The case for treatment

“Tobacco dependence treatment includes (singly or in combination) behavioural and pharmacological interventions such as brief advice and counselling, intensive support, and administration of pharmaceuticals, that contribute to reducing or overcoming tobacco dependence in individuals and in the population as a whole.”
Source: WHO evidence based recommendations on the treatment of tobacco dependence, 2002

There are currently 1.1 billion smokers alive in the world, and 5 million tobacco related deaths per year. Many of today’s smokers want to stop and around a third will try repeatedly to do so – but only around 1% will succeed on their own. If current trends continue, this year’s 5 million deaths will become 10 million annually by 2030, and by the middle of this century 520 million will have died from a smoking-related disease. While future preventive policy and education measures should slow the increase in uptake of tobacco use, but over a very long time scale, premature deaths among those already using tobacco will only be reduced in the short to medium term if those people stop.

World Bank. Curbing the Epidemic:

Governments and the economics of tobacco control. World Bank Publications, 1999, p.80.

 

Public policy vs individual treatment – a chicken or egg situation?
It is sometimes suggested that tobacco dependence treatment is something that need only be considered after other population-level measures such as public education campaigns, taxation, advertising bans and smokefree policy have been introduced. However, tobacco control policies will increase the number of smokers in a population who want to stop, and we know from population cessation data that the unaided quit rate is extremely low. Many smokers who want to stop cannot do so without help. Treatment supports tobacco control policies like taxation and smokefree legislation, by helping those motivated by the policies to stop. Furthermore those policies are more likely to be perceived as fair and reasonable when help is offered to those who need it. There is therefore a strong ethical case to provide treatment to support the introduction of tobacco control policy measures .

“Cessation” or “treatment”?
The term “cessation” is often used to cover everything that promotes attempts by individuals to stop using tobacco, but “treatment” specifically refers to interventions that support people during their attempts to stop. Treatment can be at individual, group, or community level, but what characterises treatment is that it is based on evidence of effectiveness and delivered by people trained in the strategies being used. Examples include simple advice delivered by a health care professional, sustained 1-1 or group support, pharmaceutical therapies, telephone counselling, mass-media-led or community-wide quit events, and Internet-based support programmes.