Best Practices

2008 Update Image

Treating Tobacco Use and Dependence

Clinical Practice Guideline from the US Department of Health and Human Services

Treating Tobacco Use and Dependence: 2008 Update is a Public Health Service-sponsored Clinical Practice Guideline which outlines the best practices for cessation interventions. It is recommended that colleges use the information found in the guideline when designing or revising a program.

The guideline outlines 10 key recommendations which strongly encourage that accessible, affordable, and evidence-based tobacco cessation services be offered to all tobacco users seen in the health care setting.


10 Key Recommendations *

1.  Tobacco dependence is a chronic disease that often requires repeated intervention and multiple attempts to quit. Effective treatments exist, however, that can significantly increase rates of long-term abstinence.

2. 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.

3. 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.

4. 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.

5. Individual, group, and telephone counseling are effective, and their effectiveness increases with treatment intensity. Two components of counseling are especially effective, and clinicians should use these when counseling patients making a quit attempt:

• Practical counseling (problem solving/skills training)
• Social support delivered as part of treatment

6. 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 (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

• Clinicians also should consider the use of certain combinations of medications identified as effective in this Guideline.

7. Counseling and medication are effective when used by themselves for treating tobacco dependence. The combination of counseling and medication, however, is more effective than either alone. Thus, clinicians should encourage all individuals making a quit attempt to use both counseling and medication.

8. 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.

9. 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.

10. 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 the counseling and medication identified as effective in this Guideline as covered benefits.

Office on Smoking and Health (OSH)

From the Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC), through OSH, is the lead federal agency for comprehensive tobacco prevention and control. OSH is a division within the National Center for Chronic Disease Prevention and Health Promotion, which is located within CDC’s Coordinating Center for Health Promotion. OSH offers a wealth of information and resources for individuals seeking more information on tobacco use and cessation.

From the Tobacco Control Research Branch of the National Cancer Institute is intended to help tobacco users quit. The information and professional assistance available on this website can help to support the immediate and long-term needs of tobacco users as they become, and remain, tobacco free.

From the US Department of Health and Human Services offers general information on tobacco, health effects of tobacco use, as well as information and resources for tobacco prevention and cessation.

* Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.