• Stephanie L. HsiaEmail author
  • Anna K. Mischel
  • Arthur L. Brody


Though the use of tobacco has been declining, smoking continues to be the leading preventable cause of morbidity and mortality in the United States. The primary addictive compound in tobacco is nicotine, a nicotine receptor agonist which causes stimulant effects. Nicotine also triggers the dopamine reward pathway, which contributes to its addictive properties. Treatment of tobacco use disorder should ideally consist of both behavioral and pharmacological interventions. First-line behavioral treatment often consists of cognitive behavioral therapy (CBT) and motivational interviewing (MI). First-line pharmacological treatments include combination nicotine replacement therapy (NRT), varenicline, and bupropion. There is some evidence that varenicline and combination NRT are the most effective. However, selection of therapy should be based on patient-specific factors, as use of some medications are contraindicated in certain populations. Combination NRT should be dosed based on the patient’s nicotine dependence as assessed through a validated scale such as the Heaviness of Smoking Index. Electronic cigarettes are becoming increasingly popular; however, their efficacy as smoking cessation aids has not yet been established, and their use comes with some risks.


Nicotine Tobacco Smoking Tobacco use disorder Smoking cessation Nicotine replacement Bupropion Varenicline Electronic cigarettes E-cigarette 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Stephanie L. Hsia
    • 1
    Email author
  • Anna K. Mischel
    • 2
  • Arthur L. Brody
    • 3
  1. 1.Department of Clinical PharmacyUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Veterans Medical Research Foundation, VA San Diego Healthcare SystemSan DiegoUSA
  3. 3.Department of PsychiatryUniversity of California, San DiegoSan DiegoUSA

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