence.

Nicotine dependence symptoms and assessment tool

Commonly reported experienced from a nicotine dependence individuals are:

  • They are unable to stop smoking even when they really try to do so.
  • They will experience withdrawal symptoms once they stop smoking.
  • They often continue smoking even when they are sick.
  • They confess to giving up on social activities when the venue or setting does not allow smoking in the near vicinity.

These experiences listed above are actually clear symptoms of nicotine addiction.

On the contrary, the act of labelling someone as a nicotine addict can be stigmatising. It will cause them to pull themselves away from the person who is trying to help overcome their addiction. Hence, research has shown that the least threatening and prosecutory way of screening nicotine addiction is by using the CAGE questionnaire.

  • CAGE questionnaire (modified for smoking behaviour)

It involves 4 types of questions regarding an individual’s daily smoking behaviour. These questions are as follows:

As mentioned before, this is just a screening test. If the person answers yes to two out of the four questions, it indicates a positive test. The next step of assessment would require an interview session with a certified clinician to gauge the severity of nicotine dependence.

The next assessment tool in identifying the level of nicotine dependence is the Fagerströmtest.

  • Fagerström test (modified for nicotine dependence)

It is an instrument developed in order to stratify intensity of nicotine dependence. It is able to classify nicotine addicts into three groups based on their scores to these series of questions. The higher the score, the more dependent they are.

Nicotine withdrawal symptoms and assessment tool

Similar to every addictive substance in the world, once the user stops consuming nicotine, they will start to experience withdrawal symptoms. These symptoms include:

  • Strong cravings
  • Mood disturbance
  • Depression
  • Anxiety
  • Cold symptoms (sore throat, coughing, sneezing)
  • Hunger
  • Constipation
  • Diarrhoea
  • Insomnia
  • Irritability
  • Difficulty concentrating

This is normal. One of the most successful ways of managing these symptoms is nicotine replacement therapy (NRT). In government run Quit Smoking Clinic, NRT are reserved for high to moderately dependent nicotine addicts who have a strong resolve to quit smoking. This is because, without NRT, most people will relapse around two to three weeks after quitting. Keep in mind that you can still have withdrawal symptoms while on NRT because the amount of nicotine supplied by NRT is very small.

When does the withdrawal symptoms start and for how long?

The time at which withdrawal symptoms start vary from person to person. It depends on the individual’s mindset and what kind of activities they are associated with smoking. Craving for cigarettes mostly starts hours after your last cigarette. Followed by changes in mood, fatigability and concentration. This is because your brain is so used to the nicotine stimulant.

These changes generally worsens and reach their peak around 2-3 days after quitting. You may also experience cold-like symptoms and worsening health. Again, this is just how your brain and body adjust to not having nicotine surge. It is very crucial to persevere during this trying period. This is because as your days go by, the symptoms will start to fade. Until you reach 2 to 4 weeks where most people reported the symptoms to almost be non-existence.


The nicotine withdrawal symptoms can be daunting especially if your work requires you to be constantly sharp or physically active. Nonetheless, it is still manageable.