Clinical Practice Guideline

Tobacco Use

Treating Tobacco Use and Dependence

(Endorsed, April 2008)

The guideline,Treating Tobacco Use and Dependence: 2008 Update, was developed by the United States Department of Health and Human Services and endorsed by the American Academy of Family Physicians.

Key Recommendations

  • It is essential that clinicians and health care delivery systems consistently identify and document tobacco use status and assess willingness to quit of every tobacco user seen in a health care setting.
  • Tobacco dependence treatments are effective across a broad range of populations. Clinicians should encourage every patient willing to make a quit attempt to use counseling treatments and/or medications to help with cessation.
  • Although intensive treatment is more effective, even brief treatment can increase abstinence rates.
  • Individual, group, and telephone counseling are effective, and their effectiveness increases with treatment intensity. Two types of counseling are especially effective, and should be included when counseling patients making a quit attempt:
    • Practical counseling (problem solving skills/training)
    • Social support delivered as part of treatment
  • 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.
  • Numerous effective medications are available for tobacco dependence, and all patients attempting to quit smoking should be encouraged to use them, either alone or in certain combinations--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

  • The combination of counseling and medication is more effective than either alone. All individuals making a quit attempt should be encouraged to use both counseling and medication.
  • If a tobacco user currently is unwilling to make a quit attempt, clinicians should use the motivational intervention techniques effective in increasing the likelihood of future quit attempts.

See the full recommendation for further details, including details about medications, counseling and motivational techniques, and billing codes.


These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.