Clinical Interventions to Treat Tobacco Use and Dependence Among Adults

Tobacco use and dependence is a chronic, relapsing condition that often requires repeated intervention and long-term support. Quitting can be hard, but evidence-based treatments improve success. Below are clinical interventions that work to help adult patients quit smoking.

Nicotine Replacement Therapy (NRT) reduces nicotine withdrawal symptoms and is available over the counter (patch, gum, and lozenge) and by prescription (inhaler and nasal spray).
Varenicline is a nicotine receptor partial agonist available only by prescription. It reduces nicotine withdrawal symptoms (including craving) and reduces the rewarding effects of cigarettes by blocking nicotinic receptors.
Bupropion is a dopamine and norepinephrine reuptake inhibitor with nicotine receptor antagonist properties. It reduces craving and other withdrawal symptoms and is available by prescription only.

Combining Treatments:

Counseling and medication are effective on their own but using them together can more than double the chances of quitting.
Combining long-acting NRT (patch) with short-acting NRT (e.g., gum, lozenge) also increases the chances of quitting.

For Pregnant Patients

Behavioral Counseling:

Pregnant women who smoke should be encouraged to attempt cessation using behavioral interventions, such as counseling and social support, before considering pharmacologic approaches.
Brief counseling can increase quit success, but studies indicate intensive and tailored counseling is most effective in helping pregnant women quit smoking. Counseling can be in-person (one-on-one or in a group) or over a telephone quitline.
Text messaging (e.g., SmokefreeTXT) and web-based interventions (e.g., cdc.gov/quit and smokfree.gov) also help people quit smoking.

Medication:

There are seven FDA-approved smoking cessation medications. However, to date, there is insufficient evidence for the effectiveness of these medications in pregnant women and the balance of benefits and harms is not clear.
Nicotine replacement therapy and other FDA-approved medications (bupropion, varenicline) can be considered on a case-by-case basis.
These decisions should be made carefully while considering the specific circumstances and weighing the risks of using medication against the risks of continued smoking.

For Pregnant Patients

Behavioral Counseling:

Pregnant women who smoke should be encouraged to attempt cessation using behavioral interventions, such as counseling and social support, before considering pharmacologic approaches.
Brief counseling can increase quit success, but studies indicate intensive and tailored counseling is most effective in helping pregnant women quit smoking. Counseling can be in-person (one-on-one or in a group) or over a telephone quitline.
Text messaging (e.g., SmokefreeTXT) and web-based interventions (e.g., cdc.gov/quit and smokfree.gov) also help people quit smoking.

Medication:

There are seven FDA-approved smoking cessation medications. However, to date, there is insufficient evidence for the effectiveness of these medications in pregnant women and the balance of benefits and harms is not clear.
Nicotine replacement therapy and other FDA-approved medications (bupropion, varenicline) can be considered on a case-by-case basis.
These decisions should be made carefully while considering the specific circumstances and weighing the risks of using medication against the risks of continued smoking.

E-Cigarettes and Pregnancy

E-cigarettes are not safe to use during pregnancy.
Nicotine is a health danger for pregnant women and developing babies and can damage a developing baby’s brain and lungs.
There is currently not enough evidence to know whether e-cigarettes increase smoking cessation.
E-cigarettes are not currently approved by the U.S. Food and Drug Administration (FDA) as a smoking cessation aid.

The Entire Clinical Care Team Can Help

A team approach is the best way to treat tobacco use and dependence. Integrating treatment into the routine clinical workflow and engaging the entire healthcare team in treatment delivery can make a difference.

People at a table with a talk bubble over their heads.

Advise Patients to Quit

Talk to patients at every visit about their tobacco use. Even brief advice can influence a patient’s decision to quit smoking.
Advise patients that quitting is one of the most important things they can do to improve their health and prognosis. Advise pregnant patients that quitting is one of the most important things they can do to improve their health and the health of their baby.
Remind patients that it is never too late to quit smoking. Quitting is beneficial at any age. For pregnant patients, remind them, although smoking cessation at any point during pregnancy yields health benefits, quitting early in pregnancy provides the greatest benefit to mother and baby.
Provide patients support, regardless of their readiness to quit.

Offer Patients Treatment

Offer patients a combination of counseling and medications.

Refer Patients to Additional Support

Refer patients to cessation resources and programs in your health system and community. You can also refer them to telephone quitlines (1-800-QUIT-NOW) and text messaging (e.g., SmokefreeTXT) and web-based interventions (e.g., cdc.gov/quit and smokfree.gov).

Follow Up with Patients

Assess your patients’ progress over time and provide additional support. It may take several attempts for them to quit smoking.
Try new strategies, like new medications the patient hasn’t tried, medication combinations, or new approaches to handling triggers.
Provide ongoing support and encourage patients to keep trying and not give up.