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Clinical Interventions to Treat Tobacco Use and Dependence Among Adults										Related Pages
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For Non-Pregnant Patients | For Pregnant Patients | The Entire Clinical Care Team Can HelpTobacco use and dependence is a chronic, relapsing condition that often requires repeated intervention and long-term support. Quitting can be hard, but evidence-based treatments improve success. Below are clinical interventions that work to help adult patients quit smoking.On This PageFor Non-Pregnant PatientsFor Pregnant PatientsThe Entire Clinical Care Team Can HelpClinical Interventions WorkTobacco use and dependence is a chronic, relapsing condition that often requires repeated intervention and long-term support. Quitting can be hard, but evidence-based treatments (listed below) improve success.**Behavioral Counseling:**
Counseling can be in person (one-on-one or in a group) or over a telephone quitline.
Text messaging and web-based interventions also help people quit smoking.
**Medication:** Seven medications are approved by the U.S. Food and Drug Administration (FDA) for smoking cessation.
**Nicotine Replacement Therapy (NRT)** reduces nicotine withdrawal symptoms and is available over the counter (patch, gum, and lozenge) and by prescription (inhaler and nasal spray).
**Varenicline** is a nicotine receptor partial agonist available only by prescription. It reduces nicotine withdrawal symptoms (including craving) and reduces the rewarding effects of cigarettes by blocking nicotinic receptors.
**Bupropion** is a dopamine and norepinephrine reuptake inhibitor with nicotine receptor antagonist properties. It reduces craving and other withdrawal symptoms and is available by prescription only.
**Combining Treatments:**
Counseling and medication are effective on their own but using them together can more than double the chances of quitting.
Combining long-acting NRT (patch) with short-acting NRT (e.g., gum, lozenge) also increases the chances of quitting.For Non-Pregnant PatientsSpeech bubbles
**Behavioral Counseling:**
Counseling can be in person (one-on-one or in a group) or over a telephone quitline.
Text messaging (e.g., SmokefreeTXT) and web-based interventions (e.g., cdc.gov/quit and smokfree.gov) also help people quit smoking.

lozenge, patch, nasal spray
**Medication:** Seven medications are approved by the U.S. Food and Drug Administration (FDA) for smoking cessation.
**Nicotine Replacement Therapy (NRT)** reduces nicotine withdrawal symptoms and is available over the counter (patch, gum, and lozenge) and by prescription (inhaler and nasal spray).
**Varenicline** is a nicotine receptor partial agonist available only by prescription. It reduces nicotine withdrawal symptoms (including craving) and reduces the rewarding effects of cigarettes by blocking nicotinic receptors.
**Bupropion** is a dopamine and norepinephrine reuptake inhibitor with nicotine receptor antagonist properties. It reduces craving and other withdrawal symptoms and is available by prescription only.

