At present, the best methods for treating tobacco dependence involve combined use of behavioral and pharmacologic therapies. Because they operate by different mechanisms, complimentary and potentially additive effects may be expected when behavioral and pharmacologic treatments are used in combination. Absolute rates of successful quitting are enhanced by combined therapy compared with single therapies, with effects being additive or less than additive. There is evidence both that behavior therapy enhances the efficacy of NRT and that NRT enhances the efficacy of behavior therapy. Thus, combined therapies produce quit rates greater than those generally produced by either treatment intervention alone and substantially better than general population quit rates of 5 percent or less.
Data are available only for the second mechanism listed.
This is an important observation, as early smoking behavior is a very powerful predictor of subsequent success versus failure. Approximately 90 percent of smokers who have lapses during the first 2 postquit weeks of combined therapy go on to fail in that quit attempt, while only 50 percent of early abstainers ultimately return to smoking. The role of withdrawal suppression here is controversial. With the exception of craving, symptom suppression has not been reliably related to abstinence success. Evidence for relapse prevention effects of therapies that extend beyond the initial few postquit weeks is sparse.