What is the Anxiety-Nicotine Connection?

People may tell you that they smoke to relive feelings of stress and anxiety. While this may something that people feel at least short-term when they smoke a cigarette, the bigger picture is more complex and shows that really smoking (and nicotine in particular) do more to create stress than to relieve it.

Smoking alters stress hormones

Our feelings of stress and anxiety are mediated by hormones. Chronic smoking is known to create changes to the two major systems that are most responsible for creating our emotional and physical experience of these conditions.1

The Autonomic Nervous System (ANS) – the autonomic nervous system controls a lot of essential functions in the body such as breathing, heart rate, digestion, and blood pressure. Nicotine reliably stimulates the ANS, in particular causing increases in levels of epinephrine and norepinephrine – the hormones that are responsible for what is commonly called the “fight or flight” response. In smokers this is most commonly noticed as elevated heart rate and blood pressure. In chronic smokers this also leads to a blunting of heart rate variability (HRV).1 Decreased HRV is associated with both heart and lung disease as well as a range of psychiatric disorders including anxiety, panic disorders, PTSD, and depression.

 The Hypothalamic-Pituitary-Adrenal Axis (HPA) – Nicotine is well-known to elevate levels of cortisol – the primary hormone in the body associated with chronic stress. This process is initiated in the brain where nicotine stimulates the release of Corticotrophin Releasing Hormone, which in turn causes the release of Adrenocorticotropic Hormone (ACTH), which causes cortisol release in the Adrenal Glands. Chronic smokers have been shown to have chronically elevated cortisol levels throughout the day2 along with a blunted acute cortisol response. The severity of HPA changes has been correlated with rates of relapse in individuals attempting to quit smoking.

A vicious cycle

So even if smoking may give an immediate sensation of relief, the long-term result of nicotine addiction creates dysfunction of both the major stress-response systems of the body. This can create a vicious cycle that helps to drive addiction, creating a psychological association with stress-relief coupled with feelings of stress and increases in anxiety that are amplified by attempts to quit.



  1. Richards J, Stipelman BA, Bornovalova MA, Daughters S, Sinha R, Lejuez CW. Biological Mechanisms Underlying the Relationship between Stress and Smoking: State of the Science and Directions for Future Work. Biol Psychol. 2011;88(1):1-12. doi:10.1016/j.biopsycho.2011.06.009
  2. Contributors WE. What Is Heart Rate Variability? WebMD. Accessed March 30, 2022. https://www.webmd.com/heart/what-is-heart-rate-variability
  3. Olff M, Meewisse ML, Kleber RJ, et al. Tobacco usage interacts with postdisaster psychopathology on circadian salivary cortisol. Int J Psychophysiol. 2006;59(3):251-258. doi:10.1016/j.ijpsycho.2005.10.014