Helping Patients Quit Tobacco: 5 Things to Know

Robert Adsit, MEd; Lauren E. Owens, MPH; Brenna VanFrank, MD, MSPH

March 16, 2020

Editorial Collaboration

Medscape &

Even after decades of public health efforts to reduce tobacco use, it remains the leading preventable cause of disease and death in the United States and is a significant driver of healthcare costs. In fact, in 2018, 34 million US adults reported smoking cigarettes, and approximately 20% of US adults said they used some type of tobacco product. Smoking-related illnesses, deaths, and costs can be prevented by helping people quit using tobacco. But how do we do it?

Here are five things to help you identify and treat your patients who use tobacco.

1. Most people who use tobacco want to quit.

Nearly 70% of adults who smoke want to quit, and more than half have made a serious attempt to quit in the past year. However, only 31% used evidence-based cessation treatment (counseling, medications), and less than 5% used both counseling and medication.

2. Evidence-based treatments help people quit.

Behavioral interventions and pharmacotherapy each substantially improve a person's chances of quitting, and the combination of the two is even more effective.

Behavioral interventions for tobacco cessation include both in-person (individual or group) and telephone counseling (1-800-QUIT-NOW [1-800-784-8669]), a free service in all 50 states.
Pharmacotherapy for tobacco cessation consists of seven FDA-approved medications: nicotine replacement therapy (patch, lozenge, gum, inhaler, nasal spray), bupropion sustained-release, and varenicline.

Details about evidence-based treatment can be found in the Treating Tobacco Use and Dependence clinical practice guideline and the US Preventive Services Task Force tobacco cessation recommendation.

3. You can provide evidence-based tobacco dependence treatment.

Million Hearts®, a national initiative to prevent a million cardiovascular events in 5 years, published a tobacco cessation protocol that you can adapt for your practice and workflow. This group has also developed a tobacco cessation action guide for clinicians with tested, evidence-based clinical strategies for addressing tobacco use in your patients.

4. Treatment for tobacco dependence can be integrated into routine healthcare.

The new Million Hearts® Tobacco Cessation Change Package is a clinical quality improvement tool intended to help you optimize treatment for patients who use tobacco. It contains dozens of practical, tested, real-world approaches and tools for outpatient, inpatient, and behavioral healthcare settings, such as:

Assessing the status of tobacco dependence treatment in your practice or system and making tobacco dependence treatment a priority;
Preparing and motivating healthcare staff to address tobacco use consistently;
Promoting consistent universal screening for tobacco use;
Ensuring that people who use tobacco are consistently advised to quit, assessed for willingness to make a quit attempt, and offered assistance; and
Arranging follow-up for people who use tobacco and referring to resources that can extend the treatment that you provide.

5. Tobacco dependence is a chronic, relapsing disorder that often requires multiple interventions and long-term support.

Tobacco use disorder is driven by addiction to nicotine and has behavioral components. Comprehensive treatment includes addressing both the behavioral and chemical dependence aspects of the disorder.
Most people who succeed attempt to quit several times before they are successful.
Relapse is common. Although relapse occurs most frequently in the first several weeks after quitting, it can also happen years after quitting.
Less than 10% of adults who smoke report recent successful cessation.
Overcoming tobacco dependence is difficult but possible, particularly with the use of counseling and FDA-approved medications.