Smoking is the leading preventable cause of premature death and a leading cause of illness and mortality. Smoking is also one of the VA's biggest public health challenges. Many Veterans first began using tobacco while in the military and the culture of the military has historically supported tobacco use. The rate of smoking among all Veterans currently enrolled for care in VA is roughly that of the U.S. population (16.8%). However, the rate of smoking among Veterans with mental health or substance use disorders is roughly 2-3 times that rate.
Approximately 70 percent of all smokers say they want to quit, but even the most motivated smoker may try to quit five or six times (or more) before they are able to quit. Over 3 million Americans successfully quit smoking every year. There is a strong evidence base for what works to help smokers quit. The 2008 update of the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence, outlines that a combination of behavioral counseling and the use of FDA-approved smoking cessation medications can greatly increase a smoker's likelihood of quitting.
Other tobacco use (e.g., smokeless tobacco, snuff, cigars, etc.) is not as prevalent and is less well studied, but it has harmful health consequences as well, such as increased cardiovascular disease and oral cancers. The combination of behavioral counseling and medications is also the most effective treatment in helping these tobacco users quit as well.
What about Co-occurring Conditions?
Higher rates of smoking are seen in a variety of populations, including those with psychiatric disorders such as PTSD, depression, psychoses, and other substance use disorders. However, all these populations can successfully quit smoking with evidence-based treatment without any exacerbation of psychiatric symptoms or increased substance use. Research suggests that quitting smoking is frequently associated with improvements in psychological functioning, including decreased anxiety among smokers with PTSD and other disorders and increased abstinence in substance use disorder populations.
Please see the Treatment and Training tab to learn more about addressing challenges in treatment.
There are many tools for assessing Smoking status. As a first step, get a smoking or tobacco use history. Ask the patient how much they smoke and how long they have been smoking. You can calculate their 'pack years' by asking multiplying the number of years they smoke by the amount that they smoke each day (for example- 1 pack a day for 30 years = a 30 pack year history).
A quick and brief way to assess level of dependence is to use the Brief Fagerström Test for Nicotine Dependence*.
SCORE NICOTINE DEPENDENCE:
*Used with permission by Dr. Karl Fagerström.
Check these websites for Patient Information on Smoking and Tobacco Use Cessation:
These web sites link to key resources that can support training in and treatment for smoking and tobacco use:
What Should I Consider When Referring?
If your client reports smoking or tobacco use and wants assistance with quitting, VA offers a variety of evidence-based treatment options, including brief counseling and FDA-approved mediations provided through outpatient primary care, mental health, and pharmacy settings.
Services offered by VA:
Veterans may work with a member of their primary care team or receive more intensive behavioral counseling and support through specialty program developed to provide smoking and tobacco use treatment. In addition, telehealth programs to support patients during a quit attempt are also available.
Veterans enrolled for care in VA may contact the nearest VA health care facility or contact their Patient Aligned Care Team (PACT) to learn more about treatment options or to schedule an appointment.
SmokefreeVET is a smoking cessation tool that provides up to eight weeks of supportive and encouraging texts to Veterans quitting smoking. SmokefreeVET, a collaboration between VA and the National Cancer Institute (NCI), is based on NCI's successful text program, which showed an 11% quit rate after six months among individuals who used the program.
Stay Quit Coach:
Stay Quit Coach is a mobile phone app designed to help with quitting smoking. It is intended to serve as a source of readily available support and information for adults who are already in treatment to quit smoking - to help them stay quit even after treatment ends.
Download the Stay Quit Coach for free to any mobile Apple device (iPhone, iPod touch, iPad) in the Apple App Store. Stay Quit Coach is also available on Android and can be downloaded from the Google Play Store.
This app represents a collaborative effort between the VA National Center for PTSD, VISN 21 & VISN 6 MIRECCs, the DoD National Center for Telehealth & Technology, and the VA Clinical Public Health Group.