VA/DoD guideline broadens tobacco treatment
Recommendations prioritize varenicline and combination NRT while extending pharmacotherapy to patients not ready to quit.
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By
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Andrea Surnit
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September 28, 2026
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Clinical Scorecard: VA/DoD guideline broadens tobacco treatment
At a Glance
| Category | Detail |
|---|
| Condition | Tobacco and nicotine dependence |
| Key Mechanisms | Biochemically verified long-term abstinence, pharmacotherapy, behavioral treatment |
| Target Population | Military service members and veterans |
| Care Setting | Clinical practice guideline |
Key Highlights
- Guideline includes 32 recommendations across 10 topic areas.
- Strong recommendation for varenicline monotherapy over bupropion or single-agent NRT.
- Combination NRT is strongly recommended over NRT monotherapy.
- Weak recommendations for NRT or varenicline for patients not ready to quit.
- Weak recommendation for concurrent behavioral treatment and pharmacotherapy.
Guideline-Based Recommendations
Diagnosis
- Assessment of tobacco and nicotine dependence.
Management
- Strongly recommend varenicline, combination NRT, and pharmacotherapy for cessation.
Monitoring & Follow-up
- Biochemical verification of abstinence and monitoring quit attempts.
Risks
- Consideration of neuropsychiatric effects with pharmacotherapy.
Patient & Prescribing Data
Patients with tobacco and nicotine dependence, including those not ready to quit.
Pharmacotherapy may double to triple abstinence rates compared to placebo.
Clinical Best Practices
- Prioritize biochemically verified long-term abstinence.
- Consider patient and clinician preferences in treatment decisions.
- Encourage combination NRT for improved treatment success.
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