Tobacco dependency syndrome is an organic disease caused by chronic use of
inhaled tobacco smoke. It is occasionally controlled by willpower alone, bu
t often requires pharmacotherapy in conjunction with various techniques to
manage the psychological manifestations. The two effective drugs are buprop
ion, which is an oral antidepressant, and nicotine, which can be administer
ed by several modalities, including a skin patch, an oral inhalant, a nasal
spray, and a chewable oral preparation. Successful therapy may require bot
h drugs, and multiple simultaneous nicotine modalities. High-dose nicotine
therapy may achieve an abstinence rate of 80% during therapy, but maintaini
ng drug-free abstinence at such high levels over long periods is less succe
ssful, possibly because the tobacco smoke-induced changes in brain structur
e and function are not easily reversed.