Helping patients quit smoking: lessons learned in the trenches.

Cigarette smoking is a genuine and complex addiction that involves three interconnecting links: the central link, nicotine (physiologic) addiction, is joined to two additional links, psychologic (cognitive and affective) dependence and sociocultural (environmental) factors. It is precisely this dynamic combination of related factors that makes cigarette smoking so incredibly resistant to long-term extinction. Successful management of highly dependent smokers requires that clinicians use a structured, multifaceted, patient-oriented approach that includes the use of nicotine replacement and nicotine withdrawal therapy, intensive monitoring, and long-term follow-up. In this article, the author offers practical advice gleaned from 30 years of practical experience and one-on-one contact with 400 patients who have attempted to quit smoking during the past 5 years at the Indiana University Nicotine Dependence Program.