TABLE II. Recommended treatment for nicotine dependence. CBT, cognitive behavior therapy; FDA, US Food and Drug Administration; MAOI, Monoamine oxidase inhibitors; NicA, Nicotine Anonymous; NRT, nicotine replacement therapy; SR, sustained release.

Intervention	Details	Appraisal	Setting	Key references
Integrated/combined treatment	Examples - Using a combined psychosocial and pharmacological approach - Treating tobacco-use disorder concurrently with other illnesses and psychiatric disorders - Concurrently pairing a long-acting NRT (ie, nicotine patch) with a short-acting NRT (ie, gum, lozenge, inhaler, or nasal spray) - Concurrently pairing a long-acting medication, such as varenicline or bupropion, with a rescue medication, such as the gum or lozenge	- Integrated treatment delivers the best outcomes - Medications can complement each other, and combined psychosocial and pharmacological approaches can address both psychological and biological dependence	Clinical	Lancaster et al,30 2000 Stead et al,31 2015 Stead et al,32 2016
Constituent treatments
Nicotine replacement therapies (NRT)	Five types: patch, gum, lozenge, inhaler, and nasal spray	- FDA-approved - Relatively low cost - Marginally less effective than Varenicline and Bupropion - Offer more steady delivery of nicotine than cigarettes, reducing reinforcement - Patch, gum, lozenge over-thecounter - Inhaler and nasal spray by prescription only in the United States	Clinical; nonclinical	Lawrence et al,33 2009
Varenicline (Chantix)	Relieves craving and withdrawal, reducing the reinforcing effects of nicotine	- Most effective of the pharmacological interventions - FDA-approved - Be aware of black-box warning for cardiovascular adverse events - Be aware of possible neuropsychiatry symptoms in some patients (depressed mood, agitation, suicidality)	Clinical	Lawrence et al,33 2009
Bupropion SR (Zyban)	An antidepressant that reduces cravings and other withdrawal effects	- Effective, but less so than Varenicline - FDA-approved - Do not use with seizure disorders, current use of bupropion, or MAOIs, electrolyte abnormalities, eating disorders	Clinical	Lawrence et al,33 2009
Individual psychological intervention	Examples include brief counseling, motivational interviewing, cognitive behavior therapy	- Addresses psychological motivation to use tobacco and to quit - Even brief interventions have been shown to be effective	Clinical	Stead et al,34 2013 Lindson-Hawley et al,35 2015
Group support	NicA, online support groups, CBT-based groups	- Leverages social support and social modeling in quitting - Aligns with other peer-support models for substance dependence - More effective than self-help, but not more effective than individual counseling	Community, clinical, online	Steadt et al,36 2005
Mobile technologies	Text-message support, limited number of mobile apps	- Limited evidence for publicly available apps - Text-messaging support has been shown to be effective	Community, online	Free et al,37 2011 Abroms et al38 2013
Organizational interventions	Smoke-free institutions, workplace counseling	- Provides environmental supports for quit attempts, reducing cues and increasing motivation - Effective when combined with individual interventions	Community	Abroms et al,38 2013