Treating Tobacco Use and Dependence
Tools to help you help your patients quit
Clinical Practice Guidelines
The Public Health Service Clinical Practice Guidelines contains strategies and recommendations designed to assist clinicians; tobacco dependence treatment specialists; and health care administrators, insurers, and purchasers in delivering and supporting effective treatments for tobacco use and dependence.
Ten Key Guideline Recommendations
Tobacco dependence is a chronic disease
and it often requires repeated intervention and multiple attempts to quit.
It is essential that clinicians and health care delivery systems consistently identify and document tobacco use status and treat every tobacco user seen in a health care setting.
Tobacco dependence treatments are effective
across a broad range of populations. Clinicians should encourage every patient willing to make a quit attempt to use the counseling treatments and medications recommended in the Guideline.
Brief tobacco dependence treatment is effective.
Clinicians should offer every patient who uses tobacco at least the brief treatments shown to be effective in the Guideline.
Individual, group, and telephone counseling are effective
and their effectiveness increases with treatment intensity. Two components of counseling are especially effective, and clinicians should use these when counseling patients making a quit attempt:
- Practical counseling (problem solving/skills training)
- Social support delivered as part of treatment
Numerous effective medications are available for tobacco dependence
and clinicians should encourage their use by all patients attempting to quit smoking—except when medically contraindicated or with specific populations for which there is insufficient evidence of effectiveness (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents).
- Seven first-line medications (5 nicotine and 2 non-nicotine) reliably increase long-term smoking abstinence rates:Bupropion SR
- Nicotine gum
- Nicotine inhaler
- Nicotine lozenge
- Nicotine nasal spray
- Nicotine patch
- Varenicline
- Clinicians also should consider the use of certain combinations of medications identified as effective in the Guideline.
Counseling and medication are effective when used by themselves
for treating tobacco dependence. The combination of counseling and medication, however, is more effective than either alone. Thus, clinicians should encourage all individuals making a quit attempt to use both counseling and medication.
Telephone quitline counseling is effective
with diverse populations and has broad reach. Therefore, both clinicians and health care delivery systems should ensure patient access to quitlines and promote quitline use.
If a tobacco user currently is unwilling to make a quit attempt
clinicians should use the motivational treatments shown in the Guideline to be effective in increasing future quit attempts.
Tobacco dependence treatments are both clinically effective and highly cost-effective
relative to interventions for other clinical disorders.
Full version of Guidelines Available Here
