7.12 Smoking and mental health

Last updated: August 2020     

Suggested citation: Greenhalgh, EM., Jenkins, S, Stillman, S., & Ford, C. 7.12 Smoking and mental health. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2018. Available from http://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-12-smoking-and-mental-health 


In Australia, while the prevalence of smoking is declining in the general community, it remains high among people with mental illness. 1 Compared with the general population, people with mental illness have higher smoking rates, higher levels of nicotine dependence, and a disproportionate health and financial burden from smoking. 2, 3 Smokers with co-occurring mental illness or substance use disorders have limited access to cessation treatment, longer durations of smoking, and lower rates of quitting. Such smokers are also far more likely to die from their smoking than as a result of their psychiatric condition. 2 Australian men with mental illness live 15.9 years less and women live 12 years less than those without mental illness, 4  and most of the excess morbidity and mortality is attributable to smoking-related illnesses such as cardiovascular disease, respiratory disease, and cancer. 4 5

The mechanisms underlying the relationship between mental health conditions and smoking are complex, and vary between disorders. 6 Smokers often perceive their smoking to be helpful in relieving or managing psychiatric symptoms, such as feelings of depression, anxiety, and stress. 7 Many mental health workers also believe that smoking cessation will exacerbate mental illness. 8 However, recent evidence suggests that the reverse is true; quitting smoking for at least six weeks actually improves mental health, mood, and quality of life, both among the general population and among people with a psychiatric disorder. 7

Smokers with mental illness are as motivated to quit as the general population, and despite lower overall success rates, can quit successfully. 9 Integrating tobacco cessation interventions into routine mental health treatment, and providing more intensive intervention when required, forms an important part of reducing the large health disparities between those with and without a mental health problem. 6, 7

This section includes information on:

7.12.1 Prevalence of smoking among people with mental health problems

Data from the National Drug Strategy Household Survey show that in Australia in 2019 (refer NDSHS 2019 table 2.60), daily smokers were more than twice as likely to have high/very high levels of psychological distress compared with people who had never smoked (25% compared with 12%, respectively) and were more than twice as likely to have been diagnosed or treated for a mental health condition (29% compared with 14%). 10 Conversely, the same 2019 survey shows (NDSHS 2019, table 8.9) that smoking rates among those with mental illness are roughly double those among people without mental illness. Among those who self-reported any sort of mental illness, 20.2% were daily smokers compared to 9.9% of people who did not report mental illness. 10

Smoking prevalence tends to increase alongside the severity of the psychiatric disorder. 8 For example, two Australian studies conducted 10 years apart both found that among people living with psychotic disorders, about 70% of men and 60% of women are smokers. 1,  11 Figure 7.12.1 shows the prevalence of smoking among people diagnosed and/or treated for mental disorders in Australia in 2016.  (Data for 2019 will be added when the 2019 data file becomes available.)

Figure 7.12.1
Prevalence of daily smoking by mental disorder (diagnosed or treated in past 12 months), Australians aged 14+, 2016 
*Estimate has a relative standard error of 25% to 50% and should be used with caution. 

Note: Diagnosed or treatment for the condition are not mutually exclusive. Respondent may have been diagnosed and treated for the condition in the last 12 months.
Source: Australian Institute of Health and Welfare 12

Results from the 2014–15 National Health Survey show a similarly high prevalence of smoking among people with mental disorders, and also show the extremely high prevalence of smoking among those with harmful use or dependence on alcohol or drugs.

Figure 7.12.2
Prevalence of daily smoking by mental disorder (ICD-10 classification), Australians aged 18+, 2014–5

Sources: Australian Bureau of Statistics Table Builder, 13  using data from the National Health Survey 2014–15 14

International data also show high smoking rates among those with mental illness. Large-scale survey research has found that those with any current psychiatric diagnosis had more than three times greater odds of currently smoking than those with no diagnosis, and were much less likely to quit. 15 Among people with anxiety disorders, smoking rates appear to range from 31.5% for people with social phobia to 54.6% for people with generalised anxiety disorder. 16 Smoking rates are also disproportionately high among people with depression, and conversely, smokers have significantly higher rates of lifetime depression. 6 Another study in the US found that adults with serious psychological distress were more likely to be current smokers and to smoke heavily, and less likely to quit than those without serious psychological distress. 17 US studies 18, 19 have estimated that while nicotine-dependent individuals with a comorbid psychiatric disorder make up only 7.1% of the population, they consume more than one-third of all cigarettes.

A 2014 survey of secure mental health services in the UK found that 64% of mental health patients were smokers, compared with 18% of the general population. 20 A meta-analysis of studies from 20 different countries found that people with schizophrenia have more than five times the odds of current smoking than the general population, and smoking cessation rates are much lower in smokers with schizophrenia compared with the general population. 21 Research in the US and Europe has consistently found that the prevalence of smoking is approximately two to three times higher among people with bipolar disorder than in the general population. 6 Limited data suggest that smoking appears highly prevalent among adolescents with diagnoses of mental illness. 22 Both adults and adolescents with ADHD smoke at significantly higher rates than the general population, 5 and the risk of smoking increases with the number of symptoms. 23

An Australian study of people with psychotic illness found that current smokers smoked on average 21 cigarettes per day, 1 compared with an average of 14 cigarettes per day among smokers in the general Australian population  at that time. 24  Among smokers with severe mental illness, other studies indicate average daily consumption of 30 cigarettes, with a range of 5–80 per day. 25,26 Smokers with schizophrenia smoke more heavily and are more nicotine dependent, 27 and extract more nicotine from each cigarette. 28 Evidence suggests that major depression may be a risk factor for progression of nicotine dependence. 29

7.12.2 Smoking prevalence over time among those with mental health problems

In Australia, while the prevalence of smoking is declining in the general community, it remains high among people with mental illness. For example, the prevalence of smoking among Australians with psychotic disorders remained steady at about 67% between 1997 and 2010, while smoking in the mainstream Australian population declined from 26% to 19%. 1 The gap in life expectancy between those with and without mental illness has also widened over time, largely due to smoking-related diseases. 4 Similarly in the US, several studies have shown growing disparities over time between smoking in the general population and among people with high levels of psychological distress and serious mental illness. 30-33  As overall smoking rates decline, those with serious psychological distress comprise a greater proportion of the remaining smokers. 34  These findings suggest that tobacco control policies and cessation interventions that have effectively reduced smoking in the general population have not been as effective for people with severe mental illness.

