Introduction

Key messages—Nicotine is extremely addictive; it is comparable to cocaine, opiates, and amphetamines. In one study, even heroin users rated cigarettes as their most needed drug. Quitting is possible, and almost half of smokers have quit for at least some time. Half of smokers quit eventually. People who quit decrease their rates of death and illness, including heart disease and cancer, even if they quit late in life. The benefits of quitting late in life are less than quitting when young. Helping patients quit typically involves helping them through many attempts (five to seven, on average). Because most relapses occur within three months of quitting, and half within the first two days, patients need follow up within days, not weeks, of starting treatment.

It is important to warn patients about what they are likely to experience when they try to quit. In particular, they can expect a weight gain …