If treatment for tobacco addiction was evidence-based, what would it look like?

This papers reviews the current evidence on effectiveness of treatment for tobacco addiction. The primary source of evidence is randomised controlled trials but other sources of evidence are also important to help guide decisions about implementation. The goals of a treatment programme are twofold: to attract as many smokers into effective treatment as possible and to deliver the most effective treatment that resources and practicalities permit. Randomised controlled trial evidence strongly indicates that the treatment of choice is a combination of psychological support and medication. The preferred medication will depend on patient preference and contra-indications but optimal results appear to be achieved with a combination of nicotine patch plus one other form of nicotine replacement therapy with medication starting before the quit date. Highest success rates appear to come from psychological support that involves multiple sessions using a group-oriented approach. There are pragmatic reasons why one might deviate from this, primarily to do with client acceptance and accessibility, so one-to-one support, web-based packages and telephone counselling are also important vehicles for psychological support. There are also grounds for providing medication and support for smokers who wish to cut down as a prelude to stopping. This paper concludes with an assessment of how far current treatment practices in the UK and globally are following this model and what the advent of new medications such as varenicline and rimonabant will mean for future treatment programmes.