Tobacco use disorder: Treatment​

Key points

• Once a client screens positive for tobacco use, a time-limited and structured brief interview should follow.
• All clients should receive information about their disorder, treatment options and where to find self-help material.
• Treatment approaches to consider include psychotherapy, psychoeducation and pharmacotherapy.

Psychotherapy

• Counselling delivered in various formats (e.g., self-help, individual, group, helpline, web-based) is effective in helping clients who want to stop smoking.
• Minimal interventions of 1–3 minutes are effective and should be offered to every tobacco user. However, there is a strong dose–response relationship between session length and successful treatment, so intensive interventions should be used whenever possible.
• Multiple counselling sessions increase the chances of prolonged abstinence; therefore, four or more counselling sessions should be offered.
• Combining counselling and smoking cessation medication is more effective than either approach used alone; therefore both should be offered to clients who want to stop smoking.
• Motivational interviewing should be used to support the client's willingness to engage in ongoing treatment.

Support and education

• Clients should be counselled about the nature of addiction.
• Addiction is a chronic, relapsing condition, and single episodes of treatment rarely lead to permanent remission.
• Exploring with clients the factors leading to substance use is more effective than lecturing them.
• Encourage smoke-free homes, which includes helping clients to develop the skills they need to modify their habits and minimize, avoid or counter tobacco-use triggers.

Pharmacotherapy

• Pharmacotherapy doubles the chances of quitting per given quit attempt.
• Pharmacotherapy for smoking cessation includes the patch, nicotine gum, inhaler, bupropion (Zyban) and varenicline (Champix).

Evidence summary

Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment (CAN-ADAPTT). (2011). Canadian Smoking Cessation Clinical Practice Guideline. Toronto, ON: Centre for Addiction and Mental Health.

Centre for Addiction and Mental Health. (2010). Tobacco. Toronto, ON: Author.

Herie, M., Dragonetti, R. Selby, P. (2012). Alcohol and tobacco use problems. In A. Khenti, J. Sapag, S. Mohamound & A. Ravindran (Eds.), Collaborative Mental Health: An Advanced Manual for Primary Care Professionals (pp. 195–214). Toronto, ON: Centre for Addiction and Mental Health.