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Cigarette smoking is perhaps the most prevalent form of drug dependence in the world, and certainly the most lethal, eventually killing one in every two persisting users. Tobacco is notorious for the tenacious hold it has on smokers, and nicotine is now regarded by many as the purest pharmacological dependence, the very paradigm of drug addiction. Yet for years cigarette smoking was widely regarded as no more than a social habit and there was little awareness that it delivered a psychoactive drug. At usual dose levels, nicotine does not intoxicate or impair motor or cognitive performance or the ability to interact socially in an appropriate way. It does not induce violence. As a result, it is the most mundane, almost invisible, drug dependence. It presents numerous other paradoxes as well. Nicotine is a stimulant drug which users say calms them down and sedates. Smoking is often viewed as a form of self-medication to cope with stress, but there is little evidence that nicotine possesses any anxiolytic or antidepressant properties. Unlike the case of alcohol, cigarette smoking is usually seen as having little bearing on psychopathology, yet in the general population it is far more strongly associated with adverse mood states and with both neurotic and psychotic disorders. (1) The past decade has seen considerable progress in understanding the neurochemical basis of nicotine's effects and in the development of effective behavioural and pharmacological interventions to promote cessation. Despite this, there is little room for optimism. Worldwide both prevalence and deaths from tobacco continue to increase, and are likely to continue to do so for the foreseeable future.

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