Need of the future: treatment of tobacco dependence and smoking cessation
According to WHO and other national and international bodies, the prevalence of smoking and mortality from smoking related diseases are still increasing in most countries. Some of the European countries experience among the highest smoking rates in the world. In the 1970s, WHO reckoned that about one million deaths per year world-wide were attributable to smoking. This figure became 3 million in the 1990s, According to WHO it is now 5 million and, if sufficient measures are not taken to stop the pandemic, it will rise to 10 million by 2030s. It appears evident that the classical approaches thus far promoted over the past several decades by national and international health bodies and which included legislation, school-based education, public information, congresses, statistics, tar and nicotine levels and many such advocacy actions, failed to reduce the prevalence of smoking and of related diseases to a significant extent. It is hoped that the new WHO Framework Convention on Tobacco Control, FCTC, will empower governments to stop the spreading of tobacco use.
WHO’s International Classification of Diseases, in its 10th edition, classifies the use of tobacco (F17.2 and 17.3) among the mental and behavioural disorders due to psychoactive substance use (F10-F19) together with alcohol, cocaine, opioids and similar drugs. Being a disease issue, a new and medically more pragmatic approach is, therefore, needed to tackle the smoking epidemic. Although the preventive approaches mentioned above are essential and must proceed, consideration should be given to medical treatment of smoking which includes therapy and assistance to smokers in giving up the addiction. Besides primary prevention of the onset of smoking i.e., preventing young people from starting smoking, cessation of smoking is also needed, i.e. counselling and treatment provisions to be available for the millions of adults who smoke and would like to stop. Already in 1988 WHO, in its Smoke-free Europe (Strategy No.5) emphasised the need to secure a vast availability of assistance to smokers wishing to stop. Stopping smoking is becoming evermore timely, as public and governments' attitudes against passive smoking are getting stronger and smokers are under rising social pressure not to smoke.