The Pharmacotherapy of Adolescent Tobacco Dependence

In the United States, people with mental illness are 2.7 times more likely to smoke than are those without mental illness. In fact, 44% of cigarettes are sold to consumers with a mental illness. (Most smokers start before age 18; Kandel, Kiros, Shaffran, & Hu, 2004.) Starting before age 13 is linked to psychopathology in later adolescence. Tobacco dependence continues to be the single most preventable cause of morbidity and mortality worldwide. Health care providers are beginning to address tobacco use and dependence more assertively, however, there is limited research to guide clinical practice in the pediatric population. This article examines what clinicians can do to better screen, assess, and treat tobacco use and dependence among young people focusing on pharmacotherapeutic strategies. The pattern of tobacco use and nicotine dependence among youth is different from that of adults. Even youth who do not smoke on a daily basis can have difficulty with quitting tobacco. Although adolescents attempt to quit smoking less often than adults, 64% have attempted to quit on their own. Little is known about the longitudinal course of nicotine dependence following interventions with adolescents designed to affect smoking habits, particularly among high-risk samples. Many adolescents who cannot quit on their own may benefit from medication and behavioral smoking cessation therapies.