Treatment of tobacco dependence needs to be part of any comprehensive tobacco-control policy. World Bank projections suggest that if adult consumption were to decrease by 50% by the year 2020, approximately 180 million tobacco-related deaths could be avoided between now and the year 2050. In view of the addictiveness of tobacco products, many tobacco users will need support to quit. Support for treatment of tobacco dependence refers to a range of techniques, all of which aim to encourage and help tobacco users to stop using tobacco and to avoid subsequent relapse. Most treatments for tobacco dependence are safe and efficacious. Tobacco dependence treatment should ideally be offered as one component of a comprehensive tobacco-control programme and should be integrated within the country's health-care systems.
There are two main methods for the treatment of tobacco dependence: behavioural treatment and pharmacotherapy. Behavioural treatment includes motivation support, advice and guidance, counseling, telephone and Internet support, all of which range in complexity from simple advice offered by a physician or other health-care provider to much more extensive therapy offered by counselors or through specialized smoking-cessation clinics.
Although many people are able to successfully quit smoking on their own and with behavioral self-help guidance, most smokers are nicotine-dependent and could benefit from interventions to address the physiological aspects of quitting, specifically the disorders of tobacco dependence and tobacco withdrawal. There are two types of pharmacotherapy: Nicotine replacement therapy (NRT) and antidepressants such as bupropion. Through NRTs, nicotine can be delivered in a continuous manner though transdermal patches (of different dosages) or in an acute form through gums, lozenges, sublingual tablets, nasal sprays and oral inhalers. When properly used, NRTs have been shown to be safe and effective.
Of the non-nicotine substances that have been marketed for tobacco dependence treatment, currently only bupropion has received any national regulatory approval. However, clonidine and nortriptyline are also listed as “second-line medications” in the United States. In a meta-analysis of two placebo trials of bupropion, the estimated odds ratio of quitting efficacy relative to placebo was 2.1.
There is, therefore, a wide range of treatment options that have been proved effective. Because the therapies vary widely in their efficacy, their acceptability, their cost-effectiveness, and their cost on an individual and population basis, there is no single approach that should be emphasized to the exclusion of others. However, the most effective treatment modality is a combination of both behavioural and pharmacological therapies.