Treating tobacco use and dependence: 2008 update - Clinical practice guideline

The 2008 update to Treating Tobacco Use and Dependence is the result of the Tobacco Use and Dependence Guideline Panel and a partnership among federal government and nonprofit organizations. The strategies and recommendations are designed to assist clinicians; tobacco dependence treatment specialists; and healthcare administrators, insurers, and purchasers in delivering and supporting effective treatments for tobacco use and dependence.

PDF (2.04 MB): www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf

The update, the first since 2000, encourages doctors to prioritize tobacco cessation using medication and counseling for every patient who smokes. Among the changes in this edition of the guideline: - Counseling adds significantly to the effectiveness of medications in smoking control, and the two together work better than either alone. Counseling also increases smoking cessation among adolescents. - Telephone quit lines have broad reach and work with diverse populations. - Several medications are now available that increase the likelihood of long-term smoking abstinence, including and nicotine delivered as gum, inhaler, lozenge, nasal spray, or patch.

Ten Key Guideline Recommendations

1. Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit. Effective treatments exist, however, that can significantly increase rates of long-term abstinence.

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 a healthcare setting.

3. 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 this guideline.

4. Brief tobacco dependence treatment is effective. 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 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

6. Numerous effective medications are available for tobacco dependence, and if possible, 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).

7. 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.

8. Telephone quit line counseling is effective with diverse populations and has broad reach. Both clinicians and health care delivery systems should ensure patient access to quit lines and promote quit line use.

9. If a tobacco user currently is unwilling to make a quit attempt, clinicians should use the motivational treatments shown in this guideline to be effective in increasing future quit attempts.

10. 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 this Guideline as covered benefits.

Date Posted: 16 May 2008