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Tobacco or nicotine dependence is now established as a disease and listed by several countries and by the World Health Organization. The characteristics and mechanisms of tobacco dependency will be described as well as its assessment and implications for treatment.

Hundred smokers were admitted for treatment of smokers by means of nicotine chewing gum; they were divided into three groups: smokers without diseases associated with smoking, smokers suffering from bronchitis and smokers suffering from cardiovascular disease. In 1989 the results obtained in 94 patients were evaluated 12 months after the onset of treatment. Four smokers were eliminated. The value of nicotine dependence according to Fagerström was on average 7.6 +/- 1.8 points which is a strong dependence. The majority of smokers smoked 15 to 24 cigarettes per day, one third 25 cigarettes or more per day. Five-months treatment was completed by 70 subjects and after one year, abstinence was recorded in 46, i. e. 48% of those evaluated. Abstinence was verified by the absence of carbon monoxide in the expired air: 3.1 +/- 1.6 ppm CO. In individual groups abstinence was achieved in 42, 42 and 63% resp. No serious side effects of treatment nor abstinence symptoms were detected. They occurred only during the first months of treatment. In the treatment psychological support was emphasized, frequent contact of the patient and therapist and correct chewing of adequate amounts of chewing gum. Treatment of smokers with cardiovascular disease was without complications and without manifestations on the ECG tracing. Patients with chronic bronchitis had after one year's abstinence better FEV1 values in 25%.