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New York City has seen firsthand the tremendous impact that our smoking cessation efforts, including hard-hitting, graphic education campaigns, have made on smoking rates, spokeswoman Samantha Levine said

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and continued use of substance(s) and/or engagement in behaviour(s) despite adverse physical, psychological and/or social consequences. (The Canadian Society of Addiction Medicine, 1999) General Characteristics of Nicotine Addiction People who smoke more than 20 cigarettes/day and have their first cigarette within 30 minutes of waking indicates high nicotine dependence Causes a release of adrenaline from the adrenal glands providing a hit or kick from each puff of a cigarette Dependence develops fairly rapidly often within 60 days of regular use Withdrawal syndrome occurs when blood levels fall sharply Severity of dependence depends more on the difficulty the person has in quitting smoking than on the amount and pattern of smoking Chronic disease it can be progressive, relapsing and fatal (Fiore, Jaen, Baker, et al, 2008) Treatment Options for Nicotine Addiction Combination of counseling and pharmacotherapy is more effective than either option alone (Fiore, et al., 2008) The more intense the intervention, the better the outcome of abstinence (Cairney & Lawrence, 2002) Pharmacologic Options Clients/patients attempting to quit smoking should always be encouraged to use effective medications unless they are contraindicated in specific populations eg