This is going to be a whirlwind tour through the treatment system, describing the realities for people who are trying to quit smoking in today’s treatment environment. First, I want to explore the basic assumptions that underlie, and in some cases inappropriately influence, how we look at the treatment of tobacco addiction. Next, I want to provide some of the characteristics of the system, recognising that there is really no comprehensive description of tobacco treatment available to us. And finally, I want to look at the factors that I think affect the system and will affect it in the future.

There are three basic assumptions. First, we often say “most smokers quit on their own”, and that has some very significant implications. It permeates the thinking of many of the health care providers who are supposed to be addressing this problem. Second, we have communicated the idea that if you want help to quit smoking, it is available to you. And third, we have said, with some evidence, that tobacco control policies create incentives for cessation, and we also have said that the economic justification for smoking cessation is irresistible - the numbers are overwhelming.

Let me examine the assumptions briefly. The first assumption is that most smokers quit on their own.¹1 do not think we know whether that is a preference or whether that is by default. We do not often ask smokers about why they choose to do what they do. We also know that they often do not recall what it was they finally did to quit smoking, or they may recall what they finally did, but not what they did the first two or three times they tried and failed. The idea that they quit on their own suggests, I think, that we know …