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Tobacco Use Treatment, How To Quit Tobacco

APRIL 22, 2026 – The Department of Defense and the Department of Veterans Affairs have jointly released a new, evidence-based clinical practice guideline, Tobacco Use Treatment, to help service members and veterans quit tobacco.

Since the publication of the previous VA/DOD CPG in 2008, substantial advances in tobacco cessation research, “specifically in options for medication, created a significant gap between knowledge and practice for providers,” said Dr. Jackie Allen Hayes, a pulmonary and critical care physician at Brooke Army Medical Center and a champion of the CPG. The guideline contains two clinical algorithms and 32 evidence-based recommendations.

In delivering integrated capabilitiesfrom DOD and VA, the new CPG ensures providers are equipped to treat all beneficiaries and veterans with the latest “information to make a better-informed decision,” added Hayes.

Tobacco risks to warfighter readiness

Tobacco use is the leading cause of preventable death in the United States and military and veteran populations have higher rates of tobacco use than civilian populations, according to the Centers for Disease Control and Prevention. The new CPG enables providers to give patients the most effective, personalized strategies to improve long-term health and continuity of care — while reducing risk of chronic medical conditions associated with tobacco and nicotine use in service members, which all can lead periods they are not deployable.

With tobacco posing such a threat to warfighter lethality and force health, “previous CPG’s lacked specific focus on military and veteran populations. A big component of the mission now is delivering warfighter readiness,” said Capt. (Dr.) Patricia Vu, chief of public health at Fort Leonard Wood, Missouri, and a co-champion of the new CPG.

A central aim of the new CPG is to reframe tobacco use disorder as a complex, treatable medical condition — not a character flaw, said Vu. “We must think about it like a chronic medical condition that requires overcoming physiological dependence, as well as developing new behaviors to sustain abstinence from smoking.”

A dynamic approach to assessment, treatment

To help providers integrate these recommendations into time-constrained appointments, the guideline advocates for tools like motivational interviewing and the “5 A’s” model:

  • Ask about tobacco use, such as how frequently they use nicotine or tobacco products each day or week (if not daily).
  • Advise the patient to quit using the nicotine or tobacco product using a clear, personalized message.
  • Assess readiness to quit.
  • Assist with treatment for patients who are ready to quit and not ready to quit.
  • Arrange follow-up and support for continuity of care.

At the heart of the new CPG is an approach combining medication, nicotine replacement therapy, and behavioral counseling, emphasizing the use of these treatments to give patients the best chance of success. These include:

  • Medications: Bupropion and Varenicline to help increase abstinence from combustible tobacco
  • Nicotine replacements: Nicotine gum, lozenge, or patch
  • Behavioral strategies: Counseling, support groups

The multifaced approach means medications can address the chemical dependence “by reducing withdrawal symptoms and cravings while the behavioral counseling part of it provides additional support to patients,” Vu said.

A key focus of the new guideline is its specific guidance for military and veteran populations, including those with complex comorbidities like PTSD, a group historically undertreated for tobacco use, Vu said. Of this population, “generally, the more counseling that the patient receives in terms of intensity of treatment, the more desirable the effects.”

Shared decision making, keeping provider skills sharp

A collaborative, nonjudgmental approach is key to empowering patients to make informed decisions that align with their overall health goals, said Hayes. “Shared decision making is very important in these processes — it means that the patient is an active participant in their care.” Cultivating trust with patients allows providers to more effectively share facts about tobacco use, Hayes added.

“The provider can present clear, evidence-based information about the benefits of quitting tobacco versus the risks of continued tobacco use and present the available treatment options.”

The CPG also helps deliver medical warrior currency by keeping providers up to date on the latest data, techniques, and approaches to tobacco cessation.

“This new guideline helps ensure that our providers are equipped with the most current evidence-based recommendations so that we can deliver the best care for our beneficiaries,” Hayes said. “We are going to have a renewed emphasis on tobacco cessation and assisting patients in stopping smoking.”

When the combined treatments are successful, Hayes said it’s “extremely rewarding for the patient and provider. As someone goes through the process and the challenges and even if they stop on the third or fourth attempt — we’re always happy to treat them and offer them help.”

The end goal, he said, is supporting warfighters through their personalized treatment plan to keep them healthy and lethal.

“Preventing life-threatening illnesses that are caused by smoking and using tobacco products is one of the most important things that we can do to improve the quality of life and longevity of patients.”

CPG and Military Health System resources

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