Tobacco dependence is a chronic, relapsing health condition that requires multiple, discreet interventions by a clinician.¹ The standard of treatment for tobacco is for all clinicians to ask all school-aged children, adolescents, and adults about tobacco use; advise them to stop; and provide behavioral interventions in the form of individual, group, or telephonic counseling plus FDA-approved pharmacotherapy for tobacco treatment to those adults who use tobacco.^{2, 3}

Varenicline or combination nicotine replacement therapy (NRT) -- patch + gum or lozenge -- is the cornerstone of tobacco treatment. Research supporting the use of varenicline or combination NRT is so compelling that no individual should receive less effective treatment (e.g., patch, gum, or bupropion alone) unless there is a valid reason contraindicating the use of these treatment options.⁴

Don't forget to follow up with your client/patient about their tobacco use and treatment.

Tobacco Treatment Standard of Care (PDF, 762 KB)

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Smoking Cessation: A Report of the Surgeon General

Screening and Brief Intervention for Tobacco Use

Providing tobacco dependence treatment is quick and easy when using the evidence-based 5As counseling method. We have developed a series of treatment algorithms for quick navigation through the 5As counseling method, detailing approximate length of time to complete each step.

QuitlineNC Referral

• Referral Options

QuitlineNC Prescription

• QuitlineNC Prescription
• QuitlineNC Prescription (Spanish)

The 5 As Counseling Method

1. Ask
2. Advise
3. Assess
4. Assist
5. Arrange

Counseling Delivery Methods

• Provision of Practical Counseling
• Provision of Social Support
• Motivational Interviewing
• Stages of Change
• Readiness Ruler

Telehealth

• AAFP Tobacco Cessation Telehealth Guide

References

¹ Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Quick Reference Guide for Clinicians. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. April 2009.

² U.S. Preventive Services Task Force. Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions 2015 https://www.uspreventiveservicestaskforce.org/Search/tobacco

³ U.S. Preventive Services Task Force.  Tobacco Use in Children and Adolescents: Primary Care Interventions 2013 https://www.uspreventiveservicestaskforce.org/Search/tobacco

⁴ Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis.
Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2