Anti-Smoking therapies: is harm reduction a viable alternative to smoking cessation?

Smoking cessation should be proposed to all smokers by healthcare workers; however, severely dependent smokers are frequently unable or unwilling to quit smoking. For some of them, particularly if they have failed in previous cessation attempts and have smoking-related disorders, a long term reduction of tobacco consumption may be proposed as the 'second best' attitude and may offer a perspective for reduction of some of the risk factors associated with smoking. This attitude, which cannot be regarded as a general health policy, usually requires the prolonged use of nicotine replacement therapy. From available studies, it does not seem that a period of sustained smoking reduction decreases the chance of future cessation, it may even increase it.