According to the 2007 National Survey on Drug Use and Health, an estimated 70.9 million Americans aged 12 or older reported current use of tobacco—60.1 million (24.2 percent of the population) were current cigarette smokers, 13.3 million (5.4 percent) smoked cigars, 8.1 million (3.2 percent) used smokeless tobacco, and 2 million (0.8 percent) smoked pipes, confirming that tobacco is one of the most widely abused substances in the United States. Although the numbers of people who smoke are still unacceptably high, according to the Centers for Disease Control and Prevention there has been a decline of almost 50 percent since 1965. There are more than 4,000 chemicals found in the smoke of tobacco products. Of these, nicotine, first identified in the early 1800s, is the primary reinforcing component of tobacco. Cigarette smoking is the most popular method of using tobacco. The cigarette is a very efficient and highly engineered drug delivery system. By inhaling tobacco smoke, the average smoker takes in 1–2 mg of nicotine per cigarette. When tobacco is smoked, nicotine rapidly reaches peak levels in the bloodstream and enters the brain. Immediately after exposure to nicotine, there is a "kick" caused in part by the drug’s stimulation of the adrenal glands and resulting discharge of epinephrine (adrenaline). The rush of adrenaline stimulates the body and causes an increase in blood pressure, respiration, and heart rate.
Research has shown that treatments for tobacco addiction do work. Although some smokers can quit without help, many individuals need assistance with quitting. This is particularly important because smoking cessation can have immediate health benefits. For example, within 24 hours of quitting, blood pressure and chances of heart attack decrease. Long-term benefits of smoking cessation include decreased risk of stroke, lung and other cancers, and coronary heart disease. A 35-year-old man who quits smoking will, on average, increase his life expectancy by 5 years.Nicotine Replacement Treatments. Nicotine replacement therapies (NRTs), such as nicotine gum and the transdermal nicotine patch, were the first pharmacological treatments approved by the Food and Drug Administration (FDA) for use in smoking cessation therapy. NRTs are used (in conjunction with behavioral support) to relieve withdrawal symptoms—they produce less severe physiological alterations than tobacco-based systems and generally provide users with lower overall nicotine levels than they receive with tobacco. An added benefit is that these forms of nicotine have little abuse potential since they do not produce the pleasurable effects of tobacco products, nor do they contain the carcinogens and gases associated with tobacco smoke. Behavioral treatments, even beyond what is recommended on packaging labels, have been shown to enhance the effectiveness of NRTs and improve long-term outcomes. The FDA’s approval of nicotine gum in 1984 marked the availability (by prescription) of the first NRT on the U.S. market. In 1996, the FDA approved Nicorette gum