Combined behavioral and pharmacological treatments for smoking cessation.

Combined behavioral and pharmacological therapies appear to be the best approach for treating tobacco dependence. Because these therapies operate by different mechanisms, complementary and potentially additive effects may be expected. This paper focuses on nicotine replacement therapies (NRT) combined with supportive counseling because they are the most widely used and intensively researched treatment methods. Nicotine replacement medications and counseling appear to produce additive or less than additive effects when combined. Additive effects of combined therapies are generally apparent in the number of smokers who survive the first few weeks without smoking, but may disappear at longer-term follow-up. Because any smoking in the first two post-quit weeks is strongly associated with poor treatment outcome, reduced incidence of early smoking re-exposure appears to be important for improving long-term smoking cessation. Mechanisms underlying additive effects need further clarification. What are the independent and interactive roles of compliance with medication and with behavior change prescriptions, of pharmacological withdrawal suppression, of relapse prevention skills training, and of social support provided by counseling? Given the prevalence and importance of post-quit smoking relapses, can anything be done to further reduce incidence or to counteract their deleterious effects? Do any existing treatments slow relapse? If not, how can this be accomplished? Effective treatments now exist, but these cannot have an impact unless they are used; we need to know what methods can effectively enhance use.