[Current therapeutic strategies for tobacco dependence]

Smoking remains the first preventable cause of premature death worldwide. Despite the knowledge of adverse consequences of smoking, many smokers have difficulties to quit for good. This is due to the addictive nature of tobacco, at least as strong as the one of illicit drugs. The mechanisms of nicotine dependence are very similar to those of other addictive behaviors, and are based on disequilibrium of the meso-cortico-limbic reward system. The withdrawal syndrome responds well to nicotine replacement therapy, bupropion, and varenicline. Recent guidelines stress the responsibility of all health care professional to address the smoking problem of every patient through the 5 A model: Ask - Advise - Assess - Assist - Arrange.