VA/DoD guideline broadens tobacco treatment
Recommendations prioritize varenicline and combination NRT while extending pharmacotherapy to patients not ready to quit.
By
Andrea Surnit
September 28, 2026
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. Related Resources & Content
