An expert work group convened by the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) has developed a set of updated guidelines to help clinicians treat tobacco and nicotine dependence in military members.
Published in the
Annals of Internal Medicine, these new recommendations affirm the use of varenicline or combination nicotine replacement therapy (NRT) as the top choices for achieving tobacco abstinence.
Why It’s Relevant
The rates of smoking and other tobacco use are known to be higher among active military and veterans than the general population. Given how smoking deteriorates both physical and mental health, this elevated tobacco use can significantly affect both military readiness and post-active-duty quality of life.
By the Numbers
- The VA/DoD work group developed 22 recommendations (with strong supporting evidence) or suggestions (weaker supporting evidence) across multiple areas, including medications, counseling, and relapse strategies.
- The work group recommended the use of FDA-approved pharmacotherapies—varenicline, bupropion, and NRT agents—to achieve abstinence from combustible tobacco.
- For individuals using a single treatment, varenicline is recommended over bupropion or NRT.
- Combination NRT (e.g., a long-acting patch alongside short-acting gum or lozenges) is recommendedover any single NRT product.
- Varenicline was recommended to achieve abstinence from smokeless tobacco, with weaker evidence for NRT. Both varenicline and NRT had weak evidence to support their use in achieving abstinence from electronic cigarettes.
What’s More
Though there had previously been concerns about the use of smoking cessation medications in individuals with a psychiatric illness, the VA/DoD guidelines suggest that varenicline, bupropion, and NRT can all be safely used in people with stable psychiatric illness.
The Other Side
The quantity and quality of studies varied across topics, so some areas still have insufficient evidence on which to base recommendations, such as the therapeutic potential of brain stimulation or smartphone apps for tobacco abstinence.
Takeaway Message
As with other clinical guidelines, these recommendations are not absolute, the work group noted. They are intended to “promote the delivery of evidence-based care while allowing flexibility for individual clinical judgment and patient preferences.” Further, strengthening clinical practice is just one component of tackling the public health issue of tobacco use.
Related Information
Source
Mark G. Myers, et al. Tobacco use treatment: synopsis of the 2026 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guideline. Annals of Internal Medicine. Published September 22, 2026. doi:10.7326/ANNALS-26-01499
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