TOBACCO DEPENDENCE TREATMENTS - REVIEW AND PROSPECTUS

Cigarette smoking continues to place an enormous burden on US health s ystems. The treatment of tobacco-dependent persons is vital to the pub lic health, since unmitigated smoking could lead to the development of disease and premature death in as many as 20 million current smokers in the United States. Much of this tobacco-related morbidity and morta lity could be prevented by the application of existing treatments, as well as newer ones. Access to safe and effective treatments was signif icantly expanded in 1996, when two forms of nicotine replacement thera py (NRT), the nicotine gum and patch, became available for over-the-co unter sale. Expanded access has led to significantly increased utiliza tion and quitting. Even with these advances, however, the scope of thi s tobacco dependence demands that we explore alternative treatment str ategies, including exposure reduction therapy (ERT) as a possible opti on for smokers not currently making quit attempts. In this review, we present principles to guide the development of such a therapy, and for its application, should it be proven effective.