Tobacco dependence has been found to increase smoking cravings, and reduce both self-efficacy and motivation to quit. The present research proposes to test the hypothesis that such negative consequences are related to identity concerns and should thus appear more strongly in dependent smokers with a high (vs. low) smoker identity. In two correlational studies, daily smokers (Study 1: N = 237; Study 2: N = 154) were assessed for tobacco dependence, smoker identity, self-efficacy, craving to smoke (Study 1), and motivation to quit (Study 2). Among smokers who declared to be strongly dependent, those scoring high in smoker identity reported more smoking cravings (β = .28, p = .008, 95% CI [0.084, 0.563], $ {\upeta}_p^{{}^2} $ = .03) and less motivation to quit than those scoring low (β = –.58, p = .003, 95% CI [–1.379, –0.282], $ {\upeta}_p^{{}^2} $ = .06). Smoker identity was unrelated to these variables among non-dependent smokers (ps > .40). The relationship between tobacco dependence and self-efficacy was not affected by smoker identity (ps > .45). Through these studies, we provided evidence that the implications of tobacco dependence on smoking maintenance and difficulties in quitting may be, in part, explained by identity mechanisms.

Tobacco use is the leading preventable cause of death in developed countries. Millions of smokers are willing to stop, but few of them are able to do so. Clinicians should only use approaches that have demonstrated their efficacy in helping patients to stop smoking. This article summarizes the evidence-based major findings and clinical recommendations for the treatment of tobacco dependence of the French Health Products Safety Agency (AFSSAPS). Clinicians should enquire about the smoking status of each patient and provide information about health consequence of smoking and effective treatments available. These treatments include counseling (mainly individual or social support and behavioral and cognitive therapy) and pharmacological treatment with either nicotine replacement therapy (NRT) or bupropion LP. Pharmacological treatments should be used only for proven nicotine dependence, as assessed by the Fagerstrom test for Nicotine Dependence. The choice of pharmacologic treatment depends of the patient's preference and history and of the presence of contra-indications. The clinician should start with a single agent, but these treatments may be used in combination. Smoking behavior is a chronic problem that requires long-term management and follow-up. Access to intensive treatment combining pharmacological treatment and extensive behavioral and cognitive therapy should be available for highly dependent patients.

Tobacco dependence is the most common substance use disorder in adults with mental illness. The prevalence rates for tobacco dependence are two to four times higher in these patients than in the general population. Smoking has a strong, negative influence on the life expectancy and quality of life of mental health patients, and remains the leading preventable cause of death in this group. Despite these statistics, in some countries smokers with mental illness are disadvantaged in receiving intervention and support for their tobacco dependence, which is often overlooked or even tolerated. This statement from the European Psychiatric Association (EPA) systematically reviews the current evidence on tobacco dependence and withdrawal in patients with mental illness and their treatment. It provides seven recommendations for the core components of diagnostics and treatment in this patient group. These recommendations concern: (1) the recording process, (2) the timing of the intervention, (3) counselling specificities, (4) proposed treatments, (5) frequency of contact after stopping, (6) follow-up visits and (7) relapse prevention. They aim to help clinicians improve the care, health and well-being of patients suffering from mental illness.