Nov 07, 2024

Nicotine addiction - All you need to know

by Snuzone Redaktion

Nicotine Addiction - Abstract Representation

This article explains what nicotine addiction entails, why nicotine addiction and dependence are not exactly the same, and why tobacco remains the primary source of consumption for this addiction. It also covers the so-called Fagerström Test and how cigarette addiction can be effectively combated.

What is Nicotine Addiction?

Nicotine addiction refers to an uncontrollable craving for the experiences associated with nicotine consumption, leading to the acquisition of nicotine-containing substances and often abusive consumption. This results in a lack of control over usage behavior with harmful consequences, including a tendency to increase the dosage.

Nicotine addiction is a substance-related form of addiction, with tobacco being the primary nicotine-containing substance used by those seeking to repeatedly experience the desired effects. Key elements of tobacco addiction include both psychological and physical dependence, which, when the effect wears off, can lead to withdrawal symptoms. These withdrawal symptoms (both mental and physical) are distinct from cravings, which are largely influenced by the so-called addiction memory and are often associated with psychological dependence on tobacco.

>> For more on symptoms and the role of addiction memory in tobacco addiction, see: Nicotine Withdrawal: Symptoms, Duration, and Support

Is Nicotine Dependence the Same as Nicotine Addiction?

Although the two terms are commonly used interchangeably, the World Health Organization (WHO) has recommended the use of "dependence" since 1964, replacing the former term "addiction" in scientific contexts.*1

But why was the former term "addiction" replaced with "dependence," and did this change result in the loss of an important nuance?

On the one hand, this change brought about a sharper terminological distinction in professional language – what was once broadly referred to as nicotine addiction can now be described with terms like “(abusive) harmful use” and “dependence.” Thus, no meaning was lost; rather, it is described more precisely today.
On the other hand, this avoided the negative connotation of "addiction," which had increasingly led to stigmatization. Though "addiction" originally derives from the Middle High German word for "sickness," by the 20th century, it carried strong negative associations, often steering the understanding away from illness toward a socially undesirable condition. This shift in language reflects a broader understanding of addiction, distinguishing socially undesirable (abusive) use from harmful use as defined in ICD-10.*2

The new terminology emphasizes the disease aspect of dependence and provides linguistic precision for scientific and professional discourse.

This distinction in professional language shows that dependence and addiction are not exactly the same and clarifies the varying meanings of "nicotine addiction" in everyday language. Thus, addiction can be seen as an umbrella term in everyday speech, encompassing at least “dependence,” “socially undesirable abusive use,” and “harmful use.”

Is Nicotine Addiction the Same as Tobacco Addiction?

Today, the WHO defines nicotine dependence within the ICD-10 under Tobacco Dependence as part of the "Dependence Syndrome (F17.2)." Abusive use, on the other hand, is covered by Nicotine Abuse and classified as “harmful use of tobacco (F17.1).”*2

In this sense, nicotine addiction and tobacco addiction appear to be used synonymously, with tobacco playing a primary role in diagnosing nicotine addiction under ICD-10.

Nicotine Addiction Primarily Through Tobacco and Smoking

Although global tobacco consumption has declined in recent decades*3, tobacco remains the most common source of nicotine, through which addiction manifests in affected individuals. Smoking tobacco cigarettes still holds the leading role.

This is largely due to the long tradition and history that this form of consumption enjoys compared to other nicotine-containing alternatives.

Nicotine Addiction Through Tobacco as a Social Issue

Tobacco addiction is problematic due to its harmful effects on individuals, their surroundings, and society. Notably, the high mortality rate associated with tobacco use is concerning. Additionally, tobacco-related outpatient treatments and increased absenteeism are burdensome in various ways. They place a significant strain on the healthcare and social systems, and employers face preventable absences.

Tobacco Addiction and Mortality

The high mortality associated with nicotine addiction through tobacco, particularly cigarette addiction, makes it a societal issue. According to data from Statista, over 7.6 million people worldwide die each year from the consequences of smoking. Approximately one in seven deaths is attributed to smoking, with an additional 2% due to passive smoking.*4

>> Also of interest: EU Cancer Control Plan: The Future of Snus and Nicotine Pouches

Tobacco Addiction and Increased Absenteeism

Recently, the KKH Health Insurance released data on consumption-related absenteeism, which shows a significantly higher rate of absenteeism for working individuals with tobacco addiction in Germany.

>> More on this in: Tobacco Dependence in Germany: One in Twelve Employees Affected

Nicotine Addiction Symptoms and the Fagerström Test

In 1957, before the term "addiction" was replaced with the more precise terms “dependence” and “harmful use,” the WHO defined the following four criteria for nicotine addiction:

Uncontrollable desire to use and obtain the substance
Tendency to increase dosage
Psychological and often physical dependence on the substance's effects
Harm to the individual and/or society*5

In today’s understanding, "symptoms" are considered more nuanced, as categorized under ICD-10 with diagnostic codes F17.2 (Dependence Syndrome) or F17.1 (Harmful Use).

The Fagerström Test remains a globally established method for determining the extent of nicotine dependence. It outlines relevant criteria for cigarette addiction through structured questions and response options, awarding points based on answers. The resulting score then categorizes the level of dependence into four stages.*7

Combating Nicotine Addiction

To combat nicotine addiction, it’s essential to consider multiple dimensions and recognize the factors promoting “harmful, abusive use.” The biopsychosocial model addresses how various treatment options target different levels of this addiction:

HERE

Understanding the cycle of dependence can also be helpful – learn more here:

HERE

Nicotine Pouches as an Aid Against Cigarette Addiction

Nicotin-free pouches offer an option for quitting smoking and are increasingly used in smoking cessation programs.

>> Find out why in: Nicotine Pouches as a Cigarette Alternative – Raising Awareness Could Encourage Quitting

Especially suitable here are:

White Snus with Nicotine Polacrilex

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*1 Source: https://www.blaues-kreuz-muenchen.de/sites/default/files/download/suchtforschung_auf_neuen_wegen.pdf
*2 Source: https://www.icd-code.de/icd/code/F17.-.html and: https://www.dimdi.de/static/de/klassifikationen/icd/icd-10-who/kode-suche/htmlamtl2019/block-f10-f19.htm
*3 Source: https://de.statista.com/statistik/daten/studie/1167833/umfrage/tabakkonsumenten-weltweit-nach-who-region/
*4 Source: https://de.statista.com/themen/150/rauchen/#topicOverview
*5 Source: https://www.caritas.de/hilfeundberatung/onlineberatung/suchtberatung/haeufiggestelltefragen/166903
*7 Source: https://www.uni-wuerzburg.de/fileadmin/32500600/fagerstroemtest.pdf