The nicotine addiction trap: a 40-year sentence for four cigarettes.

It is generally recognized that smoking causes more preventable illness than any other form of drug addiction. Despite this, and unlike the case with other addictions, few services are provided to help people to give it up. Yet nicotine is highly addictive. Its role in the recruitment process, the development of dependence and as a block to smoking cessation are discussed within the context of the typical smoking career. Over 90% of teenagers who smoke 3-4 cigarettes are trapped into a career of regular smoking which typically lasts for some 30-40 years. Only 35% of regular smokers succeed in stopping permanently before the age of 60, although the large majority want to stop and try to stop. The pharmacological effects of nicotine and other factors that determine dependence on smoking, together with the attitudinal and cognitive factors that determine motivation to stop smoking, are considered within the framework of a decision-making model which reflects the cycles of change in smoking status at different stages of the smoking career. It is argued that, in future intervention strategies, the newly developed treatment approaches should be included to complement traditional motivational approaches based on educational and restrictive measures.