'Consonant' smokers know and accept the risks associated with tobacco consu
mption, and do not wish to change their smoking, whereas 'dissonant' smoker
s are tobacco consumers whose attitudes differ from their behaviour. Disson
ant smokers have several options: to quit smoking (the optimal solution), r
educe their smoking, switch products or brands, or do nothing. To dale, nic
otine replacement therapy (NRT) is the best-established medical aid to smok
ing cessation, but several important factors impact on NRT use. As smokers
constitute a diverse group there is a need for various different formulatio
ns, some of which will suit certain smokers better than others. Smokers sho
uld be allowed to select their preferred products in order to increase comp
liance, and should also be permitted to combine various products if desired
. Adequate dosage regimens should be stressed in order to avoid under-dosin
g, which is common with NRT. It is also essential that the medical system f
ocuses increasingly an the diagnosis and treatment of those smokers who are
unable or unwilling to quit smoking. Nigh nicotine dependence correlates w
ith a high risk of pulmonary and cardiovascular disease; because these smok
ers cannot quit, cessation efforts have little impact on the incidence of t
obacco-related diseases in this population. Additional smoking control inte
rventions, such as smoking reduction therapy, are therefore required to tre
at this group. Our experience in Vienna shows that these smokers can be tar
geted through approaches that utilize new messages offering alternatives to
cessation.