A Practical Guide to Help 

Your Patients Quit Using Tobacco

Tobacco dependence is a chronic condition 

driven by addiction to nicotine. No amount 

of tobacco use is safe, and treatment of tobacco 

use and dependence often requires multiple 

interventions and long-term support. Effective 

clinical interventions are available to help patients 

who use tobacco to quit.

This guide provides simple steps and suggested 

language that you can use to briefly (3 to 5 

minutes) intervene with patients who use tobacco. 

These steps can be integrated into the routine 

clinical workflow and can be delivered by the 

entire clinical care team.

Key considerations for treating tobacco dependence:

Behavioral counseling can benefit all patients.

Medication can help patients quit and can be used with 

most patients, though special considerations may apply 

for some individuals. See page 3.

Combining behavioral counseling and medication

is more effective than either treatment alone.

Follow-up is key to monitoring patients for treatment 

adherence, side effects, and efficacy, along with 

providing support and continued assistance.

Overview: Tobacco Cessation Brief Clinical Intervention

1

Ask 

about current tobacco use

NO Provide a message of prevention

If recently quit (last 1 to 12 months), assess 

challenges, confidence, and need for support

YES

Advise 

to quit

Assess 

willingness to make a quit 

attempt

NO Not willing at this time

Provide a brief motivational message, set 

expectations, and leave the door open to 

future conversations

YES

Assist 

the quit attempt

1. Brief counseling

2. Medication, if appropriate

3. Refer to additional resources

YES

Arrange 

a follow-up appointment (in person or by telephone)
Clinical Intervention – Language You Can Use

2

Ask

Ask every patient about tobacco use 

at every visit.

“Do you use tobacco products, for example cigarettes 

or e-cigarettes?”

If your patient has recently quit (in the last 1 to 12 

months), congratulate them and assess challenges, 

confidence, and need for support. 

“The first few weeks after quitting can be hard. Have 

you felt the urge to use tobacco?”

“You are doing a great job. This is such an important 

step to take. Is there anything I can do to 

support you?”

If your patient has recently relapsed, provide 

encouragement and support to try to quit again. 

“Quitting can be hard. It can often take someone 

several tries to quit successfully. Would you like to 

try again?”

Advise + Assess

Advise your patient to quit using tobacco, 

and assess their willingness to quit.

A clinician’s advice to quit is an important motivator 

for patients. Using nonjudgmental language, deliver a 

message that is clear, strong, and personalized.

“Quitting [smoking, chewing, etc.] is the most 

important thing you can do for your health. As 

someone who cares about you and your health, I’d like 

to help you quit.”

“I’d like to hear your thoughts about quitting 

[smoking, chewing, etc.].”

“Would you be willing to quit in the next 30 days?”

If your patient is not ready to quit, provide a brief 

motivational message, set expectations, and leave the 

door open to future conversation. 

“I feel strongly about tobacco use and its effect on 

your health. I understand that quitting can be hard, 

but I am here to support you. I will ask you about it 

again the next time I see you.”
Assist

If your patient is ready to make a quit attempt, assist with counseling, medications 

(if appropriate), and resources for support. 

Provide and document brief tobacco cessation counseling. (1-3 minutes; 3-10 minutes)

Set a quit date within 30 days

Review past quit attempts, including counseling and 

medication used

Discuss potential withdrawal symptoms and coping 

strategies – see table on page 4

Discuss potential triggers and coping strategies – see table 

on page 4

Discuss, prescribe, and document tobacco cessation medication(s) unless medically contraindicated. 

Populations for which there is insufficient evidence for the effectiveness of cessation medications include pregnant women (unless 

with medical clearance and patient consent); adolescents; people who smoke ≤5 cigarettes a day; and people who use tobacco 

products other than cigarettes, including smokeless tobacco and e-cigarettes.

Nicotine replacement therapy (NRT) – patch, gum, 

lozenge, inhaler, and nasal spray 

Bupropion 

Varenicline 

Medication combinations: combining long-acting NRT 

(i.e., patch) with short-acting NRT (e.g., lozenge) increases 

the chances of quitting compared with using a single form 

of NRT

Make a referral to additional in-depth and free cessation help. 

State tobacco quitline 

(1-800-QUIT-NOW; 1-855-DÉJELO-YA) 

Tobacco cessation program based in the community, clinic, 

or healthcare system 

Web support: CDC.gov/quit; Smokefree.gov; 

becomeanex.org

Text support: Smokefree.gov/SmokefreeTXT

App support: Smokefree.gov/tools-tips/apps/quitstart

Arrange

Arrange follow-up with patients who 

are making a quit attempt.

Follow up either in person or by telephone within 

a week of the patient’s quit date. A second follow-up 

is recommended within the first month. 

“Before you leave today, we are going to schedule a 

follow-up appointment close to your quit date. We 

will check in to see how your quit attempt is going, 

ask if you have any questions, and see if there are 

ways we can support your quit attempt.”

“Please feel free to contact us at any point. We are 

here to help and support you.”

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Withdrawal Symptoms and Coping Strategies

ANXIETY AND IRRITABILITY

Exercise; even a 5-minute walk can help

Contact a friend for support

Take a few slow, deep breaths

Chew sugar-free gum

INSOMNIA OR SLEEP PROBLEMS

Avoid caffeine in the late afternoon and evening

Exercise

Go to sleep and wake up on a regular, 

consistent schedule

RESTLESSNESS

Exercise

Focus on an existing hobby, or try something new like 

cooking, drawing, or hiking

Clean the house, garage, basement, or attic

HUNGER

Eat plenty of fruits and vegetables

Exercise regularly

Avoid high-calorie foods and beverages

Carry sugar-free gum or toothpicks

Drink more water

Triggers and Coping Strategies

SITUATIONS

Avoid people who use tobacco, or ask them not 

to use tobacco around you 

Establish friendships with people who don’t 

use tobacco

Avoid smoke breaks and other social situations where 

you use tobacco

Avoid other situations where you usually use tobacco

THINGS

Get rid of cigarettes, matches, lighters, ashtrays, and 

any other objects that are cues or triggers for smoking 

or using other tobacco products

Avoid alcohol (at least for the first month) as it may 

trigger a desire to smoke

Develop new ways to manage stress, such as going 

for a walk

PLACES

Avoid places where you usually buy tobacco products

Avoid locations where you usually use tobacco

Take a different route to work or school

Resources for Providers

CDC’s Office on Smoking and Health – 

CDC.gov/TobaccoHCP

National Cancer Institute: Help Others Quit 

(Smokefree.gov/help-others-quit/health-professionals)

Million Hearts (available at millionhearts.hhs.gov)

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Tobacco Cessation Protocol

Tobacco Cessation Clinical Action Guide

Tobacco Cessation Change Package

Treating Tobacco Use and Dependence, 

Clinical Practice Guideline: 2008 Update 

available at www.ahrq.gov)

U.S. Preventive Services Task Force (USPSTF) Tobacco 

Cessation Recommendations (available at 

www.uspreventiveservicestaskforce.org)

Adapted from: 

Million Hearts Protocol for Identifying and Treating Patients Who Use Tobacco 

(https://millionhearts.hhs.gov/files/Tobacco-Cessation-Protocol.pdf)

New York City Department of Health and Mental Hygiene Quit Smoking Coaching Guide 

(https://www1.nyc.gov/assets/doh/downloads/pdf/csi/smoke-quit-smoking-coaching-guide.pdf)

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