ABSTRACT
Smoking cessation is a major health care issue: Cigarette smoking increases the risk for a variety of cancers, chronic bronchitis, myocardial infarction, angina, peripheral vascular disease, problem pregnancies, and stroke. Annual health care costs attributed to cigarette smoking have been estimated at $50 billion each year, with an additional estimated $50 billion in indirect costs related to premature death and disease (U.S. Department of Health and Human Services, 1994a). Smoking cessation decreases an individual’s risk for smoking-related disease, and can be expected to produce subsequent decreases in smoking-related health care costs (Henningfield, Ramstrom, et al., 1994). Many cigarette smokers report that they want to stop smoking, and this self-reported desire is evident in their behavior: Approximately onethird of all cigarette smokers attempt to quit smoking each year (Hatziandreu et al., 1990). Unfortunately, it has been estimated that 1-year success rates among these self-quitters is between only 3 and 8% (Cohen, Lichtenstein, & Prochaska, 1989; Fiore et al., 1990). Many current smokers who have been unable to sustain abstinence cite tobacco withdrawal, characterized by anxiety, restlessness, irritability, and cigarette craving (e.g., Hughes & Hatsukami, 1986; Shiffman & Jarvik, 1976; Tiffany & Drobes, 1991), as a reason. Medications intended to aid smoking cessation efforts are designed, at least in part, to alleviate these nicotine withdrawal symptoms.
