Treatment

Clinical Practice Guideline. Treatment of Tobacco Dependence Use: 2008 Update

The U.S. Public Health Service released, in May of 2008, an update of the Clinical Practice Guideline providing evidence-based information to all clinicians on how to help people quit smoking. The Guideline was developed by a panel of experts that reviewed available evidence and found that “there are now seven medications approved by the Food and Drug Administration as smoking cessation treatments that dramatically increase the success of quitting. The medications are: bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline.

The 2008 PHS guideline update also found evidence that counseling by itself or especially in conjunction with medication can greatly increase a person's success in quitting. In particular, quitlines were found to be effective and can reach a large number of people; 1-800-QUIT-NOW, a national quitline, is an access number that connects people to their State-based quitline. It also provides broad access to cessation counseling for diverse populations and is easy for clinicians and patients to use.

Other recommendations issued in the 2008 PHS guideline update include the following:

• Clinicians, in their offices and in the hospital, should ask their patients if they smoke and offer counseling and other treatments to help them quit. According to AHRQ's 2007 National Healthcare Quality Report, the percentage of hospitalized heart attack patients who were counseled to quit smoking has increased from 42.7 percent in 2000-2001 to 90.9 percent in 2005. Moreover, 48 States, Puerto Rico, and the District of Columbia all performed above 80 percent on this measure in 2005.
• If tobacco users are unwilling to make an attempt to quit, clinicians should use the motivational treatments that have been shown effective in promoting future attempts to quit.
• Individual, group and telephone counseling are effective, and their effectiveness increases with treatment intensity. Counseling should include two components: practical counseling and social support.
• Tobacco cessation treatments also are highly cost-effective relative to other clinical interventions. Providing coverage for these treatments increases quit rates. Insurers and purchasers should ensure that all insurance plans include the counseling and medication treatments that have been found to be effective in the 2008 PHS guideline update.
• Counseling treatments have been shown to be effective for adolescent smokers and are now recommended. Additional effective interventions and options for use with children, adolescents, and young adults need to be determined.

The 2008 PHS guideline update and its companion products, which include a consumer guide and a pocket guide for clinicians, are available online at http://www.surgeongeneral.gov/tobacco/default.htm . Copies of the 2008 PHS guideline update products are also available by calling 1-800-358-9295.