Tobacco cessation

Abstract

Tobacco use is behind most preventable diseases with disabling consequences and death. These diseases are among the most serious, including cancer, cardiovascular diseases (brain strokes, cardiac infarcts, peripheral artery disease), and respiratory system diseases (emphysema, chronic infections). It is estimated that one-third of cancers are attributable to tobacco use and in theory can be prevented. Therefore, a comprehensive tobacco cessation program is a crucial element of successful survivorship and cancer prevention programs. Smoking cigarettes is the most common and deadliest method of consuming tobacco, and nicotine is the reinforcing substance in any tobacco use that with long-term exposure leads to dependence (addiction). Nicotine dependence involves biological, behavioral, and cognitive elements; an optimal approach to treatment for nicotine dependence should address each of these three dimensions. A comprehensive tobacco/smoking cessation program should include cognitive behavioral techniques, motivational interviewing approaches, and appropriate medications. Currently the medications approved by the US Food and Drug Administration for the treatment of nicotine dependence include nicotine replacement therapies, bupropion-SR (sustained release), and varenicline; these treatments can be used individually or in combination. Combining medications capitalizes on the synergy resulting from differing mechanisms of action.