Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

6. Tobacco 121particular reinforcing effects of nicotine. Enhanced release of dopamine, norepinephrine,and serotonin may be associated with pleasure, mood elavation,and appetite suppression. Release of acetycholine may be associated withimproved performance on behavioral tasks and improvement of memory, andthe release of beta-endorphin may be associated with the reduction of anxietyand tension (Benowitz, 2001).CLINICAL PRACTICE GUIDELINESPhysicians have a unique role to play in the anti-smoking arena (Sullivan,1991). Past reviews (Orleans, 1993), monographs (U.S. Department of Healthand Human Services, 1994b), and guidelines (American Psychiatric Association,1996) underscore the importance of physician intervention on smoking ina variety of medical settings. The Public Health Service–sponsored ClinicalPractice Guideline, Treating Tobacco Use and Dependence (Fiore et al., 2000),provides clinical and systems interventions that are intended to increase thelikelihood of successful quitting. The major findings and recommendations maybe summarized as follows:1. Tobacco dependence is a chronic condition that often requires repeatedintervention. However, existent effective treatments can produce longtermor even permanent abstinence.2. Because effective tobacco dependence treatments are available, everypatient who uses tobacco should be offered at least one of these treatments:• Patients willing to try to quit tobacco should be provided treatmentsidentified as effective.• Patients unwilling to try to quit tobacco use should be provided a briefintervention designed to increase their motivation to quit.3. It is essential that clinicians and health care delivery systems institutionalizethe consistent identification, documentation, and treatment of everytobacco user seen in a health care setting.4. Brief tobacco treatment is effective, and every patient who uses tobaccoshould be offered at least brief treatment.5. There is a strong dose–response relation between the intensity oftobacco counseling and its effectiveness. Treatments involving person-topersoncontact (via individual, group, or proactive telephone counseling) areconsistently effective, and their effectiveness increases with treatment intensity(e.g., minutes of contact).6. Three types of counseling and behavioral therapies were found to be especiallyeffective and should be used with all patients attempting tobacco cessation: