I shall begin with a brief overview of the epidemiology of smoking and quitting smoking in the United States, using the Year 2000 goals as a point of reference.¹ I shall also briefly review the public health strategies put in place in the 1980s to help us achieve the Year 2000 objectives. Last year, the US Centers for Disease Control and Prevention (CDC) issued mid-course revisions for the objectives themselves.² With only five years remaining until the Year 2000, it is also time for some mid-course revisions in the strategies to achieve those objectives.

While we have made some significant gains in the policy arena, our gains in the treatment arena have been more limited. We must improve and intensify our strategies to promote smoking cessation if we are to come close to reaching the ambitious Year 2000 goals set a decade ago. To some extent, new treatment methods and goals are needed. But I submit that by far and away the greatest need is to do a much better job of disseminating and delivering the treatments that we have.

There is an urgency about the tobacco addiction treatment agenda that comes not just from the imminence of the Year 2000, but also from these simple and stunning facts. Tobacco addiction is the most common serious medical problem in the country and the nation’s most deadly drug addiction, killing more than 420000 Americans a year.³ One in five Americans who die each year, die from tobacco use. Yet over 25% of Americans continue to smoke or use smokeless tobacco despite a strong desire to quit.⁴ Treatment programmes and policies must be responsive to these realities, and we must not forget them in the discussions and deliberations we have during this conference.

From the time of the …