摘要：Addiction is a complex brain disease with frequently overlapping expressions involving nicotine, alcohol, and other drugs. Yet current health care practices, public policies, and national treatment data too often exclude nicotine or address its use as completely separate from other forms of substance use and addiction, compromising patients’ health and incurring unnecessary health care costs. Effective prevention and treatment requires the inclusion of nicotine in a comprehensive approach addressing all manifestations of addiction within health care policy and practice. EIGHTY MILLION AMERICANS, although not addicted, engage in substance use in risky ways that threaten health and safety. Of these, nearly a third use multiple substances—most frequently alcohol and tobacco. Another 40 million are addicted; of these, 56% are risky users of and 17% are addicted to multiple substances. 1 Addiction is a complex brain disease involving compulsive behaviors, including the pathological use of nicotine, alcohol, illicit drugs, controlled prescription drugs, or a combination of these. Different manifestations of the disease have in common certain risk factors, neurologic effects, and consequences. 2 If the prevention or treatment of addiction is too tightly focused on 1 substance or behavior, relapse or a different expression of the disease may emerge. 3 Public policies and health care practices are not up to date with the science. For a complex set of reasons, including that the consequences of tobacco use are primarily confined to adverse health outcomes, as opposed to the broader range of societal costs associated with alcohol and other drugs, primary prevention approaches address tobacco use as a separate condition from other substance use in spite of the fact that early use of any addictive substance increases the risk of use of and addiction involving other substances. 4 Addiction treatment programs focus on alcohol and other drugs, generally to the exclusion of nicotine, even though nicotine itself is highly addictive and its use increases the likelihood of addiction and relapse involving other substances. 5 National data sets tracking treatment services do not address addiction involving nicotine. Each year, the United States’ failure to effectively prevent risky substance use and treat addiction in all its manifestations accounts for almost $500 billion in costs to government alone 6 and 20% of all deaths. 7–9 Including all addictive substances in comprehensive approaches to substance use prevention and addiction treatment will advance national efforts to improve public health and control costs.
