Coping with urges to smoke: what is a clinician to do?

Cigarette smoking is a public-health problem associated with significant morbidity and mortality. Effective medications such as nicotine replacement therapy (NRT), bupropion, and varenicline can assistwith nicotine withdrawal and facilitate smoking cessation. In order to sustain abstinence, however, a smoker must also disrupt strong behavioral associations with smoking. Behavioral strategies complement pharmacotherapy by enhancing the smoker's motivation to quit and teaching quitting skills such as managing relapse triggers (e.g. negative emotions, urges to smoke). Despite these therapies, long-term cigarette abstinence rates are modest for each attempt to quit. However, many smokers who are persistent in their efforts eventually quit. This review outlines strategies for smoking cessation with a focus on pharmacotherapy.