Cited by 228Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesBehavioral Health and Interventions

The DOI matches its Crossref record; 146 of the 149 references it cites were found in a registry or an index, and 3 are not checked yet; none of the 129 sources its claims cite is checked for support yet.

Tobacco addiction

Open access

Abstract

Tobacco use is associated with 5 million deaths per year worldwide and is regarded as one of the leading causes of premature death. Comprehensive programmes for tobacco control can substantially reduce the frequency of tobacco use. An important component of a comprehensive programme is the provision of treatment for tobacco addiction. Treatment involves targeting several aspects of addiction including the underlying neurobiology and behavioural processes. Furthermore, building an infrastructure in health systems that encourages and helps with cessation, as well as expansion of the accessibility of treatments, is necessary. Although pharmacological and behavioural treatments are effective in improving cessation success, the rate of relapse to smoking remains high, emphasising the strong addictive nature of nicotine. The future of treatment resides in improvement in patient matching to treatment, combination or novel drugs, and viewing nicotine addiction as a chronic disorder that might need long-term treatment.

Checked 2026-10-10 · 3 references not checked yet

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes the diagnosis, pathophysiology, and treatment of tobacco/nicotine addiction, emphasizing that tobacco use causes 5 million deaths annually worldwide and that pharmacotherapies and counseling can improve cessation. It concludes that nicotine addiction should be treated as a chronic disorder, with future gains expected from better patient matching, combination or novel medications, and broader treatment delivery.

Key findings

  • Tobacco use is associated with 5 million deaths per year worldwide; there are about 1.2 billion smokers, half of whom will die of smoking-caused diseases, with projections of 10 million deaths per year by 2020.
  • Pharmacotherapies roughly double to triple quit rates: pooled ORs were NRT 1.8 (95% CI 1.7–1.9; 104 studies), bupropion 1.9 (1.7–2.2; 31 studies), varenicline 3.2 (2.4–4.3; 4 studies), nortriptyline 2.3 (1.6–3.4; 6 studies), and clonidine 1.9 (1.3–2.7; 6 studies); estimated abstinence with active therapy was about 17–22% across these classes.
  • In the general population, >70% of smokers want to quit and 45% make a quit attempt, but <5% succeed; physician advice can enhance cessation 3–5 fold above 5%, and brief advice yields a small but significant 2.5% absolute increase.
  • Combination nicotine patch plus ad libitum NRT improved efficacy over single NRT (7 studies, OR 1.4, 95% CI 1.1–1.8), while combining nicotine and non-nicotine therapies was not strongly supported; varenicline beat bupropion in pooled analysis (OR 1.7, 95% CI 1.3–2.2).

Methods

  • Narrative review; search focused on existing meta-analyses plus MEDLINE/PubMed for articles not covered, primarily medication treatments, using terms for smoking cessation, NRT, antidepressants, varenicline, bupropion, clonidine, nortriptyline, nicotine vaccine, and rimonabant.
  • Included studies were selected if considered to have sufficient sample size and rigorous methodology and to add to the manuscript; global prevalence data came from WHO and American Cancer Society databases.
  • Main analysis was qualitative synthesis of cited meta-analyses and trials, reporting pooled odds ratios and abstinence rates; no new primary data were collected.

Limitations

  • The paper states that global prevalence rates are not strictly comparable because samples may not be representative, time periods, smoking definitions, and age cutoffs differ; they are described as the best available data.
  • The paper states that most evidence-based treatments come from developed countries, though they may generalize to developing countries, and culturally sensitive interventions are underway.
  • Evident from the text: this is a narrative review, not a systematic review, with study selection based on author judgment of sample size and rigor; one author (Hatsukami) reports advising Pfizer on varenicline and receiving a grant from Nabi Biopharmaceuticals for nicotine vaccine trials.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(08)60871-5

Cites

146 of 149 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

91 Not checked yet · 16 Own interpretation · 4 Own result · 2 No basis given · 1 Own method

Verify all 129 references — free account

Show all 72 claims

  • It may state two separate claims as one. 39
  • Probably not a substantial claim. 4
42 of 42
  • The paper relies on this without support.

