Smoking cessation
Tobacco use is the leading cause of preventable death in the United States, and every smoker should be asked about use at every visit and offered combined behavioral counseling plus pharmacotherapy, since neither alone matches the quit rate of both together. Varenicline is the most effective single agent, combination nicotine replacement therapy (long-acting patch plus a short-acting form) is equally first-line, and bupropion is an alternative, all started before a set quit date and continued for a 7- to 12-week course.
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What this article covers
- Overview
Definition: smoking cessation is the structured clinical process of helping a tobacco user stop use permanently, combining brief behavioral counseling with approved pharmacotherapy; it is a…
- Epidemiology
Tobacco use is the leading preventable cause of disease, disability, and death in the United States.
- Risk factors
Nicotine dependence itself, reinforced by rapid nicotinic acetylcholine receptor stimulation and a short half-life that drives repeated dosing.
- Pathophysiology
Nicotine binds central nicotinic acetylcholine receptors, triggering dopamine release in the mesolimbic reward pathway and producing the reinforcing effects that drive continued use.
- Clinical features
Every adult should be asked about current tobacco use at every encounter; a systematic process (for example asking with vital signs) improves detection.
- Differential diagnosis
Cannabis use: euphoria and impaired coordination rather than nicotine's restlessness-predominant withdrawal; treated supportively rather than with nicotine replacement or varenicline.
- Diagnosis
There is no confirmatory test for readiness to quit; the encounter itself establishes candidacy using the 5 A's framework (Ask, Advise, Assess, Assist, Arrange), and every current smoker without…
- Management
First, set a specific quit date and start pharmacotherapy before it, combined with behavioral counseling, which together outperform either alone.
- Complications
Withdrawal-driven relapse, the most common complication, from unmanaged irritability, restlessness, and craving in the first days to weeks after quitting.
- Prognosis
Benefits of quitting begin immediately and continue to accrue over decades.
- Prevention
Ask about tobacco use and record status at every clinical encounter, regardless of the presenting complaint.
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