Nicotine receptors in brain
Courtesy NIH: Nicotine Receptors in the Brain

By Paul Brunetta, MD

“Nicotine not only changes your brain chemistry, it also changes your brain structure by creating new nicotine receptors”

When you inhale nicotine, either by smoking tobacco or vaping e-cigarettes, the nicotine surges in your bloodstream and binds to nicotine receptors in your brain. That binding stimulates the release of a whole host of other chemicals that make you feel relaxed and can give you pleasure. Nicotine not only changes your brain chemistry, it also changes your brain structure by creating new nicotine receptors.

Nicotine hijacks your brain 

The more nicotine receptors you have over time, the more nicotine you need to feel the same effect, or just to feel normal. People who use nicotine regularly experience restlessness, anxiety and mood swings when they don’t have access to nicotine, much like the feeling of intense hunger.

Imagine a couple of baby chicks in a nest, chirping with open mouths and it’s your job to feed them. Give them a little food, and they quiet down right away. Now imagine that instead of two chicks there’s an ever-growing flock squawking at you incessantly – you need a constant supply of food! That’s how your brain’s nicotinic receptors work. They keep multiplying in response to surges of nicotine, and are only satisfied with the flood of nicotine that comes from inhaling a cigarette or vaping. Because nicotine is out of your bloodstream within a few hours, the hunger and ‘noise’ from the growing flock of receptors starts all over again.

How genetics affect your habit

We now understand that genetic differences cause some people to break down nicotine faster than others. If you are one of those people, you may need to smoke more cigarettes than someone else does to get the same effect. That is why some people might smoke less than half a pack, while others chain smoke two or three packs a day.

Another difference between smokers is that some have a much greater increase in the number of nicotine receptors on their brain cells than others. In a recent study, UCLA researcher Arthur Brody and his colleagues found PET scans of the brain showed that people with a larger increase in nicotine receptors had a more difficult time quitting smoking compared to people with fewer receptors. So it’s not your fault if you have great difficulty quitting your nicotine addiction – try not to blame yourself and feel isolated in this process.

Managing your cravings

These new findings about nicotine addiction explain why using nicotine replacement therapies (NRTs), alone or in combination with other support, can greatly reduce your most intense urges to smoke — if you use them properly and consistently and at the right dose. There are also two types of oral medications that can significantly improve your chance of quitting successfully.

  • NRTs and other therapies won’t reduce every urge, but they can reduce the discomfort until your urges naturally subside.
  • Your brain reduces the number of nicotine receptors and returns to a more normal state over several weeks to months.
  • During that time, if you start smoking or vaping again, your urge to smoke and your habit will likely be just as intense as before you quit because your nicotine receptors still dominate your brain chemistry.

The single most important thing you’ll ever do for your health as a smoker is to stop smoking. The earlier you do it, the greater the benefit. If you try to quit cold turkey and you find that you can’t, there are many more options to support you on your way to success.

Talk to your health care provider and start to review them together.

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