Despite a historical inclination to view tobacco use as a defect in character or reason, advances in the neurobiological understanding of human behavior and the associated disturbances in behavior patterns produced by exposure to nicotine lead to a conceptualization of tobacco dependence as a chronic disease of the brain. Far from being ineffective, the health care practitioner is in a supremely enabled position to effect change, given the enormous access health care has to dependent patients and the established models of longitudinal care of chronic illness. Our understanding of the biology of addiction, as well as the availability of effective methods of treatment, create a fiduciary responsibility to patients suffering from the addiction -a responsibility which is difficult to ignore given the magnitude of the problem. Until recently, the focus of change within health care has been on promoting new individual and organizational roles for the health care professional caring for tobacco-dependent patients. This chapter explores those roles more fully and suggests new ways of imagining these responsibilities. In addition, this chapter will explore the nature of the institutional role of health care in establishing cultural norms and expectations that are most likely to influence the future trajectory of the epidemic.