PURPOSE:The more severely nicotine-dependent the patient, as measured by the Fagerström Tolerance Questionnaire (FTQ) or the newer Fagerström Test for Nicotine Dependence (FTND), the less effective a fixed, “standardized”, tobacco-dependence treatment regimen and the greater the medical need for more intensive tobacco-dependence treatment. Therefore, we wanted to determine whether patients seeking treatment for tobacco dependence now were more nicotine dependent than 15 years ago.
METHODS:We compared nicotine-dependence severity, as measured prospectively by the physiologically validated Fagerström Tolerance Questionnaire (FTQ) scale (0–11 points), before any treatment began, in three different cohorts from 1989–2006: (1) Nicotine Patch Study (NPS), N=220, Enrolled 12/1989–4/1990; (2) Bupropion SR Study (BSRS), N=206, Enrolled 9/1994–12/1994; (3) St. Helena Hospital Center for a Smoke-Free Life (CSFL), N=204, Enrolled 2/2005–10/2006. NPS and BSRS were randomized, double-blind, placebo-controlled FDA registration trials using similar Inclusion/Exclusion criteria. FTQ analysis was collapsed across study-drug conditions. CSFL group were patients entering an intensive, 8-day, residential, interdisciplinary tobacco-dependence treatment program, involving individualized and optimized behavioral and pharmacological therapy.
RESULTS:Pretreatment FTQ steadily increased as a function of time: 1989 (NPS), 6.65±1.72 (mean±1SD), v 1994 (BSRS), 7.02±1.80, v 2006 (CSFL), 7.44±1.80 (Spearman P<0.0001). Also, the proportion with a high FTQ score (7–11 points) steadily increased from 1989 to 2006: NPS 55.5% (122/220) v BSRS 65.5% (135/206) v CSFL 73.0% (149/204), Fisher’s Exact P=0.0007.
CONCLUSION:Patients trying to stop cigarette use now are significantly more nicotine dependent than 15 years ago. Nicotine-dependence severity, measured by the FTQ, has increased 12% between 1989–2006, while the proportion classified as highly nicotine dependent (FTQ≥7 points) has increased 32%. Now, three-fourths of patients currently seeking tobacco-dependence treatment are highly nicotine dependent.
CLINICAL IMPLICATIONS:Because cigarette users are substantially more physically nicotine dependent now than in the past, clinicians must individualize pharmacotherapy, including dose(s), combinations, and duration, to assure treatment effectiveness and suppression of nicotine withdrawal symptoms, so that the patient does not experience a treatment failure.
DISCLOSURE:David Sachs, No Financial Disclosure Information; No Product/Research Disclosure Information