Nicotine dependence--treatment for the 1990s

Physicians must recognize that nicotine is a powerfully addictive drug, and patients with nicotine dependence will have all the hallmarks of an addictive disorder. To successfully treat such patients will require compassion and patience on the part of the physician along with the realization that successful treatment will not be easy for most. As with other drugs, there is a very high relapse rate after initial abstinence and this can be discouraging for physicians and patients alike. Applying the principles outlined above in a stepped-care fashion will lead to greater success in dealing with this difficult problem. In the future, more effective treatment interventions will be developed and tested but it is unlikely that there will be a simple cure for this complex behaviour which is complicated by a powerfully addictive drug. Though not a cure-all, adjunctive pharmacologic therapy will play an increasingly important role as we learn how to better use existing agents and as others are shown to be effective. The key to the future is in the development of better relapse prevention techniques to enhance the rather remarkable short-term success rates that can be achieved with counselling and adjunctive pharmacologic therapy.