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A system of effective and cost effective smoking cessation support/treatment includes a range of treatments from minimal to intense (see Efficacy section). Tobacco dependence treatment includes (singly or in combination) behavioural and pharmacological interventions, such as education, brief counselling and advice, intensive support, administration of pharmaceuticals or other interventions, that contribute to reducing or overcoming tobacco dependence in individuals and in the population as a whole.
Tobacco control measures that do not provide systematic access to treatment, for example, media coverage of smoking and health issues, advertising bans, taxation, smoke-free workplaces, etc., increase motivation to quit, encourage smokers to make quit attempts and access treatments, and help former smokers to maintain abstinence. Treatment systems complement these other measures by enhancing the availability of help in stopping and by increasing the chances of quit attempts succeeding. With greater reduction in number of smokers, there is more support for tobacco control measures that can positively impact the health of the country.
Treatment of tobacco dependence also complements approaches such as banning the use of misleading labelling on tobacco products, for example, ‘light’ and ‘mild’, which may dissuade smokers from quitting and therefore undermine treatment.
Tobacco dependence and withdrawal syndromes are classified as substance use disorders under the World Health Organization International Classification of Diseases (ICD 10). The American Psychiatric Association has come to similar conclusions in its Diagnostic and Statistical Manual of Mental Disorders (DSM IV), although it uses the terms ‘nicotine dependence’ and ‘nicotine withdrawal’. The more common general term used to describe these diseases is addiction. Official recognition of smoking as a dependence is important in encouraging governments to offer treatment to smokers.
In countries where the tobacco control movement is long-standing and well established and where the health consequences of tobacco use are broadly understood and accepted (mostly industralized countries), the majority of tobacco users want to stop their tobacco use and one-third or more cigarette smokers attempt to quit annually.
Even in countries where tobacco control policies are well advanced, only a very small percentage of cigarette smokers each year achieve lasting abstinence and leave the pool of smokers by cessation (0.5–5%) as opposed to death. This is because most attempts to stop are unsuccessful, partly because nicotine dependence is a chronic, relapsing disorder. In addition, many tobacco users attempt to stop without any behavioural or pharmacological assistance.
Post-certification training increases the likelihood of healthcare professionals intervening with smokers. Since their interventions have themselves been shown to be effective, then training seems very likely to improve outcomes, although this has not been directly demonstrated through research.
Mass media campaigning (such as the use of advertising or news coverage on the health risks of smoking) that motivates tobacco users to quit can encourage tobacco users to seek help in giving up. The impact of advertising for treatment products such as NRT has not yet been systematically studied.
Increasing the availability (i.e. moving from prescription-only to pharmacy or general sale, where appropriate) of pharmacological treatments increases usage. This probably increases overall cessation attempts and successful cessation efforts although the data for this are as yet inconclusive.
Evidence is emerging in high income countries that smoking cessation interventions are very cost-effective in producing population health gain, compared with other preventive and medical interventions (see Economics section). The findings support the role of the healthcare system in prioritizing and funding smoking cessation interventions.
