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Comprehensive Nicotine Treatment
On May 3, 1988 the Surgeon General's report on Nicotine Addiction was released. On June 20, 1988 the first patients were admitted to the new Nicotine Addiction Treatment Unit at Glenbeigh Hospital in Miami. The treatment team which was assembled to care for these patients consisted of a Pulmonologist, Cardiologist, Psychiatrist, Registered Dietician, Nurse-Counselor, Therapeutic Recreation Specialist, and a specially trained nursing team. The need for each team member's role became increasingly evident as each day passed.
The typical patient seen in treatment has been smoking twenty or more years, has had repeated unsuccessful attempts to quit (usually five or more in the last two years) using cigarette substitutes, hypnosis, special filters and inhalation devices, nicotine chewing gum, and a variety of behavioral interventions. All patients seen were facing serious health consequences as identified by their primary physician, including second heart attacks, strokes, and chronic pulmonary disease. Several patients were also battling cancers related to their smoking, and knew that their best hope for remission was the cessation of their smoking.
A cornerstone of the treatment methodology was the recognition that, at its core, nicotine dependence is an addiction. As an addiction, treatment has its highest probability of success if the established methods of addiction treatment are appropriately constructed to meet this challenge. Whenever we drifted from this theme, we found a loss of effectiveness in our treatment approach.
A primary concept in our treatment approach is that we are treating a medical disease of addiction, not a "bad habit." A major problem with the "bad habit" approach to treating nicotine dependence is that it ignores or minimizes the psychoactive power of the drug, nicotine. Milligram for milligram, nicotine is more potent than cocaine in modifying behavior.  The Surgeon General's recent report stated that "the pharmacologic and behavioral processes that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine." 
Recognition of the power of this drug, and the typical model of control over normal life functions it has, is critical to a patient's understanding of the disease as an addiction. Since smoking has been intimately involved in the patient's daily life for so many years, their ability and willingness to recognize its influence is impaired. The recognition that a whole lifestyle has been constructed around the use and acquisition of …