Understanding and Addressing Nicotine Addiction: A Science-Based Approach to Policy and Practice

Nicotine is a highly addictive substance that not only perpetuates tobacco use — the leading cause of preventable morbidity and mortality in the United States — but also has its own adverse effects. Nicotine addiction is a chronic and relapsing disease, its prevalence of nicotine addiction is higher than that of alcohol and other substance addiction. The use of nicotine-containing products is associated not only with developing nicotine addiction, but also with using and becoming addicted to alcohol and other substances.

Despite a decline in recent years in the use of cigarettes, the use of non-cigarette nicotine products has been rising dramatically. While the overall harm of these products appears to be considerably lower than the harms associated with cigarette use, all nicotine-containing products carry the risk of addiction and other adverse health effects and are therefore a threat to public health.

Key Takeaways

One in four (25.4 percent) individuals aged 12 and older in the United States reported using a tobacco/nicotine product (21.1 percent used cigarettes) in the past 30 days in 2013. That year, 37.0 percent of individuals aged 12 and older who reported smoking cigarettes in the past 30 days met diagnostic criteria for nicotine addiction.

Rates of nicotine addiction among those aged 12 and older who reported current (past 30-day) cigarette smoking varied somewhat by demographic variables, with rates:

• Similar among females and males (38.0 percent vs. 36.2 percent);
• Higher among white than black or Hispanic respondents (41.6 percent vs. 27.8 percent and 23.4 percent, respectively);
• Higher among older than younger age groups (17.1 percent of 12-17 year olds; 27.8 percent of 18-25 year olds; 36.7 percent of 26-34 year olds; 41.1 percent of 35-49 year olds; and 41.4 percent of those aged 50 and older); and
• Higher among those living in non-metropolitan areas than among those living in small or large metropolitan areas (42.2 percent vs. 39.8 percent and 33.1 percent, respectively).

Recommendations

For policymakers:

• Strengthen tobacco control regulations and policies, and apply them to all nicotine-containing products.
• Improve prevention, early intervention and treatment practice.
• Invest in quality research.

Research Methods

This report is based on a review of the available research on nicotine and a variety of nicotine products to determine the risks, correlates and consequences of nicotine use. Researchers also conducted secondary analysis of national data to determine the prevalence of nicotine addiction in the total population and among key demographic sub-groups, as well as its relationship to other substance use and addiction.