Tolerance of nicotine increases over time, and experienced smokers can self-administer doses of nicotine that would make nonsmokers ill. The pathophysiology of nicotine dependence clearly involves the brain, the endocrine system, and behaviour. Although the effects of nicotine administration and deprivation are complex, they are orderly and are related to factors such as the amount of nicotine administered and the time since the last dose. Physical dependence can complicate the process of achieving and maintaining tobacco abstinence, and the symptoms can be so unpleasant as to precipitate relapse. The potential for behavioural and pharmacological treatment of the addicted tobacco user and the problems of withdrawal should also be recognized.
Nicotine dependence is clearly a major barrier to successful cessation.
Currently, only a few health professionals are trained in the treatment of tobacco dependence. Tobacco dependence is a serious public health problem which warrants serious attention if the epidemic of tobacco-related mortality and morbidity are to be reduced. WHO will continue to play a leading role in the global prevention and reduction of tobacco use and in the promotion of the concept of tobacco-free societies. For further information please contact Health Communication and Public Relations, WHO, Geneva, Switzerland.