CLINICAL PRACTICE GUIDELINE

U.S. Department of Health and Human Services

 Ten Key Guideline Recommendations

The overarching goal of these recommendations is that clinicians strongly
recommend the use of effective tobacco dependence counseling and
medication treatments to their patients who use tobacco, and that health
systems, insurers, and purchasers assist clinicians in making such effective
treatments available.

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 health care 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 (problemsolving/skills training)
• Social support delivered as part of treatment

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 non-nicotine) reliably
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 identified as effective in this Guideline.

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