As an active researcher in the tobacco dependency field for nearly 20 years, I have seen our knowledge of the pathogenesis and pathophysiology of tobacco dependence grow by leaps and bounds. As our knowledge into basic behavioural and physiologic mechanisms has grown, so has our ability to improve treatment tools. Nonetheless, although we have ever more effective tools available which patients can use to help them stop smoking, there is no magic bullet that is going to make the smoker quit.

Nicotine replacement therapy, currently the most effective tool at our disposal to treat tobacco dependence, is an integral part of smoking cessation treatment. However, since each smoking patient has individual needs which must be met in order to stop smoking successfully, individualisation of treatment is a necessity for sustained smoking cessation. First, though, let us review some basic nicotine replacement therapy facts. Earlier in this conference, we reviewed material which shows that there are two fundamental, inter-linked forces driving cigarette smoking: psychological dependency and nicotine dependency. However, it is artificial to think of these driving forces as being different, because in reality they both describe various factors which affect neurotransmitter activity in the brain. Intrinsic mood states, external events (such as a pleasurable encounter with a friend), or drugs of abuse all affect brain neurochemical activity and thus change the way we feel, how we think, and how we respond to the world around us.

In the context of cigarette smoking, a large number of external factors, such as neutral habit situations, can affect neurotransmitter release rates in the brain, which serve to link smoking with those activities, and those activities with smoking. For example, having a cup of coffee, making a phone call, having a cocktail, being around other smokers, or after a meal, all can serve as …