From the Guidelines
A regular smoker and someone with nicotine addiction are distinct concepts, and the most effective approach to address both is a combination of behavioral therapy and pharmacotherapy, with varenicline being the most effective medication for achieving abstinence from cigarette smoking, as shown in a meta-analysis of randomized trials 1. The distinction between a regular smoker and someone with nicotine addiction is crucial for determining the best course of treatment. A regular smoker is someone who uses tobacco products habitually, often on a daily basis, while nicotine addiction refers to the physiological and psychological dependence on nicotine that develops from regular tobacco use. All people with nicotine addiction are regular smokers (or users of nicotine products), but not all regular smokers have developed a full addiction. Some key points to consider in addressing nicotine addiction include:
- Nicotine addiction typically involves tolerance, withdrawal symptoms, and continued use despite negative consequences
- The addiction develops because nicotine triggers dopamine release in the brain's reward pathways, creating pleasurable feelings that reinforce continued use
- Behavioral therapy, including counseling and support groups, can be effective in helping individuals quit smoking, with a meta-analysis of 37 RCTs showing a 22% increase in abstinence rates at 6 to 12 months 1
- Pharmacotherapy, such as nicotine replacement therapy, bupropion, and varenicline, can also be effective in managing withdrawal symptoms and reducing cravings
- Varenicline has been shown to be more effective than bupropion or NRT in achieving abstinence from cigarette smoking, with a pooled estimate from 5 trials showing a relative risk versus bupropion of 1.39 (95% CI, 1.25-1.54) and a pooled estimate of 8 trials showing a relative risk versus NRT of 1.25 (95% CI, 1.14-1.37) for abstinence favoring varenicline 1
- The effectiveness of NRT is highest when used as a combination of long- and short-acting NRT, and adding behavioral therapy to pharmacotherapy increases quit rates 1
- Brief advice to quit tobacco smoking provided by a clinician can also increase the rate of quitting, with a relative risk of 1.66 (95% CI, 1.42-1.94) 1
- Telephone-based support, interactive internet-based interventions, and text message–based interventions can also be effective in supporting smoking cessation, with resources such as the Quitline and web-based programs like Freedom From Smoking and Smokefree.gov available to support individuals in quitting 1
From the Research
Definition of Regular Smoker and Nicotine Addiction
- A regular smoker is someone who smokes cigarettes regularly, with approximately 34 million people in the US smoking cigarettes 2.
- Nicotine addiction, on the other hand, is a disease dependent on the complex interactions of neurotransmitter pathways, conditioned behaviors, environmental cues, genetic predisposition, and personal life circumstances 3.
Key Differences
- Nicotine addiction is a chronic disorder maintained by physical nicotine dependence and learned behaviors, whereas being a regular smoker is a behavior that can lead to nicotine addiction 2.
- Nicotine addiction can be treated with pharmacotherapy and behavioral counseling, whereas being a regular smoker requires a willingness to quit smoking and seek treatment 4, 2, 5, 6.
Treatment Options
- Nicotine replacement therapies (NRTs), bupropion, and varenicline are approved by the US FDA as first-line treatments for nicotine dependence 4, 2, 5, 6.
- Clonidine and nortriptyline are recommended as second-line treatments by the Agency for Healthcare Research and Quality 4, 6.
- Combining medication and behavioral counseling is the most effective way to treat nicotine addiction, with a quit rate of 15.2% over 6 months compared to 8.6% with brief advice or usual care 2.
Challenges
- Approximately 70% of people who smoke cigarettes want to quit smoking, but individuals who attempt to quit smoking make an average of approximately 6 quit attempts before achieving long-term abstinence 2.
- Nicotine addiction is a complex disease that requires repeated interventions and multiple attempts to quit, making treatment challenging 6.