Evidence-Based Reviews

How to help nicotine-dependent adolescents quit smoking

Current Psychiatry. 2004 September;3(9):41-61

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using behavioral therapy and patient education as first-line treatment for nonregular adolescent smokers
using medication and behavioral therapy as first-line treatment for regular smokers and medication as second-line treatment for nonregular smokers who do not respond to behavior therapy/patient education.

Algorithm Suggested smoking cessation approaches for adolescents

Offer a treatment for at least 6 to 8 weeks before considering a change in therapy. One definition of initial success is no tobacco use in a 7-day period by self-report and biological verification (such as CO levels).

Behavioral therapy is relatively low-risk and helps many adult smokers. Despite a lack of evidence, some sort of behavioral therapy in combination with pharmacologic therapy might also help adolescent smokers.

When adolescents get disheartened by a slip or relapse to smoking, be patient and encourage them to try again. Inform them that smokers often require multiple attempts before they can quit completely.

Medication. Based on the limited published evidence, we consider TNP and bupropion SR first-line medications for adolescent smokers who want to quit.

For adult smokers, clinicians often combine medication and NRT to increase success rates.¹⁵ No data suggest that combining TNP and bupropion SR may be more effective than monotherapy in adolescents, but the combination might help those who do not respond to either agent alone.

We recommend starting bupropion SR treatment at least 1 week before the patient’s quit date. Titrate the dosage based on the package insert and patient tolerance.

Start NRT according to package instructions, and titrate dosages based on response:

increase if the patient reports substantial craving and withdrawal symptoms, such as irritability and anxiety.
decrease in case of toxicity (such as nausea).

In our experience, adolescent smokers require slightly lower NRT dosages than adults, although this varies among individuals.

Related resources

Centers for Disease Control and Prevention. Tobacco Information and Prevention Source (TIPS). www.cdc.gov/tobacco/quit/iquit.htm
National Institute of Drug Abuse. NIDA for Teens. The Science Behind Drug Abuse. http://teens.drugabuse.gov/index.asp
Society for Research on Nicotine and Tobacco. www.srnt.org

Drug brand names

Bupropion SR • Zyban
Clonidine • Catapres
Doxapine • Sinequan
Mecamylamine • Inversine
Nortriptyline • Pamelor
Selegiline • Eldepryl

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.