Drug and nondrug interventions used in treating
nicotine dependence are reviewed. Tobacco use is the leading preventable cause of death in the United States. Risks of smoking-related disease and death decline sharply when smokers quit, but 26% of Americans continue to
smoke. Most smokers find it extremely difficult to quit smoking because of their
nicotine addiction. Nonpharmacologic interventions used to promote smoking cessation include behavioral
therapy, setting a specific date for quitting, receiving advice to quit from a health care professional, follow-up visits to review progress, self-help approaches, group counseling, filtration devices,
hypnosis, and acupuncture. The efficacy of these approaches ranges from substantial to almost nil. The only pharmacologic agent with FDA-approved labeling for use in smoking-cessation
therapy is
nicotine. When used in conjunction with appropriate nonpharmacologic interventions,
nicotine-replacement therapy roughly doubles the rate of quitting obtained with placebo.
Nicotine-replacement therapies consist of
nicotine transdermal (patch) systems and
nicotine chewing gum. The
nicotine patch is the first-line replacement
therapy because it is effective when accompanied by only minimal (as opposed to more intensive) nonpharmacologic interventions and because it is easier to use and comply with than gum.
Clonidine,
antidepressants, and
buspirone require further study to determine what role, if any, they should play in the treatment of
nicotine dependence. The stages of smoking cessation are precontemplation, contemplation, action, and maintenance; interventions are selected on the basis of the stage the smoker is in.
Nicotine dependence is difficult to treat, but there are
aids that boost a smoker's chances of quitting.
Nicotine patches and
chewing gum offer the most effective pharmacologic options, especially when combined with behavioral interventions and counseling.