Clinical guidelines for the treatment of tobacco dependence syndrome, tobacco withdrawal syndrome

Introduction. The provision of medical assistance to stop tobacco use is one of the leading public policy measures to effectively reduce and eliminate the harm caused by tobacco. The purpose of the study: to develop Clinical Recommendations (CR) on tobacco quitting, treatment of nicotine addiction and the consequences of consumption of tobacco and nicotine-containing products. Materials and methods. The basis for the development of CR was systematic reviews and scientific research on the main key issues of tobacco (nicotine) addiction treatment: behavioral therapy; pharmacological treatment; combination of behavioral and pharmacological therapy; traditional, complementary and alternative treatments; tobacco cessation in the treatment of NCDs. The scales of the reliability of evidence in accordance with the order of the Ministry of Health were used to determine the certainty of evidence and formulate the recommendations. Results. CR included 9 evidence-based recommendations: diagnosis of tobacco dependence syndrome and tobacco withdrawal syndrome is carried out by all doctors; assessment of medical consequences in patients who use tobacco/nicotine; behavioral support is provided to patients; pharmacological treatment aimed at the treatment of nicotine addiction is prescribed; a combination of behavioral and pharmacological therapy is recommended to increase the effectiveness of treatment; pharmacological therapy of concomitant diseases is prescribed; traditional and alternative treatments are not used; treatment is provided to both tobacco users and nicotine users at outpatient and inpatient levels of medical care. Conclusion. The recommendations are evidence-based, modern, and can be applied by doctors at both outpatient and inpatient levels of medical care. 

1. WHO report on the global tobacco epidemic, Protect people from tobacco smoke. 2023. https://iris.who.int/bitstream/handle/10665/372043/9789240077164-eng. pdf?sequence=1

2. World No Tobacco Day 2025: Unmasking the appeal. https://www.who.int/news/item/11-11-2024-no-tobaccoday 2025-unmasking-the-appeal

3. Salagay O.O., Antonov N.S., Sakharova G.M., Konradi A.O., Tanicheva A.A. Involvement of medical professionals in the provision of medical care to quit tobacco and nicotine consumption. The Russian Journal of Preventive Medicine. 2025;28(1):14–23. https://doi.org/10.17116/profmed20252801114/ (In Russian).

4. Samet J.M. Tobacco smoking: the leading cause of preventable disease worldwide. Thorac Surg Clin. 2013;23(2):103– 12. (https://doi.org/10.1016/j.thorsurg.2013.01.009)

5. Salagay O.O., Antonov N. S., Sakharova G. M., Stadnik N. M. The impact of tobacco consumption on the individual and population risk of non-communicable diseases in the Russian Federation. Public health. 2024; 2(4):18–31, DOI: 10.21045/2782-1676-2024-4-2-18-31 (In Russian).

6. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization; 2003. https://iris.who.int/bitstream/handle/10665/42811/9241591013.pdf?sequence=1

7. Guidelines for implementation of Article 14. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization; 2022 https://fctc.who.int/publications/m/item/guidelines-for-implementationof-article 14

8. WHO report on the global tobacco epidemic 2021: addressing new and emerging products. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. https://iris.who.int/bitstream/handle/10665/343287/9789240032095-eng.pdf?sequence=1.

9. WHO report on the global tobacco epidemic, 2019: offer help to quit tobacco use. Geneva: World Health Organization; 2019. License: CC BY-NC-SA 3.0 IGO. https://iris.who.int/bitstream/handle/10665/326043/978924151 6204-eng.pdf?sequence=1

10. Federal Law No. 15-FZ of 02/23/13 (as amended on 12/30/20) “On Protecting the Health of Citizens from Exposure to ambient tobacco Smoke, the Effects of Tobacco Consumption or consumption of nicotine-containing Products” https://www.consultant.ru/document/cons_doc_LAW_142515/. (In Russian).

11. Tobacco dependence syndrome (nicotine), tobacco withdrawal syndrome (nicotine) in adults, Clinical recommendations. ID601_2. 2024. Rubricator of clinical recommendations of the Russian Ministry of Health. https://cr.minzdrav.gov.ru/preview-cr/601_2 (In Russian).

12. Sakharova G.M., Antonov N. S., Salagai O. O. Effective effects on tobacco cessation: a literature review. Lechebnoe delo, 2017, № 4, с. 57–66. https://atmosphere-ph.ru/modules.php?name=Magazines&sop=viewissue&magid=7&issueid=425. (In Russian).

13. Chuchalin A.G., Sakharova G. M., Antonov N. S., Salagai O. O., Brun E. A., kutushev O.T., Lykov V. I. Tobacco dependence syndrome, tobacco withdrawal syndrome in adults. Clinical recommendations. Narkologia [Narcology], 2018: 17(3), P. 3–21. https://medq.ru/narcology

14. Order of the Ministry of Health of the Russian Federation No. 140n dated February 26, 2021 “On Approval of the Procedure for providing medical care to the adult population to stop tobacco consumption or consumption of nicotine-containing products, treatment of tobacco (nicotine) dependence, consequences of tobacco consumption or consumption of nicotine-containing products.” https://www.garant.ru/products/ipo/prime/doc/400354235// (In Russian).

15. WHO clinical treatment guideline for tobacco cessation in adults. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO.