New terminology for the treatment of tobacco dependence: a proposal for debate

Abstract

Tobacco dependence is characterised as a chronic, relapsing disorder that typically requires multiple quit attempts before successful, long-term abstinence is achieved (Steinberg, Foulds, Richardson, Burke, & Shah, 2006). Best practice, evidence-based treatment includes multiple-session counselling and pharmacotherapy, or the combination of both (Fiore et al., 2008). The field has moved past the notion that tobacco dependence is simply a bad habit, a vice, or a moral deficiency that can be overcome by willpower or education alone (Mars & Ling, 2008). However, the language used in discussing treatment has not always been consistent with this evidence. Some words and phrases used lend themselves to varied meanings, and could lead to significant misunderstanding not only among professionals in the field, but also among the general public (O'Brien, 2010; Davis, 1992; Perkins, 1999; Hughes, 2013). In this paper, we discuss some commonly used, problematic terminology, and suggest more appropriate terms (Table 1).

Increasing the Quality and Availability of Evidence-based Treatment for Tobacco Dependence through Unified Certification of Tobacco Treatment Specialists

“…The proposed unified TTS credential is, at present, timely. TTSs are quickly becoming an established specialty (Wolff, Hughes, & Woods, 2013); however, the processes and opportunities for individual TTS credentialing vary significantly by location. Several CTTTP-accredited training programs have sought to fill the certification void by providing a 'certificate' and/or an evaluation for trainees; however, these options do not offer the objectivity and rigour provided by an independent credentialing process and there is an inherent conflict of interest when training programs also offer credentialing.…”

Smokers’ Understandings of Addiction to Nicotine and Tobacco: A Systematic Review and Interpretive Synthesis of Quantitative and Qualitative Research

“…Surgeon General in 1988, 1 and it is increasingly recommended that nicotine addiction be approached as a disorder requiring medical treatment. [2][3][4] Various measures of nicotine dependence have been developed, validated and are in regular use in both research and clinical applications. [5][6][7][8] The constellation of features included in such measures include continued smoking despite known harms, difficulty quitting, feelings of craving or compulsion, and how long after waking someone smokes their first…”

The biomedicalisation of smoking cessation: a mixed methods study of lay perspectives on nicotine addiction

“…A number of authors have called for tobacco dependence to be treated as a chronic disease, similar to diabetes or hypertension (Aveyard & Raw, 2012;Leone & Evers-Casey, 2012;Prochaska & Benowitz, 2016;Wolff et al, 2013). The results of this research suggest that this definition is at odds with the way that many smokers understand their own smoking.…”

“…The BDMA highlights the addictiveness of smoking, which is portrayed as a "chronic" condition that requires treatment, much like alcoholism (Wolff et al, 2013). There is very limited evidence that explores whether belief that one is addicted to smoking impacts in any way on quit attempts or treatment choices (West, 2011).…”

“…Should people who smoke be told, as has been recently suggested, that they have a "chronic, relapsing disease"? (Wolff, Hughes, & Woods, 2013). Should they be informed that it is difficult to quit and relapse is likely?…”