Rational basis for chemotherapy of tobacco dependence

The forms of tobacco use are many, and it is likely that their number is matched by equally varied controlling variables. All the ususal forms of tobacco use, however, share at least one commonality: nicotine is extracted from the tobacco and ingested in a manner that permits its distribution to the central nervous system. The tobacco cigarette is the prevalent means of nicotine self-administration in Western society, and cigarette smoking is the primary form of tobacco use addressed by legislative, research, and treatment efforts. In 1983, the United States Public Health Service categorized cigarette smoking as a form of drug dependence in which nicotine was held to be the critical substance (USPHS 1983). Consistent with the drug dependence model of cigarette smoking, in 1984 a pharmacotherapeutic aid (nicotine gum) for the treatment of tobacco dependence was approved by the Food and Drug Administration. This paper will briefly review nicotine dependence and its implications for the use of chemotherapy in the treatment of tobacco dependence with respect to cigarette smoking.