The extraordinarily harmful health consequences of tobacco addiction are appreciated by most health care providers and by many tobacco users. Most smokers want to quit, and as many as 40% try to quit each year, but most fail. Despite the severe threat to health and the poor odds of quitting, treatment of tobacco addiction is typically conceived of as a brief intervention involving some behavioral support and sometimes pharmacotherapy. The natural history of quitting in addicted smokers includes good early cessation rates followed by high rates of relapse. Consistent with this natural history, a smoker makes on average 5 quit attempts before he or she finally succeeds, and some are never able to permanently quit. Given the serious short-term risks of smoking, including risks of acute myocardial infarction and sudden death in people with underlying coronary disease and risks of respiratory and other infections in every smoker, waiting for several years for smokers to cycle through multiple quit attempts and relapses before they quit is an unreasonable medical option.
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