Blog | Tuesday, October 28, 2008

Nicotine dependence: It's worse than you think

It's the best of times and worst of times for ending tobacco dependence, according to David Sachs, ACP Member, of the Palo Alto Center for Pulmonary Disease Prevention.

The best, because there are more tools than ever to help patients quit.
The worst, because most physicians have no idea how to treat patients effectively.

In part, that's because doctors don't know that nearly 75% of people seeking tobacco-dependent treatment are categorized as "highly" dependent-- meaning standard, OTC therapies won't work on them, Dr. Sachs said during a Chest 2008 press conference about a new study he authored. In the study, he and his colleagues analyzed pretreatment dependence severity from 1989-2006 and found severity increased 12% during that time, with those classified as "highly dependent" increasing 32%.

Doctors should measure dependence in their patients trying to quit. For treatment, they may need to increase drug doses and duration of use, try different drug combinations, and put more stress on minimizing withdrawal symptoms.

Dr. Sachs didn't have a pat answer for why dependence has increased in the last 15 years, so moderator Mark Rosen, FACP, speculated: "Can we attribute any of this (increase in dependence) to the stress of having Bush in the White House for the last eight years?"