From the Guidelines
Patient education for smoking cessation should include a comprehensive approach combining counseling with pharmacotherapy, as this combination is the most effective approach and leads to the best results for smoking cessation. I recommend a treatment plan that includes both behavioral strategies and medication options, as supported by the most recent and highest quality study 1. First-line medications include nicotine replacement therapy (NRT) in various forms, varenicline (Chantix), or bupropion SR (Zyban). Patients should set a specific quit date, identify triggers, develop coping strategies for cravings, and seek social support. They should understand that withdrawal symptoms typically peak within the first week and gradually subside over 2-4 weeks. Multiple quit attempts are often necessary before achieving long-term success. These medications work by either replacing nicotine to reduce withdrawal symptoms (NRT), blocking nicotine receptors (varenicline), or affecting brain chemistry to reduce cravings (bupropion). Combining behavioral support with medication can double or triple the chances of successful quitting compared to willpower alone.
Some key points to consider when developing a smoking cessation plan include:
- Identifying the patient's smoking status and documenting it in their health record, as recommended by 1 and 1
- Offering a combination of pharmacologic therapy and behavior therapy, as recommended by 1, 1, and 1
- Providing high-intensity behavior therapy with multiple counseling sessions, as recommended by 1 and 1
- Using first-line medications such as NRT, varenicline, or bupropion, as recommended by 1, 1, and 1
- Encouraging patients to set a specific quit date, identify triggers, develop coping strategies for cravings, and seek social support, as recommended by 1
It's also important to note that smoking cessation has numerous health benefits, including improving cancer treatment outcomes, reducing the risk of cardiovascular disease, and improving glycemic control in patients with diabetes, as supported by 1, 1, and 1. Therefore, a comprehensive approach to smoking cessation that combines counseling with pharmacotherapy is essential for improving patient outcomes and reducing morbidity and mortality.
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. Provide patients with appropriate educational materials and counseling to support the quit attempt.
Smoking cessation patient education is an essential component of treatment with varenicline. Patients should be provided with:
- An educational booklet on smoking cessation
- Up to 10 minutes of smoking cessation counseling at each weekly treatment visit
- Appropriate educational materials and counseling to support the quit attempt, according to Agency for Healthcare Research and Quality guidelines 2, 2, 2.
From the Research
Smoking Cessation Patient Education
- Smoking cessation is a crucial aspect of patient education, as tobacco use is a leading cause of preventable morbidity and premature mortality worldwide 3.
- Approximately 1 billion smokers worldwide are at risk, with the epidemic shifting to the developing world 3.
- Tobacco dependence is a chronic condition that often requires repeated intervention for success, and simply informing patients about health risks is usually not sufficient for a decision to change 3.
Effective Interventions for Smoking Cessation
- Counseling is essential when attempting to quit smoking, and pharmacologic smoking cessation aids are recommended for all smokers who are trying to quit, unless contraindicated 3.
- Evidence-based guidelines recommend nicotine replacement therapy, bupropion SR, and varenicline as effective alternatives for smoking cessation therapy, especially when combined with behavioral interventions 3, 4.
- Combination pharmacotherapy is indicated for highly nicotine-dependent smokers, patients who have failed with monotherapy, and patients with breakthrough cravings 3.
- Varenicline has been shown to be at least as effective as bupropion for smoking cessation, and possibly more effective 4, 5.
Comparison of Smoking Cessation Pharmacotherapies
- A study comparing varenicline and bupropion found that varenicline was more effective in maintaining abstinence and reducing craving than bupropion and nicotine replacement therapy 5.
- Another study found that bupropion was more beneficial than nicotine replacement therapy for smokers with a history of depression 6.
- However, a randomized trial found no difference in smoking cessation effectiveness among bupropion, nicotine replacement therapy, and their combination when used with behavioral support in clinical practice 6.
Behavioral Counseling and Smoking Cessation
- Behavioral counseling is an essential component of smoking cessation treatment, and can be delivered through various modalities, including web-based counseling and proactive telephone-based counseling 7.
- A study comparing different modalities of behavioral counseling found that phone counseling had a greater treatment advantage for early cessation and appeared to increase medication adherence 7.