This report summarizes the 2008 U.S. Public Health Service (PHS) Clinical Practice Guideline, Treating Tobacco Use and Dependence (“2008 Update”) and provides an evidence-based blueprint for clinicians and healthcare systems to treat the deadly chronic disease of tobacco addiction effectively. The importance of such a blueprint is clear—clinicians and healthcare delivery systems have unparalleled access to American smokers; over 70% of smokers visit a clinician each year and most of them report wanting to quit. Half of all smokers alive today—more than 20 million Americans—will be killed prematurely by a disease directly caused by their tobacco use, making the treatment of tobacco dependence the chief medical and public health challenge of our time.

This guideline concludes that tobacco use presents a rare confluence of circumstances: (1) a highly significant health threat,¹ (2) a disinclination among clinicians to intervene consistently,² and (3) the presence of effective interventions. This last point is buttressed by evidence that tobacco-dependence interventions, if delivered in a timely and effective manner, significantly reduce the smoker’s risk of suffering from smoking-related disease.3, 4, 5, 6, 7, 8, 9, 10 Indeed, it is difficult to identify any other condition that presents such a mix of lethality, prevalence, and neglect, despite effective and readily available interventions.

Although tobacco use is still an enormous threat, the story of tobacco control efforts over the last half century is one of remarkable progress and promise. In 1965, current smokers outnumbered former smokers three-to-one.¹¹ Over the past 40 years, the rate of quitting has so outstripped the rate of initiation that, today, there are more former smokers than current smokers.¹² Moreover, 40 years ago, smoking was viewed as a habit rather than a chronic disease. No scientifically validated interventions were available for the treatment of tobacco use and dependence and it had little place in healthcare delivery. Today, numerous effective treatments exist, and tobacco-use assessment and intervention are considered to be requisite duties of clinicians and healthcare delivery entities. Finally, every state now has a telephone quitline, increasing access to effective treatment.