Overview

The more than one billion smokers worldwide who are addicted to tobacco are victims of the tobacco epidemic. When informed of the risks, most tobacco users want to quit, but few get help and support to overcome their dependence. Health-care systems have primary responsibility for treating tobacco dependence. Programmes should include tobacco cessation advice incorporated into primary health-care services, easily accessible and free telephone help lines (known as quit lines), and access to low-cost medicines. All health-care workers should become advocates for tobacco control. Governments can use some tobacco tax revenues to help tobacco users free themselves from addiction.

Problem

Tobacco contains nicotine, which is an addictive drug on par with heroine and cocaine. Most tobacco users are dependent on nicotine, and it is difficult for them to quit on their own. The primary purpose of smoking tobacco is to deliver a dose of nicotine rapidly to the brain. The effects of tobacco and nicotine to produce dependence and withdrawal are identified by the International Statistical Classification of Diseases and Related Health Problems [I.C.D-10] as a disease in the category [T 65.2] ‘Toxic effect of other and unspecified substances’. The Diagnostic and Statistical Manual of Mental Disorders [D.S.M-IV] also classifies nicotine-related disorders into the sub-categories of dependence [305.10] and withdrawal [292.0], which may develop with the use of all forms of tobacco.

Dependence on nicotine is a biological force that drives smokers to self-dose for nicotine. Such behaviour is manifested in smoking more intensively or more cigarettes per day to obtain the dose that will give them satisfaction when using so called “low-yield” cigarettes. These cigarettes are promoted using terms, descriptors, trademarks or other signs that directly or indirectly create the false impression that the tobacco product is less harmful than other tobacco products. Most of these products are designed such that these changes in smoking behaviour return the delivery of nicotine and other smoke constituents to levels similar to those of so called “full-flavour” or “high–yield” cigarettes.

Solution

Tobacco control policies create the environment in which users can successfully stop. Treatment of tobacco dependence is a key component of any comprehensive tobacco control strategy as indicated in Article 14 of the WHO Framework Convention on Tobacco Control (WHO FCTC). Cessation support and medication can increase the likelihood that a smoker will quit successfully.

Treatment includes various methods, but programmes should include:

• Tobacco cessation advice incorporated into primary and routine health-care services
• Easily accessible and free telephone help lines (known as quit lines)
• Access to free or low-cost cessation medicines

The guidelines for Article 14 provide detailed advice to strengthen or create a sustainable infrastructure that motivates attempts to quit, ensures wide access to support for tobacco users who wish to quit, and provides sustainable resources to ensure that such support is available. The guidelines also identify the key, effective measures needed to promote tobacco cessation and incorporate tobacco dependence treatment into national tobacco control programmes and health-care systems.

Present situation

Currently, only a small number of countries provide access to comprehensive help to quit tobacco use.

For country data on the availability of brief cessation support, quit lines and pharmacotherapy, see the WHO Report on the Global Tobacco Epidemic.