Table 1.

Key recommendations for guideline-based tobacco dependence treatment [11]

1) Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit.

2) It is essential that clinicians and health care delivery systems consistently identify and document tobacco use status and treat every tobacco user seen in health care settings.

3) 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

4) 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)and Social support delivered as part of treatment

5) Telephone quitline counseling is effective with diverse populations and has broad reach. Therefore, clinicians and health care delivery systems should both ensure patient access to quitlines and promote quitline use.

6) 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 nonnicotine) reliably increase long-term smoking abstinence rates: Bupropion SR, Nicotine gum, Nicotine inhaler, Nicotine lozenge, Nicotine nasal spray, Nicotine patch, Varenicline.

7) If a tobacco user currently is unwilling to make a quit attempt, clinicians should use the 5 R’s to increase motivation, which include  •Relevance—Encourage the patient to indicate why quitting is personally relevant.  •Risks—Ask the patient to identify potential negative consequences of tobacco use.  •Rewards—Ask the patient to identify potential benefits of stopping tobacco use.  •Roadblocks—Ask the patient to identify barriers or impediments to quitting.  •Repetition—The motivational intervention should be repeated every time an unmotivated patient has an interaction with a clinician. Tobacco users who have failed in previous quit attempts should be told that most people make repeated quit attempts before they are successful.

8) Tobacco dependence treatments are both clinically effective and highly cost-effective relative to interventions for other clinical disorders. Providing coverage for these treatments increases quit rates. Insurers and purchasers should ensure that all insurance plans include the counseling and medication identified as effective in the guidelines