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Ideas and Opinions |1 April 2008

The Case for Treating Tobacco Dependence as a Chronic Disease

Michael B. Steinberg, MD, MPH; Amy C. Schmelzer, BA; Donna L. Richardson, LCSW, LCADC; Jonathan Foulds, PhD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From Robert Wood Johnson Medical School and School of Public Health, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey.

    Grant Support: From the New Jersey Department of Health and Senior Services through the Comprehensive Tobacco Control Program, Robert Wood Johnson Foundation (Drs. Steinberg and Foulds), Cancer Institute of New Jersey (Drs. Steinberg and Foulds), and Pfizer (Dr. Steinberg).

    Potential Financial Conflicts of Interest:Consultancies: M.B. Steinberg, J. Foulds (Pfizer, Novartis, GlaxoSmithKline, Celtic Pharma). Honoraria: M.B. Steinberg, J. Foulds (Pfizer Speakers' Bureau). Expert testimony: J. Foulds (provided expert witness testimony against tobacco companies). Grants received: M.B. Steinberg (Pfizer).

    Requests for Single Reprints: Michael B. Steinberg, MD, MPH, University of Medicine and Dentistry of New Jersey, School of Public Health, Tobacco Dependence Program, 317 George Street, Room 210, New Brunswick, NJ 08901; e-mail, michael.steinberg@umdnj.edu.

    Current Author Addresses: Drs. Steinberg and Foulds, Ms. Schmelzer, and Ms. Richardson: University of Medicine and Dentistry of New Jersey, School of Public Health, 317 George Street, Room 210, New Brunswick, NJ 08901.

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Most smokers are aware of the numerous health risks associated with smoking, and the majority report wanting to quit (1). Strong evidence suggests that smokers who utilize treatment in the forms of behavioral counseling and pharmacotherapy have an increased chance of success compared with those who do not receive such treatment. Seven first-line medications have been approved by the U.S. Food and Drug Administration for smoking cessation, including nicotine replacement therapy (NRT) (patch, gum, lozenge, inhaler, nasal spray), bupropion, and varenicline (2). Despite the proven benefits of these medications, a mere 17% of all smokers utilize pharmacotherapy for tobacco dependence each year (3). Our case report describes an example of a smoker who has been successful at quitting smoking only through long-term use of nicotine replacement medication.
A 41-year-old woman presented for treatment to a specialty tobacco clinic. She had previously quit smoking in March 2000 for 2 years using a nicotine inhaler. In March 2002, her primary care doctor felt she was becoming addicted to the inhaler and declined to continue to prescribe it. On stopping the medication, the patient quickly relapsed to smoking. She presented for treatment in July 2002 after returning to smoking for 4 months. At that time, she smoked 20 nonmenthol cigarettes per day, smoking her first cigarette of the day 1 minute after waking in the morning. Her medical history included depression, anxiety, and hyperlipidemia. She had a bachelor's degree and worked as an administrator. On examination, her exhaled carbon monoxide...
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Steinberg MB, Schmelzer AC, Richardson DL, Foulds J. The Case for Treating Tobacco Dependence as a Chronic Disease. Ann Intern Med. 2008;148:554–556. doi: 10.7326/0003-4819-148-7-200804010-00012

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Published: Ann Intern Med. 2008;148(7):554-556.

DOI: 10.7326/0003-4819-148-7-200804010-00012

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2008 American College of Physicians
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