Tobacco and Public Health - TCSC Indonesia

752
TREATMENT OF TOBACCO DEPENDENCE
dependence and has useful effects (weight control, mood control, relief of tobacco
withdrawal symptoms).
Tobacco dependence is associated with heavy consumption, tolerance, regulation
of intake, and withdrawal. Most smokers experience withdrawal symptoms such as
dysphoria/depressed mood, insomnia, irritability/frustration/anger, anxiety, difficulty of
concentration, restlessness, decreased heart rate, and increased appetite (Hughes 1991).
Tobacco dependence occurs often and is the most important barrier to cessation.
It shows interesting epidemiological features, some of them are outlined below.
One of the first studies in this respect was undertaken by Lagure et al. in France.
Over 1000 people took part in a telephone survey using the Fagerström Tolerance
Questionnaire (FTQ) (Lagrue et al. 1989). Approximately one-third of those who were
smokers (34% of the total sample) had an FTQ score of 3 or less (low dependence), 47%
had a score of between 4 and 6, and 19% had a score of 7 or more (severe dependence).
A smaller study (n = 201) was conducted by Hale and co-workers (1993) in the US,
using the criteria for drug dependence from the Diagnostic and Statistical Manual of
Mental Health III (DSM-III) (American Psychiatry Association 1987). Using these
criteria, they found that 24% of their sample were severely dependent (7–9 criteria), 26%
were moderately dependent (5–6 criteria), 30% were mildly dependent (3–4 criteria),
and 18% were not dependent (0–2 criteria).
Another study has been performed using the six-question Fagerström Test for
Tobacco dependence (FTND) in a representative population sample in Austria.
The sample consisted of 6000 randomly selected Austrians (aged 14 years or over)
who were interviewed face-to-face. 42% of men and 27% of women reported to be
smokers (Kunze 1993). Using a five-level categorization of the epidemiology of tobacco
dependence in Austria based on the FTND score, it was found that the majority of
smokers (all age groups and both sexes), 34%, had what was designated ‘low’ dependence
(FTND score 3–4), 30% had very low dependence (FTND score 0–2), and the
remaining 36% were divided between the medium, high, and very high dependence
groups (Schoberberger 1993).
There are interesting transcultural differences in degrees of tobacco dependence.
In societies where rates of smoking are low, it is feasible to suppose that the remaining
smokers are more highly dependent. The FTND should enable the epidemiological
aspects of tobacco dependence in different populations to be investigated in more
detail, with a view to assisting in the determination of the most effective treatment for
tobacco dependence in smoking cessation.
The lower the smoking prevalence in a country is, the higher the dependence level
of remaining smokers is; this is a result of selective quitting, because less dependent
smokers are probably stopping to a larger extent than more dependent smokers. In the
United States, a country with a low smoking prevalence, the smokers show a high
tobacco dependence. In other countries (Austria and Poland) the smoking prevalence
is high, but the averaged tobacco dependence is low (Fagerström et al. 1996).