Combo meds
**Combining Treatments:**
Counseling and medication are effective on their own but using them together can more than double the chances of quitting.
Combininglong-acting NRT (patch) with short-acting NRT (e.g., gum, lozenge) also increases the chances of quitting.For Pregnant PatientsSpeech bubbles
**Behavioral Counseling:**
Pregnant women who smoke should be encouraged to attempt cessation using behavioral interventions, such as counseling and social support, before considering pharmacologic approaches.
Brief counseling can increase quit success, but studies indicate intensive and tailored counseling is most effective in helping pregnant women quit smoking. Counseling can be in-person (one-on-one or in a group) or over a telephone quitline.
Text messaging (e.g., SmokefreeTXT) and web-based interventions (e.g., cdc.gov/quit and smokfree.gov) also help people quit smoking.
lozenge, patch, nasal spray
**Medication**:
There are seven FDA-approved smoking cessation medications. However, to date, there is insufficient evidence for the effectiveness of these medications in pregnant women and the balance of benefits and harms is not clear.
Nicotine replacement therapy and other FDA-approved medications (bupropion, varenicline) can be considered on a case-by-case basis.
These decisions should be made carefully while considering the specific circumstances and weighing the risks of using medication against the risks of continued smoking.
For Pregnant Patients**Behavioral Counseling:**
Pregnant women who smoke should be encouraged to attempt cessation using behavioral interventions, such as counseling and social support, before considering pharmacologic approaches.
Brief counseling can increase quit success, but studies indicate intensive and tailored counseling is most effective in helping pregnant women quit smoking. Counseling can be in-person (one-on-one or in a group) or over a telephone quitline.
Text messaging (e.g., SmokefreeTXT) and web-based interventions (e.g., cdc.gov/quit and smokfree.gov) also help people quit smoking.
**Medication**:
There are seven FDA-approved smoking cessation medications. However, to date, there is insufficient evidence for the effectiveness of these medications in pregnant women and the balance of benefits and harms is not clear.
Nicotine replacement therapy and other FDA-approved medications (bupropion, varenicline) can be considered on a case-by-case basis.
These decisions should be made carefully while considering the specific circumstances and weighing the risks of using medication against the risks of continued smoking.E-Cigarettes and PregnancyE-cigarettes are not safe to use during pregnancy.
Nicotine is a health danger for pregnant women and developing babies and can damage a developing baby’s brain and lungs.
There is currently not enough evidence to know whether e-cigarettes increase smoking cessation.
E-cigarettes are not currently approved by the U.S. Food and Drug Administration (FDA) as a smoking cessation aid.The Entire Clinical Care Team Can HelpA team approach is the best way to treat tobacco use and dependence. Integrating treatment into the routine clinical workflow and engaging the entire healthcare team in treatment delivery can make a difference.People at a table with a talk bubble over their heads.
**Advise Patients to Quit**
Talk to patients at every visit about their tobacco use. Even brief advice can influence a patient’s decision to quit smoking.
Advise patients that quitting is one of the most important things they can do to improve their health and prognosis. Advise pregnant patients that quitting is one of the most important things they can do to improve their health and the health of their baby.
Remind patients that it is never too late to quit smoking. Quitting is beneficial at any age.  For pregnant patients, remind them, although smoking cessation at any point during pregnancy yields health benefits, quitting early in pregnancy provides the greatest benefit to mother and baby.
Provide patients support, regardless of their readiness to quit.
counseling + medications
**Offer Patients Treatment**
Offer patients a combination of counseling and medications.

Hand holding mobile device
**Refer Patients to Additional Support**
Refer patients to cessation resources and programs in your health system and community. You can also refer them to telephone quitlines (1-800-QUIT-NOW) and text messaging (e.g., SmokefreeTXT) and web-based interventions (e.g., cdc.gov/quit and smokfree.gov).

appointment calendar
**Follow Up with Patients**
Assess your patients’ progress over time and provide additional support. It may take several attempts for them to quit smoking.
Try new strategies, like new medicationsthe patient hasn’t tried, medication combinations, or new approaches to handling triggers.
Provide ongoing support and encourage patients to keep trying and not give up.The Entire Clinical Care Team Can HelpA team approach is the best way to treat tobacco use and dependence. Integrating treatment into the routine clinical workflow and engaging the entire healthcare team in treatment delivery can make a difference.**Advise Patients to Quit**
Talk to patients at every visit about their tobacco use. Even brief advice can influence a patient’s decision to quit smoking.
Advise patients that quitting is one of the most important things they can do to improve their health and prognosis. Advise pregnant patients that quitting is one of the most important things they can do to improve their health and the health of their baby.
Remind patients that it is never too late to quit smoking. Quitting is beneficial at any age.  For pregnant patients, remind them, although smoking cessation at any point during pregnancy yields health benefits, quitting early in pregnancy provides the greatest benefit to mother and baby.
Provide patients support, regardless of their readiness to quit.**Offer Patients Treatment**
Offer patients a combination of counseling and medications.
**Refer Patients to Additional Support**
Refer patients to cessation resources and programs in your health system and community. You can also refer them to telephone quitlines (1-800-QUIT-NOW) and text messaging (e.g., SmokefreeTXT) and web-based interventions (e.g., cdc.gov/quit and smokfree.gov).**Follow Up with Patients**
Assess your patients’ progress over time and provide additional support. It may take several attempts for them to quit smoking.
Try new strategies, like new medicationsthe patient hasn’t tried, medication combinations, or new approaches to handling triggers.
Provide ongoing support and encourage patients to keep trying and not give up.Resources for Patient Care Settings and Smoking CessationHeartCardiovascular CareLungsRespiratory CareRibbonCancer CarePregnancyMaternal and Infant CareTop of Page
							
