Written by Tang Kah Hang, pharmacist

What is tobacco dependence/nicotine dependence?

Tobacco dependence or more commonly known as nicotine dependence, is the addiction to any type of smoked tobacco product.  Of all the chemical substances in tobacco, nicotine is the chemical which produces pleasing effect in the brain that makes it hard to quit.

In 2015, the overall prevalence of any tobacco products used by malaysians aged 15 years old and above, was 22.6%; where 20.1% smoked manufactured cigarette, 2.3% smoked self made hand-rolled cigarettes, and the last 0.2% smoked other tobacco product. The mentioned statistic from Institute for Public Health (IPH) shows that, 1 out of 5 malaysians aged 15 years old and above smoked manufactured cigarette.

According to WHO, tobacco use lead to 8 million death every year, while in Malaysia alone, Ministry of health estimated the number to be 20,000 annually.

Symptoms of tobacco dependence

  • You can’t stop smoking. Eventhough you have tried several times with effort
  • You have withdrawal symptoms when you try to stop. Upon the attempt to stop smoking, the following symptoms kick in, symptoms such as strong cravings for cigarette, anxiety, anger, irritability, restlessnes, frustration, depressed mood, insomnia, constipation or diarrhea.
  • You keep smoking despite health problems. Even though you’ve developed health problems with your lungs or your heart, you are still unable to stop.
  • You give up social activities. You may stop going to smoke-free restaurants or stop socializing with family and friends, because you are not allowed to smoke in these situations.

Risk factors of tobacco dependence


  • Age. Most people start smoking during childhood, the younger the person start smoking, the higher risk to become addicted.
  • Parent and peers. A person whose parents or friends smoke, is more prone to smoke as well.
  • Depression or other mental illness. A person with depression or other mental illness like schizophrenia, post-traumatic stress disorder is more likely to smoke.
  • Substance abuse.

Complication of tobacco dependence

  • Lung cancer and lung disease. Not only cancer, smoking causes lung diseases, such as emphysema, chronic bronchitis and COPD.
  • Other cancers. Including cancer of the mouth, throat, esophagus, bladder, pancreas, kidney, cervix and etc.
  • Heart and blood vessels disease. 
  • Smoking increases insulin resistance, which can lead to type 2 diabetes. For those patient with existing diabetes, smoking can speed up the progress of complications, such as kidney disease and eye problems.
  • Eye problems. Such as cataracts and macular degeneration which can lead to loss of eyesight.
  • Infertility and impotence.
  • Cold, and flu. Smokers are more prone to respiratory illness, such as colds, the flu and bronchitis.
  • Tooth and gum disease. Increased risk of gum inflammation and serious gum infection (periodontitis).

Smoking not only proven to bring harm to the smoker, it will also poses health risks to those around the smoker. Nonsmoking spouses of smokers have a higher risk of lung cancer and heart disease compared with those who don’t live in a smoking environment. While for the children whose parents smoke, they are more prone to colds, ear infection  and worsening of asthma.

Diagnosis of tobacco dependence

Fagerström Test will be used for assessing the level of tobacco dependence, knowing the level of dependence will help determine the most suitable treatment plan. 



The mainstay of tobacco dependence treatment is to conduct smoking cessation,

  • Nicotine Replacement Therapy is one of the medicial treatment where the medicine will deliver the nicotine the body craving in a safer form than cigarette. There are nicotine patches, gums and inhalers. Over time, the amount of nicotine consumed will be reduced gradually until the cravings being overcame entirely
  • Prescription medicine like CHAMPIX will ease the cravings and withdrawal symptoms of cigarette quitting.
  • Other therapy also include hypnosis, counseling, accupuncture.


  • The best way to keep children from smoking is to lead by example and not smoke. 
  • Feel free to talk to your family doctor or any other qualified healthcare professional for further information regarding smoking cessation.


  1. Clinical practice guideline, treatment of tobacco use disorder. Ministry of Health 2016. Available from: www.moh.gov.my/index.php/pages/view/135?mid=67
  2. Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel. A US Public Health Service report. Am J Prev Med. [Online] 2008. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465757/
  3. what do you want to know about smoking cessation. Healthline. [Online] 2016. Available from: https://www.healthline.com/health/quit-smoking
  4. nicotine dependence. Mayo Clinic. [Online] 2020. Available from: https://www.mayoclinic.org/diseases-conditions/nicotine-dependence/symptoms-causes/syc-20351584
  5. Tobacco. World Health Organization. [Online] 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/tobacco