The U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) issued updated clinical practice guidelines for treating tobacco and nicotine use among veterans and military service members. Published in the Annals of Internal Medicine, the guideline includes 32 recommendations covering cessation medications, counseling approaches, and treatment strategies for adults who use a range of tobacco and nicotine products. The guideline recommends varenicline or combination nicotine replacement therapy (NRT) to increase abstinence, motivational interviewing to improve treatment engagement, and immediate retreatment following relapse.
The guideline, which is based on literature published through 2024, also addresses electronic nicotine delivery systems, including e-cigarettes, but does not recommend them as a cessation treatment, stating that evidence is insufficient to establish their efficacy and that known and unknown harms outweigh potential benefits. Nicotine pouches and other newer nicotine products are included within the guideline’s broader scope of tobacco and nicotine use, but the recommendations do not endorse them as cessation treatments. The guideline also recommends offering treatment to adults who are not yet ready to quit and supports pharmacotherapy for patients with mental health conditions, citing evidence of safety and effectiveness.