					
						Page last reviewed:  June 8, 2021					Content source: 	Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion homeHomeOffice on Smoking and Health (OSH)plus iconOSH Partners with StatesFunding Opportunity AnnouncementsInteragency Committee on Smoking and Healthplus iconMembership RosterNewsroomStay ConnectedOrganizationSmoking & Tobacco Use FeaturesQuit Smokingplus iconHow to Quitplus iconBenefits of QuittingBasic Informationplus iconHealth Effectsplus iconCancerHeart Disease and StrokeChronic Obstructive Pulmonary Disease (COPD)Smoking During PregnancyEquality in Smoking & Disease: Nobody Wins!Electronic Cigarettesplus iconAbout Electronic Cigarettes (E-Cigarettes)Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young AdultsEmpower Vape-Free Youth CampaignMenthol Tobacco Productsplus iconState Menthol Fact SheetsMenthol Tobacco Products are a Public Health ProblemMenthol Smoking and Related Health DisparitiesAddressing Menthol Tobacco ProductsHeated Tobacco ProductsYouth Tobacco PreventionCommercial Tobacco and Health Equityplus iconBlack and African American Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoAmerican Indian and Alaska Native Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoAsian, Native Hawaiian, and Pacific Islander Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsQuitting TobaccoHispanic and Latino Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoLGBTQ+ Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsQuitting TobaccoPeople Across Geographic Regionsplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoPeople with Behavioral Health Conditionsplus iconHealth BurdenUnfair and Unjust Practices and ConditionsCommercial Tobacco Product Use and Behavioral Health Conditions can Affect Each OtherQuitting TobaccoPeople with Low Socioeconomic Statusplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoSecondhand Smokeplus iconGeneral InformationTrends and DisparitiesHealth ProblemsSecondhand Smoke in the CommunitySecondhand Smoke in the HomeSmokefree PoliciesResourcesGoing Smokefree Mattersplus iconBars and RestaurantsCasinosIn Your HomeMultiunit HousingSurgeon General's Reports on Smoking and Tobacco Useplus icon2020 SGR—Smoking Cessation2016 SGR—E-Cigarette Use Among Youth and Young AdultsHistorical ReportsA Brief HistoryArchiveData and Statisticsplus iconFast Facts and Fact Sheetsplus icon**Smoking and Cigarettes**Diseases and DeathHealth Effects of Cigarette SmokingTobacco-Related MortalityCigarette Smoking in the U.S.Adult DataCessationCost and ExpendituresEconomics**Smokeless Tobacco**Health EffectsProducts and MarketingSmokeless Tobacco Product Use in the United States**Other Tobacco Products**CigarsHookahsLow Yield Cigarettes**Secondhand Smoke****Youth Tobacco Use**Youth DataSmoking in the MoviesTrends in Tobacco Use Among Youth**Tobacco Industry**Tobacco Brand PreferencesIndustry MarketingSurveysplus iconNational Youth Tobacco Survey (NYTS)Alaska Native Adult Tobacco Survey Guidance ManualAmerican Indian Adult Tobacco SurveyScientific Evidence BriefsSTATE SystemMorbidity and Mortality Weekly Reports (MMWR)Vital SignsPatient Careplus iconPatient Care Settings and Smoking Cessationplus iconCardiovascular Care SettingsRespiratory Care SettingsCancer Care SettingsMaternal and Infant Care SettingsClinical Interventions to Treat Tobacco Use and Dependence Among AdultsClinical Cessation ToolsPatient Cessation MaterialsQuitlines and Other Cessation Support ResourcesClinical Education and TrainingE-Cigarettes and Patient CareState and Community Workplus iconTobacco Control Programsplus iconCessation Materials for Tobacco Control ProgramsNetworking2Save: Co-op AgreementGuidelines and ResourcesProgram FundingEvidence Based Guides for StatesState Fact SheetsTobacco Ingredient and Nicotine ReportingTobacco Counter-Marketing CampaignGlobal Tobacco Controlplus iconAbout Global Tobacco Surveillance System (GTSS)GTSSDataThe Global Adult Tobacco Survey (GATS) AtlasHelp & Glossaryplus iconGlossaryData and DocumentationUsing the GTSSData HomepageUsing the GTSSData Explorer PageContact UsMultimedia & Toolsplus iconMedia Campaign Resource Center (MCRC)Publication Catalog To receive email updates about Smoking & Tobacco Use, enter your email address: Email Address			What's this				Submit
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