The Case for Treating Tobacco Dependence as a Chronic Disease

Smoking remains the leading cause of preventable death in the United States, yet it is still regarded by many as merely a bad habit. Most smokers want to quit but find it difficult. Behavioral counsel-ing and pharmacotherapies are available, safe, and effective in the treatment of tobacco dependence. Nicotine replacement therapy effectively delivers nicotine in safer doses without exposure to the toxins and chemicals in cigarette smoke. The optimal duration of tobacco dependence treatment is unknown, and some smokers may require extended courses. For smokers using long-term cessa-tion medications, health care providers should encourage treatment and insurance carriers should cover it. Both tobacco dependence and such conditions as diabetes are similar in their potential to exacerbate other diseases, their behavioral components of treat-ment, and their effectiveness of medications. Despite these similar-ities, treatments for diabetes are well covered by insurance, whereas tobacco dependence treatments are often limited. Tobacco dependence should share the status of other chronic illnesses, with effective treatments given as long as is necessary to achieve suc-cessful clinical outcomes. Ann Intern Med. 2008;148:554-556. www.annals.or