Pharmacological approach to smoking cessation.

At present, the possibilities of pharmacological intervention in smoking cessation remain limited. Some products, like smoking deterrants, lobeline, amphetamine and sedatives, definitely seem to have been rejected. The efficiency of other drugs aiming to treat the withdrawal syndrome (e.g. clonidine) or to eradicate the smoking habit (e.g. mecamylamine) must still be confirmed in large controlled trials. The same is true of the "cigarette substitutes" which have appeared recently. The only effective substitute treatment currently available is nicotine, presented as nicotine gum; other modalities of administration of nicotine are in preparation. Even if it has not fulfilled all the expectations of its promoters and of the smokers who hoped for a panacea, nicotine gum, when administered to highly dependent smokers motivated to stop, with the appropriate technique, effects a moderate increase not only in the cessation rate but also in the long-term abstention rate, in so far as the necessary psychological support is provided, either by the physician in medical settings, or by other health professionals, in smoking-cessation clinics or in industrial and community settings. The addiction to psychoactive nicotine presents only one facet of the smoking process in chronic smokers. They must also be helped to face the behavioural components of their habits, so individualized counselling remains essential, in addition to the prescription of the gum, in order to achieve satisfactory rates of long-term smoking cessation.