Clinical Practice Guideline on Treating Tobacco Use and Dependence 2008
Department of Family and Community Medicine, College of Medicine, Philippine General Hospital, University of the Philippines
This guideline starts below.
Introduction: Ten Key Guideline Recommendations
- Tobacco dependence is a chronic disease that often requires repeated interventions and multiple attempts to quit. Effective treatments exist, however, that can significantly increase rates of long-term abstinence.
- 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.
- 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.
- 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.
- Individual, group, and telephone counseling are effective, and their effectiveness increases with treatment intensity. Two components of counseling are effective, and clinicians should use these when counseling patients making a quit attempt: practical counseling (problem solving/skills training) and social support delivered as part of treatment.
- 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 reliably increase long-term smoking abstinence rates: Bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline.
- Counseling and medications are effective when used by themselves for treating tobacco dependence. The combination of counseling and medication, however, is more effective that either alone. Thus, clinicians should encourage all individuals making a quit attempt to use both counseling and medication.
- 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.
- 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.
- 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 counseling and medications identified as effective in this guideline as covered benefits.