U.S. Public Health Service Clinical Practice Guideline:
Treating Tobacco Use and Dependence

Guideline Findings and Recommendations
The following is a brief summary of general findings of the U.S. Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence.

1. Tobacco dependence is a chronic condition that often requires repeated intervention. However, effective treatments exist that can produce long-term or even permanent abstinence.

2. Because effective tobacco dependence treatments are available, every patient who uses tobacco should be offered one or more of these treatments.

3. It is essential that clinicians and health care delivery systems (including administrators, insurers, and purchasers) institutionalize the consistent identification, documentation, and treatment of every tobacco user seen in a health care setting.

4. Brief tobacco dependence treatment is effective, and every patient who uses tobacco should be offered at least brief treatment.

5. There is a strong dose-response relation between the intensity of tobacco dependence counseling and its effectiveness. Treatments involving person-to-person contact (via individual, group, or proactive telephone counseling) are consistently effective, and their effectiveness increases with treatment intensity (e.g., minutes of contact).

6. Three types of counseling and behavioral therapies were found to be especially effective and should be used with all patients attempting tobacco cessation:

• Provision of practical counseling (problem-solving/skills training)
• Provision of social support as part of treatment (intra-treatment social support)
• Help in securing social support outside of treatment (extra-treatment social support)

7. Numerous effective pharmacotherapies for smoking cessation now exist. Except in the presence of contraindications, these should be used with all patients attempting to quit smoking.

Six first-line pharmacotherapies have been identified that reliably increase long-term smoking abstinence rates:

• Bupropion SR
• Nicotine Nasal Spray
• Nicotine Gum
• Nicotine Patch
• Nicotine Inhaler
• Nicotine Lozenge

8. Tobacco dependence treatments are both clinically effective and cost-effective relative to other medical and disease prevention interventions. As such, insurers and purchasers should ensure that:

• All insurance plans include as a reimbursed benefit the counseling and pharmacotherapeutic treatments identified as effective in the Guideline.
• Clinicians are reimbursed for providing tobacco dependence treatment just as they are reimbursed for treating other chronic conditions.

To access the full guideline, click here.