Smoking cessation and treatment of nicotine dependence
EBM Guidelines
Nov 18, 2024 • Latest change Mar 16, 2026
Table of contents
Extract
- 6–7 out of ten smokers would like to stop smoking. Smoking cessation usually needs 3–4 attempts to succeed.
- A simple encouragement by a doctor to stop smoking is effective, but a three minute counselling session is even more effective Simple physician apos;s advice to quit smoking is effective for smoking cessation compared with no advice. With more intensity the quitting rate is slightly higher.A.
- Ask about the patient’s smoking habits and discuss with him/her about his/her willingness to stop.
- Varenicline Varenicline together with brief counselling is effective for smoking cessation compared with placebo. Varenicline is more effective than bupropion, and as effective as combination nicotine replacement therapy.A, bupropion The antidepressants bupropion and nortriptyline are effective for long term smoking cessation but selective serotonin reuptake inhibitors are not.A and nortriptyline The antidepressants bupropion and nortriptyline are effective for long term smoking cessation but selective serotonin reuptake inhibitors are not.A are effective in supporting smoking cessation.
- Nicotine replacement therapy increases the success rate of smoking cessation 1.5–2 fold Nicotine replacement therapy (NRT) in different forms is effective for smoking cessation. NRT increases quit rate approximately 1.5 to 2 fold. Combination nicotine replacement therapy is as effective as varenicline.A.
- Support combined with pharmacotherapy enhances the success of cessation Interventions that combine pharmacotherapy and behavioural support are more effective than a minimal intervention or usual care for smoking cessation.A.
- Counselling, brief intervention and varenicline appear to be effective in quitting snuff and other smokeless tobacco products, and nicotine replacement therapy can also help Cessation counselling, brief advice, and varenicline each appears to be effective for smokeless tobacco cessation compared with minimal or no support, or placebo. Nicotine replacement therapy may be effective for smokeless tobacco cessation compared with placebo or no medication.B.
- Nicotine dependence (F17.2) is similar to other substance dependence disorders as regards to pharmacological and behaviour control factors.
- Smoking is the most important preventable cause of mortality. 50% of smokers will die of an illness caused by smoking The most important known health risks of smoking and nicotine products1.
- Nicotine appears to be the cause of many of the harmful effects of smoking.
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Linked evidence summaries
- Simple physician apos;s advice to quit smoking is effective for smoking cessation compared with no advice. With more intensity the quitting rate is slightly higher.A
- Varenicline together with brief counselling is effective for smoking cessation compared with placebo. Varenicline is more effective than bupropion, and as effective as combination nicotine replacement therapy.A
- The antidepressants bupropion and nortriptyline are effective for long term smoking cessation but selective serotonin reuptake inhibitors are not.A
- Nicotine replacement therapy (NRT) in different forms is effective for smoking cessation. NRT increases quit rate approximately 1.5 to 2 fold. Combination nicotine replacement therapy is as effective as varenicline.A
- Interventions that combine pharmacotherapy and behavioural support are more effective than a minimal intervention or usual care for smoking cessation.A
- Cessation counselling, brief advice, and varenicline each appears to be effective for smokeless tobacco cessation compared with minimal or no support, or placebo. Nicotine replacement therapy may be effective for smokeless tobacco cessation compared with placebo or no medication.B
- Additional behavioural support to pharmacotherapy may be effective for smoking cessation.C
- Interventions with elements sensitive to stage of change and using motivational enhancement may be effective for tobacco cessation.C
- Personal and tailored interventions, and recruitment strategies that are proactive and intensive in nature may enhance recruitment of participants into smoking cessation programmes.C
- Smoking cessation may be associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke.C↑
- Smoking appears to increase the risk of postoperative complications. Preoperative smoking interventions including nicotine replacement therapy appear to increase short-term smoking cessation and appear to reduce postoperative morbidity.B
- Exercise may be effective for preventing weight gain after smoking cessation. Individualized behavioural interventions may not be effective for preventing weight gain after smoking cessation.C
- Therapy with nicotine replacement, bupropion, or varenicline appears to have some effect for preventing weight gain after smoking cessation, but not at 12 months compared with placebo.B
- Smoking cessation counselling can assist smokers to quit.A
- Physician apos;s advice is effective for smoking cessation. More intensive smoking cessation advice or follow-up in person or via telephone after the intervention increases the smoking quit rates slightly compared with very brief interventions or no follow-up.A
- Proactive telephone counselling is effective for smokers interested in quitting compared with brief advise or self-help material. Three or more calls increase the odds of quitting compared to a minimal intervention.A
- Automated text messaging interventions, and taylored Internet or mobile phone-based smoking cessation interventions appear be effective for smoking cessation.B
- Nursing interventions appear to be effective in smoking cessation.B
- Nicotine replacement therapy with fast-acting products appears to be effective for smokers who want to reduce but not quit compared to placebo or reduction alone. It may also help quitting.B
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- Tobacco cessation counselling interventions delivered by dental professionals appears to be effective in helping both cigarette smokers and smokeless tobacco users to quit.B
- Group therapy is effective and better than self help, and other less intensive interventions for smoking cessation. There is not enough evidence on its effectiveness compared to intensive individual counselling.A
- Group programmes, peer support, individual counselling and nicotine replacement therapy (NRT) are all effective for smoking cessation when offered in the workplace.A
- Combining nicotine replacement therapy (NRT) especially NRT patch with varenicline appears to be effective for smoking cessation, and more effective than NRT or varenicline alone.B
- Bupropion appears not to enhance the effect of nicotine replacement therapy (NRT) compared with NRT alone.B
- Combination therapy with a patch and a rapid delivery form of nicotine replacement therapy increases abstinence compared with monotherapy in smoking cessation.A
- Psychosocial interventions especially counselling, feedback and incentives are effective for smoking cessation in pregnancy. Smoking cessation is effective for reducing preterm birth, low birthweight, small for gestational age, and admissions to neonatal intensive care compared with usual care.A
- Nicotine replacement therapy may be effective for smoking cessation in pregnancy, and may be safe.C
- Anxiolytics may not help in smoking cessation.C
- Naltrexone is not effective for long-term abstinence in smoking cessation .A
- Acupuncture and related therapies (acupressure, laser therapy, electrostimulation) do not appear effective for smoking cessation.B
- Hypnotherapy is probably not effective for smoking cessation.C
- Exercise might slightly aid in smoking cessation but evidence is insufficient .D
- Cytisine is effective for smoking cessation compared to placebo.A
- E-cigarettes may be effective for cigarette smoking cessation compared with nicotine replacement therapy or no use of e-cigarettes. However, there is a high risk of continued e-cigarette use at 6 months or longer.C
Search terms
Bupropion, COPD, ENDS, Electronic Nicotine Delivery Systems, F17*, Internal medicine, NRT, Neoplastic diseases, Nicotine, Nortriptyline, Pulmonary Disease, Chronic Obstructive, Pulmonary diseases, Smoking, Smoking Cessation, Substance Withdrawal Syndrome, Tobacco, Tobacco Use Disorder, Weight Gain, Z71.6, Z72.0, e-cigarette, electronic cigarette, group counseling, nicotine addiction test, nicotine chewing gum, nicotine inhalator, nicotine nasal spray, nicotine patch, nicotine replacement therapy, nicotine tablet, snus, vape, vaping, varenicline