To provide comprehensive clinical practice guidelines for tobacco cessation targeting veterans and military service members.
Approach:
Motivational Interviewing: Used to enhance engagement in treatment for tobacco and nicotine use.
Pharmacotherapy Recommendations: Varenicline is recommended over monotherapy with other pharmacologic agents.
Nicotine Replacement Therapy (NRT): NRT monotherapy is not preferred; multiple nicotine replacement modalities are encouraged.
Bupropion Use: Bupropion sustained-release is recommended for use beyond 12 weeks.
Varenicline for Smokeless Tobacco and ENDS: Varenicline is recommended to increase abstinence among users of smokeless tobacco and electronic nicotine delivery systems.
Quit Attempts and Abstinence: NRT or varenicline use is associated with increased quit attempts and abstinence among patients not prepared to quit within 30 days.
Key Findings:
The guideline includes 32 recommendations across ten topic areas.
It emphasizes the importance of motivational interviewing in treatment engagement.
Varenicline is preferred over other pharmacologic agents for tobacco cessation.
The guideline addresses emerging tobacco products, including ENDS.
Interpretation:
The guideline offers evidence-based guidance on managing tobacco and nicotine dependence, incorporating recent research and addressing new products.
Limitations:
The guideline identifies areas needing further research, such as head-to-head comparisons of pharmacotherapy combinations and individual responses to medications.
Conclusion:
The 2026 VA/DoD CPG for tobacco use treatment provides updated, evidence-based recommendations for tobacco cessation.
