Commissioned Corps of the U.S. Public Health Service

Smoking Cessation

Guidelines for Clinicians

Guidelines for Clinicians: Ten Key Guideline Recommendations1

 

The goal of these recommendations is for clinicians to strongly recommend effective tobacco addiction counseling and medication treatments to their patients who use tobacco; and for health systems, insurers, and purchasers to assist clinicians in making these treatments available.

 

  1. Tobacco addiction is a long-term disease that often requires repeated actions and multiple attempts to quit. However, effective treatments exist that can significantly increase rates of long-term abstinence.
  2. Clinicians and health care delivery systems should consistently identify and document tobacco use status and treat every tobacco user seen in a health care setting.
  3. Tobacco addiction treatments can make a difference for many people. Clinicians should encourage every patient willing to make a quit attempt to use the recommended counseling treatments and medications.
  4. Brief tobacco addiction treatment can also make a difference. Clinicians should offer every patient who uses tobacco at least the brief treatments shown to be effective in this Guideline.
  5. Individual, group, and telephone counseling can help, and the amount of help increases with treatment intensity. Clinicians should use the following two methods when counseling patients trying to quit:
    • Practical counseling (problem solving/skills training)
    • Social support delivered as part of treatment
  6. Many effective medications are available for tobacco addiction. Clinicians should encourage all of their patients to use these when trying to stop smoking—except when this could harm the patient or with specific groups of people for which there isn’t enough evidence that they will help (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents).
    • Seven first-line medications (5 nicotine and 2 non-nicotine) 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 which this Guideline states can help.
    • Bupropion hydrochloride SR (Zyban®) should not be used by patients with seizure disorder, major head trauma, eating disorders, and in patients on
    • Wellbutrin® or monoamine oxidase (MAO) inhibitors.
    • Serious symptoms have occurred in patients being treated with CHANTIX. All patients being treated with CHANTIX should be observed for symptoms such as changes in behavior, anxiety, depressed mood, suicidal thoughts, and suicidal behavior. Families and caregivers should know of the need to watch for these symptoms and to report them immediately to the patient's healthcare provider.
  7. Counseling and medication can help when used by themselves for treating tobacco addiction. Using counseling and medication together, however, can help more than either alone. Clinicians should encourage everyone trying to stop to use both counseling and medication.
  8. Telephone quitline counseling can help with many people and can reach many people. Therefore, both clinicians and health care delivery systems should make sure that people trying to quit can contact quitlines and encourage that people use quitlines.
  9. If a tobacco user currently doesn’t want to stop using tobacco, clinicians should use the motivational treatments which this Guideline shows can help people try to stop use in the future.
  10. Tobacco addiction treatments help more often and cost less compared to actions taken to help relieve other clinical disorders. If these treatments are covered by insurance more people will be able to stop use of tobacco. Insurers and purchasers should ensure that all insurance plans include the counseling and medication that have been shown to help in this Guideline as covered benefits.

 

1 From “Treating Tobacco Use and Dependence: 2008 Update – Clinical Practice Guideline” http://www.ncbi.nlm.nih.gov/books/NBK63952/

 

Page Last Modified on 12/1/2015

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