Highlights: Management of Nicotine Addiction

Minimal Clinical Interventions

• According to three study findings, nearly 70% of American smokers (36 million) make at least one outpatient visit each year, but health care providers gave smoking cessation advice to only 40% to 52% of the smokers.
• One recent study reported that only 15% of smokers who saw a physician in the past year were offered assistance with quitting, and only 3% were given a follow-up appointment to address the problem.
• In 1992, about half of all adult U.S. smokers visited a dentist, but only 25% were advised to quit by their dentist.
• Effective strategies for treating tobacco use include brief advice by medical providers, counseling, and pharmacotherapy.
• Less intensive interventions, as simple as physicians advising their patients to quit smoking, can produce cessation rates of 5% to 10% per year. More intensive interventions, combining behavioral counseling and pharmacologic treatment, can produce 20% to 25% quit rates in one year.

Pharmacotherapy

• Nicotine nasal spray was approved for prescription use in March 1996. The spray consists of a pocket-sized bottle and pump assembly, with a nozzle that is inserted into the nose. Each metered spray delivers 0.5 mg of nicotine to the nasal mucosa.
• In May 1997 the nicotine inhaler was approved as a prescription medication to treat tobacco dependence. The inhaler consists of a plastic tube about the size of a cigarette and contains a plug filled with nicotine. Menthol is added to the plug to reduce throat irritation. Smokers puff on the inhaler as they would a cigarette. Each inhaler contains enough nicotine for 300 puffs.

Economic Benefits

• Cost-effectiveness analyses have shown that smoking cessation treatment compares favorably with hypertension treatment and other preventive interventions such as annual mammography, pap tests, colon cancer screening, and treatment of high levels of serum cholesterol.
• Treating tobacco dependence is particularly important economically because smoking cessation can help prevent a variety of costly chronic diseases, including heart disease, cancer, and lung disease. In fact, smoking cessation treatment has been referred to as the "gold standard" of preventive interventions.
• Progress has been made in recent years in disseminating clinical practice guidelines on smoking cessation. Healthy People 2010 calls for universal insurance coverage, both public and private, of evidence-based treatment for nicotine dependency for all patients who smoke.