Comparison of Available Treatments for Tobacco Addiction
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Cigarette smoking is a major public health problem that causes more than 5 million deaths annually worldwide. Cigarette smoking is especially common among individuals with psychiatric comorbidity, including individuals with primary psychiatric disorders and other addictions. Effective behavioral and pharmacologic treatments for smoking cessation are available. Behavioral treatments including brief (< 3 min) counseling by physicians are effective. Seven first-line pharmacologic treatments are currently available: five nicotine replacement therapies, bupropion, and varenicline. In addition, clonidine and nortriptyline are second-line treatments for smoking cessation. These treatments increase the chances of quitting smoking by two- to threefold, supporting their use in smokers who are motivated to quit. However, effective treatments for many subpopulations, including smokers with psychiatric comorbidities as well as adolescent, pregnant, or postpartum smokers, remain to be developed and represent an important challenge.
KeywordsNicotine Nicotine pharmacotherapy Special populations Tobacco use disorder Clinical trials Smoking cessation
This research was supported by the Veterans Administration Mental Illness Research, Education, and Clinical Center and National Institute on Drug Abuse grants K02 DA021304 (to Dr. Sofuoglu) and K12 DA00167 (to Dr. Herman)
No potential conflicts of interest relevant to this article were reported.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.•• Fiore MC, Jaén CR, Baker TB, et al.: Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service; 2008. The clinical practice guidelines are the main resource for treating individuals with tobacco use and dependence. The guidelines are based on the review of literature for most evidence-based treatments.Google Scholar
- 5.• Sofuoglu M, Yoo S, Hill KP, Mooney M: Self-administration of intravenous nicotine in male and female cigarette smokers. Neuropsychopharmacology 2008, 33:715–720. Although nicotine is the main addictive chemical in tobacco, there have been few studies of pure nicotine self-administration in humans. This study showed that smokers self-administer intravenous nicotine doses that are within the range of those of average intake from cigarette smoking. This model may be useful in the evaluation of the effects of both behavioral and pharmacologic manipulations on nicotine self-administration in humans.CrossRefPubMedGoogle Scholar
- 12.Physicians’ Desk Reference. Montvale, NJ: Medical Economics Data; 2010.Google Scholar
- 21.• Sofuoglu M, Herman AI, Mooney M, Waters AJ: Varenicline attenuates some of the subjective and physiological effects of intravenous nicotine in humans. Psychopharmacology (Berl) 2009, 207:153–162. Varenicline is a first-line treatment for smoking cessation, but its exact mechanism of action has not been elucidated. This study examined how varenicline affects the physiologic, subjective, and cognitive-enhancing responses to pure nicotine, administered intravenously, in male and female smokers.CrossRefGoogle Scholar
- 28.• Piper ME, Smith SS, Schlam TR, et al.: A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Arch Gen Psychiatry 2009, 66:1253–1262. Few research studies have investigated the relative efficacies of multiple smoking cessation pharmacotherapies. This study compared the efficacy of five smoking cessation pharmacotherapies in a placebo-controlled clinical trial. After correcting for multiple comparisons, the only medication that was more effective than others was the combination of the nicotine patch and nicotine lozenge.CrossRefPubMedGoogle Scholar
- 30.•• Hall SM, Prochaska JJ: Treatment of smokers with co-occurring disorders: emphasis on integration in mental health and addiction treatment settings. Annu Rev Clin Psychol 2009, 5:409–431. In the United States, more than 30% of smokers have psychiatric comorbidity. However, there is limited information to guide clinicians on how best to treat tobacco addiction in this population. The authors reviewed the literature of how best to integrate smoking cessation into mental health and addiction settings.CrossRefPubMedGoogle Scholar
- 39.Poling J, Rounsaville BJ, Gonsai K, et al.: The safety and efficacy of varenicline in cocaine using smokers maintained on methadone: a pilot study. Am J Addict 2010 (in press).Google Scholar
- 40.Tong VT, Jones JR, Dietz PM, et al.: Trends in smoking before, during, and after pregnancy—Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 sites, 2000–2005. MMWR Surveill Summ 2009, 58:1–29.Google Scholar
- 43.• Oncken CA, Kranzler HR: What do we know about the role of pharmacotherapy for smoking cessation before or during pregnancy? Nicotine Tob Res 2009, 11:1265–1273. This is a comprehensive review of pharmacotherapy for smoking cessation during pregnancy. In the United States, about 13% of women smoke during pregnancy. Smoking during pregnancy is associated with several health risks to the mother and the fetus, emphasizing the need for effective treatments for pregnant women.CrossRefPubMedGoogle Scholar