Achieving tobacco cessation: current status, current problems, future possibilities.

Assisting smokers to achieve tobacco cessation has always been difficult. The development of pharmacological approaches to the attainment of abstinence from tobacco usage has been very helpful, although our understanding of optimal clinical use is still incomplete and imperfect. Bupropion and nicotine therapy (NT) will help reduce the severity of nicotine withdrawal symptoms, whether used separately or in combination. Effectiveness is greater with the combination of drugs than with either drug alone. Nevertheless, the initial 'quit rate' is usually less than 50%, and there is a considerable decrease in the abstinence rate after the course of therapy has been completed. Effectiveness is increased if higher doses of NT are employed, with or without concomitant bupropion. Much remains to be learned about optimal doses, preferred durations of therapy and tapering, prevention and management of relapses, and selection of modes of delivery of NT. The discovery that nicotine dependence has a major genetic component has stimulated much interest and many research studies. The preliminary results are interesting, to say the least.