From the Guidelines
Combining pharmacologic therapy and behavior therapy is the most effective approach to tobacco cessation counseling, as it leads to the best results for smoking cessation. I recommend using a combination of counseling techniques and pharmacotherapy for the best results, as supported by the most recent and highest quality study 1. The counseling should follow the 5A's framework: Ask about tobacco use, Advise to quit, Assess willingness to quit, Assist in quit attempt, and Arrange follow-up. First-line medications include nicotine replacement therapy (NRT) in various forms, varenicline (Chantix/Champix), or bupropion SR (Zyban). Counseling sessions should address triggers, coping strategies, and relapse prevention, with multiple sessions over at least 4 weeks significantly improving success rates.
Some key points to consider in tobacco cessation counseling include:
- Combining behavioral counseling and pharmacotherapy can increase tobacco smoking cessation rates compared with either usual care/brief cessation interventions alone or pharmacotherapy alone 1
- High-intensity behavior therapy with multiple counseling sessions is most effective, but at least a minimum of brief counseling is highly recommended 1
- The two most effective pharmacotherapy agents are combination nicotine replacement therapy (NRT) and varenicline 1
- Smoking status should be documented in the patient health record, and patient health records should be updated at regular intervals to indicate changes in smoking status, quit attempts made, and interventions utilized 1
- Smoking relapse and brief slips are common, and providers should discuss this with patients and provide guidance and support to encourage continued smoking cessation attempts despite slips 1
Overall, the goal of tobacco cessation counseling is to help individuals quit smoking through a combination of behavioral support and medication, with the ultimate goal of improving morbidity, mortality, and quality of life. Using a combination of counseling techniques and pharmacotherapy, as recommended by the most recent and highest quality study 1, is the most effective approach to achieving this goal.
From the FDA Drug Label
In all studies, patients were provided with an educational booklet on smoking cessation and received up to 10 minutes of smoking cessation counseling at each weekly treatment visit according to Agency for Healthcare Research and Quality guidelines.
The approach to tobacco (nicotine) cessation counseling is to provide patients with appropriate educational materials and counseling to support the quit attempt, with counseling provided at each weekly treatment visit, up to 10 minutes per visit, following Agency for Healthcare Research and Quality guidelines 2.
- Key elements: educational booklet, weekly counseling sessions
- Counseling duration: up to 10 minutes per session
- Guidelines: Agency for Healthcare Research and Quality guidelines
From the Research
Approach to Tobacco (Nicotine) Cessation Counseling
The approach to tobacco (nicotine) cessation counseling involves a combination of non-pharmacological and pharmacological therapies.
- Non-pharmacological therapies include behavioral counseling, which is an essential component of smoking cessation treatment 3, 4, 5, 6.
- Pharmacological therapies include nicotine replacement therapy (NRT), varenicline, bupropion, and cytisine, which have been proven to be effective and safe in real-world settings 3, 4, 6, 7.
Effective Strategies for Smoking Cessation
Effective strategies for smoking cessation include:
- Combining behavioral support with medication, which has been shown to increase smoking cessation success compared to a minimal intervention or usual care 5.
- Using NRT, varenicline, or bupropion as pharmacological therapies, which have been proven to be effective in aiding smoking cessation 3, 4, 6, 7.
- Customizing the smoking cessation strategy based on the patient's preference and medical history, including cardiovascular and psychiatric comorbidities 3.
Comparison of Pharmacological Therapies
Comparing the effectiveness of different pharmacological therapies, studies have shown that:
- Varenicline is at least as effective as, and possibly more effective than, bupropion for smoking cessation 7.
- Bupropion is more effective than NRT in some studies, but NRT remains a standard treatment for smoking cessation in many countries 7.
- The choice of pharmacological therapy should be based on the patient's individual needs and medical history, as well as the availability of the medication 3, 6.