Feature Article

The ‘treatment-resistant’ smoker

Renee Bittoun



Strategies to help smokers who are resistant to treatment include intensive combination pharmacotherapies and the use of nicotine replacement therapy to reduce the harm caused by smoking.

Key Points

  • There is a hierarchy of strategies available to help tobacco smokers that begins with permanent cessation and provides safe options for those people unable to achieve this.
  • Some smokers respond well to some pharmacotherapies and others do not. Every smoking cessation pharmacotherapy for which there is substantiated evidence should be tried – a patient just might strike the most suitable one for them.
  • The harm reduction strategy of reducing smoking by the use of nicotine replacement therapy (NRT) should be considered for treatment-resistant smokers. It is less harmful for a person to smoke while using NRT than it is to smoke without it.
  • There is good evidence that it is never too late to quit smoking. Reducing smoking by the transient use of NRT may be a gateway to quitting for treatment-resistant smokers.
  • Algorithms are provided for smoking cessation therapy options and the use of combination NRT in treatment-resistant smokers.