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Treating Tobacco Dependence: State of the Science and New Directions

Caryn Lerman, Freda Patterson, Wade Berrettini

From the Abramson Cancer Center, Center for Neurobiology and Behavior, Annenberg Public Policy Center, University of Pennsylvania Health System, Philadelphia, PA

Address reprint requests to Caryn Lerman, PhD, Tobacco Use Research Center, 3535 Market St, Suite 4100, Philadelphia, PA 19104; e-mail: clerman{at}mail.med.upenn.edu.

Despite almost two decades of intensive tobacco control efforts, nearly one quarter of Americans continue to smoke. The two United States Food and Drug Administration–approved medications used to treat tobacco dependence, bupropion and nicotine replacement therapy, are effective for only a fraction of smokers. Investigations of medications approved for affective disorders and other forms of substance abuse, such as fluoxetine and naltrexone, have yielded mixed results as tobacco dependence treatments. A particular challenge in tobacco dependence treatment is the development of effective approaches for smokers with unique needs, such as cancer patients and pregnant women. Despite new developments in these areas, significant gaps in knowledge and practice remain. Basic research in the neurobiologic and genetic basis of nicotine dependence offers promise for the development of novel and more effective treatment approaches. For example, emerging research in pharmacogenetics explores how genetic variation in drug-metabolizing enzymes and drug targets modifies response to pharmacotherapy. These discoveries could someday help practitioners to individualize the type, dosage, and duration of tobacco dependence treatment based on genotype, and maximize the efficacy.

Supported by a Transdisiciplinary Tobacco Use Research Center Grant P5084718 from the National Cancer Institute and National Institute on Drug Abuse.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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