Such figures qualify tobacco dependence as a public health
epidemic, creating an acute need for intervention to save lives.
Ironically, the people most qualified to intervene --
physicians and other health care clinicians -- usually have not
done so. One study reported that only 15 percent of smokers who
saw a physician were offered help with quitting tobacco. Only 21
percent of practicing physicians say that they have received
adequate training to help their patients stop smoking, according
to a survey of U.S. medical schools.
Today the opportunities to intervene are much improved.
"Current treatments for tobacco dependence offer clinicians
their greatest single opportunity to halt the loss of life,
health, and happiness caused by this chronic condition,"
note the authors of Treating Tobacco Use and Dependence,
a clinical practice guideline released in 2000 by the U.S.
Public Health Service. The guidelines were established to help
patients quit tobacco and are based on a comprehensive review of
the medical literature published from 1975 to 1999.
Most prominent in the updated guidelines is the fact that
there are more medical treatments than ever before to help
To begin, the guidelines list four kinds of nicotine
replacement therapy: nicotine gum, the nicotine inhaler,
nicotine nasal spray, and the nicotine patch. Technically known
as nicotine replacement therapies, these treatments aim to
diminish the symptoms of withdrawal for people attempting to
quit smoking. They work by allowing people to consume nicotine
in steadily decreasing doses. All of them provide nicotine
without the toxins found in cigarette smoke.
The guidelines also recommend three medications to reduce
nicotine withdrawal symptoms: the antidepressant bupropion (Zyban),
the most commonly prescribed non-nicotine medication to deal
with tobacco dependence, and clonidine and nortriptyline, two
second-line medications that require more medical supervision.
In addition, the guidelines highly endorse counseling and
behavioral therapies for everyone who tries to quit tobacco.
Counseling can help people solve problems such as weight gain
and mood changes after quitting tobacco. Through counseling,
people can also learn how to gain support from relatives,
friends, and coworkers.
The guidelines offer strong evidence that tobacco cessation
treatments are both effective and cost-effective relative to
other medical and disease prevention interventions. It
recommends that insurance plans reimburse for the cost of
Dr. Michael Fiore, director of the Center for Tobacco
Research and Intervention at the University of Wisconsin Medical
School in Madison, headed the expert panel that developed Treating
Tobacco Use and Dependence. He is upbeat about the odds for
those who want to become tobacco-free, citing research that four
out of 10 smokers can successfully quit. "If this 40
percent quit rate is applied for people who try repeatedly,
there is a very high likelihood that any smoker committed to
quitting can do so successfully," said Fiore.
To view a summary of the clinical practice guidelines, go
online to http://www.surgeongeneral.gov/tobacco/smokesum.htm.
If you want to quit tobacco, you can draw on many resources
for information and strategies. Here are a few places to start: