Treatment of Nicotine Dependence: An Update
Abstract
Nicotine is the most common substance of abuse in India, and the most neglected substance of abuse. Nicotine dependence is a significant public health problem. Effective assessment tools for those with the condition include Fagerstrom’s test for nicotine dependence and carbon monoxide concentration of expired air. Nicotine Replacement Therapy (NRT) or bupropion doubles the quit rates, and varenicline triples them. There is no difference in efficacy between the five forms of NRT currently available. NRT in combination with varenicline or bupropion would be of a greater benefit than NRT alone. Data on e-cigarettes are inconclusive as of now. Psychosocial interventions with proven efficacy include setting of a quit date, brief advice, motivational interviewing, and group behavioral programs. A combination of pharmacological and behavioral strategies is most likely to produce the best results. Treatments under development include those based on the principles of pharmacogenetics, agents targeting the cognitive dysfunction that accompanies nicotine withdrawal, and nicotine vaccine.
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