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Today’s severely nicotine-dependent patient may not respond to the current ‘standard’ in tobacco dependence treatment, much of which is founded on nicotine dependence data and outmoded treatment principles from 15 years ago. To address the increase in nicotine dependence, Dr. Sachs shows that physicians may need to boost pharmacologic doses and period of medication use, try different mixtures of pharmacotherapy, and place more emphasis on minimizing withdrawal symptoms to avoid treatment failing. All Fellows of the ACCP consider the ‘no tobacco’ pledge, stating that they can remain tobacco-free and encourage their sufferers to accomplish the same, said James A.