The Etiology and Treatment of Nicotine Dependence: A Biopsychosocial Perspective

Chronic use of tobacco-containing products, particularly cigarettes, remains one of the most avoidable causes of death and illness in the United States and claims the lives of more than 430,000 individuals each year (U.S. Department of Health and Human Services [DHHS], 1999). The number of tobacco-related deaths alone exceeds that of deaths due to AIDS, murders, other drugs, alcohol, car crashes, fires, and suicides combined (Centers for Disease Control and Prevention [CDC], 2002). Illnesses associated with tobacco use include, but are not limited to, laryngeal cancer, oral cancer, esophageal cancer, obstructive pulmonary disease, cardiovascular disease, intrauterine growth retardation, and low birth weight (DHHS, 1999). Evidence of significant health risks due to environmental tobacco smoke has also been documented. Adverse health risks caused by exposure to “secondhand” tobacco smoke include lung cancer, asthma, respiratory infections, and decreased pulmonary function (DHHS, 1999). Despite public health efforts to reduce tobacco use in the United States, adult prevalence rates have not changed significantly, and in some cases increases were observed during the 1990s (CDC, 2002). For example, the overall rate of adult cigarette smokers has decreased slightly from 25.0% to 23.3% across all age groups except that of 18- to 24-year-olds (CDC, 2002), whereas the use of smokeless (spit) tobacco and cigars has increased substantially (U.S. Department of Agriculture, 1997). To date, 65.5 million Americans continue to use tobacco products on a regular basis (CDC, 2002) and appear to be more difficult to treat than their counterparts of the 1970s and 1980s (Irvin & Brandon, 2000). As such, tobacco use continues to represent an important health behavior that faces health care professionals