Nicotine Dependence as a Chronic Disease
Nicotine dependence should be treated as a chronic condition rather than a transient bad habit. [1, 2] Tobacco dependence is characterized by long-term cycles of remission and relapse, which requires repeated, ongoing clinical intervention. [1]
Guideline Positioning of Tobacco/Nicotine Dependence
The U.S. Public Health Service (PHS) clinical practice guideline states that “tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit.” [1] The VA/DoD clinical practice guideline states that tobacco dependence should be treated as a chronic relapsing condition and that it should include long-term follow-up to identify and prevent recurrence. [2]
Clinical Implications of the Chronic-Disease Model
A chronic disease model supports repeated assessment of tobacco/nicotine use over time. [1] The chronic disease model supports an expectation of relapse risk rather than treating relapse as failure of care. [1] Treatment planning emphasizes repeated evidence-based intervention after setbacks. [2]
Treatment Structure for Chronic Management
The PHS guideline emphasizes consistent identification and treatment of every tobacco user seen in a health care setting. [1] The VA/DoD guideline emphasizes treatment that includes long-term follow-up to prevent recurrence. [2]
Initiating Evidence-Based Intervention Across the Care Pathway
The PHS guideline states that the guideline offers clinicians approaches designed to prevent relapse, especially in the first 3 months after cessation. [3] The VA/DoD guideline supports long-term follow-up by health care professionals to identify and prevent recurrence. [2]
Relapse and Quit Attempts
The PHS guideline describes that only a minority of tobacco users achieve permanent abstinence after an initial quit attempt. [1] The PHS guideline states that most users persist in tobacco use for many years and cycle through multiple periods of remission and relapse. [1]
Chronic Care Goals
Intermediate goals, including reduced use and making quit attempts, are part of the path toward abstinence in chronic tobacco dependence care. [2] Treatment goals should include prevention of recurrence through ongoing follow-up. [2]