    Comprehensive tobacco control programs can significantly reduce the prevalence of tobacco use.

    “Comprehensive tobacco control programs can significantly reduce the prevalence of tobacco use.”
  • The paper relies on this without support.

    Most evidence-based treatments have been from studies conducted in developed countries.

    “Although smoking is a global problem and the burden of tobacco-related death and disease has been shouldered by developing countries, most of the evidenced-based treatments have been from studies conducted in developed countries.”
  • The paper relies on this without support.

    These evidence-based treatments may be generalized to developing countries.

    “Nonetheless, these treatments may be generalized to developing countries and efforts are underway to develop culturally sensitive interventions that are based on the principles of these evidence-based treatments.”
  • The paper relies on this without support.

    The use of medicinal nicotine leads to the reduction in withdrawal symptoms.

    “The use of medicinal nicotine leads to the reduction in withdrawal symptoms.”
  • The paper relies on this without support.

    Despite their limitations, the WHO and American Cancer Society prevalence data are the best data available.

    “Despite limitations, they are the best data available.”
  • The paper relies on this without support.

    Quit rates in the absence of pharmacotherapy depend on motivation, level of dependence, amount of behavioural support, definition of abstinence, and period of follow-up.

    “The quit rates that can be expected in the absence of pharmacotherapy will depend on the motivation and level of dependence of the smokers and the amount of behavioural support provided, as well as the definition of abstinence and period of follow-up.”
  • The paper relies on this without support.

    The absolute cessation rate with currently available pharmacotherapies remains around 20%.

    “Although currently available pharmacotherapies have been shown to improve success rates, the absolute cessation rate remains relatively low—around 20%.”
7 of 7

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

1 of 1

Citations

Cites

Show all 144 references

Research works printed but not linked: 5

  1. Hughes, 1992, The nicotine withdrawal syndrome: a brief review and update, Int J Smoking Cessation, 1, 21
  2. Hughes, 1990, Effects of abstinence from tobacco: a critical review, 317
  3. 2001, Tobacco use prevention and control, Am J Prev Med, 20, 1
  4. 2000, Introducing the guide to community preventive services, Am J Prev Med, 18, 1
  5. Cinciripini PM, Aubin H-J, Dale LC, Niaura R, Anthenelli RM, Stratus Group. Pooled analysis of three short-term, randomised, double-blind, placebo controlled trials with Rimonabant 20 mg/day in smoking cessation. 8th annual conference of the Society on Research on Nicotine and Tobacco Europe; Sept 23–26, 2006; Kusadasi, Turkey.

Cited by

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Items 101–200 of 228

Metadata

Authors
Hatsukami, D. K., Stead, L. F., & Gupta, P. C.
Affiliations
  • University of Minnesota (US)
  • University of Oxford (GB)
  • Healis Sekhsaria Institute For Public Health (IN)
Corresponding author
Hatsukami, Dorothy K
Venue
The Lancet
Publisher
Elsevier BV
Published
2008-06
Volume
371
Issue
9629
Pages
2027-2038
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W2470020720
Cited by
227
References
144
Citations by year
2026: 4 · 2025: 8 · 2024: 8 · 2023: 10 · 2022: 10 · 2021: 9 · 2020: 9 · 2019: 14 · 2018: 6 · 2017: 10 · 2016: 12 · 2015: 10 · 2014: 13 · 2013: 17 · 2012: 17
FWCI
2.45
Type
journal article
Language
en
Open access
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • American Cancer Society
  • National Institutes of Health (5p50da013333-10)
  • National Institute on Drug Abuse (P50- DA013333)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
tobacco dependence, nicotine dependence, smoking cessation, tobacco control, pharmacotherapy, behavioral interventions, relapse, neurobiology of addiction, treatment accessibility, patient matching
MeSH terms
Counseling, Female, Humans, Male, Nicotine, Physician's Role, Smoking, Tobacco Use Disorder, Prevalence, Smoking Cessation, Nicotinic Agonists

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