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Treatment of Alcoholism and Nicotine Dependence-Reply

Richard D. Hurt, MD
JAMA. 1996;276(10):784. doi:10.1001/jama.1996.03540100028022.
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In Reply.  —There is no doubt that improvement in functional outcome is an important measure of the effectiveness of alcoholism treatment. However, if the patient has achieved social stability and psychosocial adjustment but still dies prematurely because of an untreated addictive disorder, we believe this is a less than desirable outcome. Mortality is the ultimate outcome by which many medical treatments are judged. Many studies point out that mortality is an important outcome following alcoholism treatment.1,2The problem in most addictions treatment programs at this time is that nicotine dependence is not addressed in the same way that other addictive disorders are treated. Historically, the early efforts at treatment of alcoholism by the Salvation Army did include the treatment of nicotine dependence.3 Somewhere between then and the early 1960s when inpatient treatment programs began to develop, that concept was lost and the emphasis was on treating the alcoholism to the


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