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* Key Point Nicotine is at least as strong an addiction as drugs of abuse. In the past there was some controversy regarding whether or not smoking was a dependency or an addiction. However, it is now generally agreed that nicotine is at least as strong an addiction as drugs of abuse.1 The use of nicotine results in significant changes in the brain that make people want to smoke, regardless of the deadly potential of long-term smoking. Long-term smoking also causes unpleasant psychological and physiological withdrawal symptoms when individuals stop.1 Historically, nicotine addiction has been one of the hardest substance-use dependencies to break. The 1988 Surgeon Generals Report, Nicotine Addiction, concluded that: Cigarettes and other forms of tobacco are addicting, Nicotine is the drug that causes addiction and that the pharmacological and behavioral characteristics that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine.2 According to this report, certain criteria must be met before a drug can be classified as addictive. The criteria are primary: highly controlled or compulsive use, psychoactive effects (eg, pleasure), and drug-reinforced behavior. Other additional criteria include: addictive behaviors (ie, stereotypical patterns of drug use, drug use despite known harmful effects, relapse after drug use is stopped, and recurrent drug cravings); dependence-producing effects (ie, tolerance, physical dependence, and pleasant effects [euphoria]).2 References Jarvis MJ. Why people smoke. BMJ. 2004;328:277-279. Centers for Disease Control and Prevention. The Health Consequences of Smoking: Nicotine Addiction; A Report of the Surgeon General. Washington DC: US Department of Health and Human Services; 1988. * Relapse is very common. Overall overwhelming majority of unaided quit attempts are not successful. 6 month abstinence 3-5%. * Key Point Nicotine addiction is a cycle which begins with nicotine