Nonetheless, there are some encouraging trends. Several US studies have shown increased quit rates over time among people with psychological distress and some mental disorders. 35, 36  Data from the two most recent ABS Health Surveys show that daily smoking prevalence among those with non-psychotic disorders appears to have declined in line with the general population.

Figure 7.12.3
Prevalence of daily smoking by type of condition (ICD-10 classification), Australians aged 18+, 2011–12 and 2014–5

Sources: Australian Bureau of Statistics Table Builder, 13 using data from the Australian Health Survey 2011–1230 and National Health Survey 2014–15 14

7.12.3 Why those with mental health problems are more likely to smoke

There are a number of potential explanations for why people with mental health problems are more likely to smoke; risk factors for smoking among the general population are experienced to a greater degree, and there are also unique factors that contribute to the higher prevalence of smoking. These include:

  • the historical and environmental context: many mental health institutions have a strong smoking culture and have traditionally condoned and encouraged smoking, with cigarettes used by staff to build rapport, calm, reward, or punish clients. 38-41 Mental health staff may also hold negative attitudes toward patients quitting. 42
  • self-medication, such that smoking is perceived to have a beneficial effect on cognition and mood, and to relieve symptoms of mental illness such as anxiety and stress. 43
  • the psychosocial disadvantage of many people living with mental illness, 44 including lower-than-average education levels and income, 38 and high levels of unemployment. 45
  • social inclusion, such that smoking can be perceived as a way to fit in, cope with exclusion, and alleviate stigma among people with severe mental illness. 46
  • a shared genetic predisposition to smoking and mental illness. 43

The self-medication hypothesis suggests that people with mental illness smoke to ease the symptoms of depression, schizophrenia, substance abuse and other disorders, and is the most common explanation for the very high prevalence of smoking among this group. 38,  47 The hypothesis has also been expanded to suggest that smoking can relieve side effects of antipsychotic medication. 41 Smokers with mental illness frequently cite stress and anxiety relief as reasons for smoking, 45 and young people with mental illness perceive nicotine as protective against the adverse effects of stressful stimuli. 22 However, results from recent studies have led to questioning of the self-medication hypothesis 48, 49  (with the exception of ADHD—see Section The supposed beneficial effects of smoking on stress can be largely attributed to the temporary alleviation of nicotine withdrawal symptoms, which creates the false impression that smoking is relaxing. 50 However, smoking actually increases stress levels overall. 8 A 2014 meta-analysis found that quitting for at least six weeks is associated with reduced depression, anxiety, and stress and improved positive mood and quality of life compared with continuing to smoke among people with psychiatric disorders. 7 Smoking is also associated with suicidal ideation, suicide plan, suicide attempt, and suicide death, 51  but this association is reduced when a person quits. 52 Among people with psychosis, one study estimated that smoking contributed to 21% of suicidal behaviours; 53  reducing consumption may also reduce suicidality in this population. 54  A review of smoking among people with schizophrenia concluded that, despite some enhanced performance for cognitive tasks, smoking appears to be less beneficial on schizophrenic symptomology than generally assumed, while clearly increasing the risk of cancer and other smoking-related diseases responsible for early mortality. 48 A 2015 systematic review and meta-analysis also concluded that daily tobacco use is associated with increased risk of psychosis and an earlier age at onset of psychotic illness. The authors propose that smoking could have a causal role in psychosis, which further brings into question the self-medication hypothesis. 55 Smoking may also increase the risk of anxiety and depression. 8

Another proposed explanation for the higher rates of smoking among people with mental health problems is that once addicted, they find it much more difficult to quit than the general population. Although treating tobacco dependence in people with mental illness is challenging, several randomised treatment trials and systematic reviews have documented that success is possible. 56 Smokers with chronic mental illness are able to quit with standard cessation approaches with minimal effects on psychiatric symptoms. 57 (See  Section 7.12.5) Socio-economic status (SES) is inversely related to smoking, such that the prevalence of smoking is substantially higher among lower socio-economic groups (see  Chapter 1.7). Mental disorders are associated with low incomes and higher levels of debt; 58 thus, there is likely interplay between low socioeconomic status, mental illness, and smoking. In 2011–12, 62% of working age Australians with a mental illness were employed, compared to 80% of those without a mental illness. 59 One study found that smokers with mental illness frequently smoke to combat boredom, and suggested that the higher rates of unemployment among this group may contribute to more frequent experiences of boredom and therefore smoking. 45 (See  Section 7.19.2 and Chapter 9,  Section 9.6.4)

Looking at why and how some people resist smoking despite being at-risk can also shed light on potential protective factors. 60 One small study with people diagnosed with mental illness found that strong, negative attitudes to smoking as children that have persisted into adulthood, lasting associations with smoking, a clear sense of ‘self’ separate from peers from an early age, and developing a range of coping strategies and external supports not related to smoking served as protective factors from taking up smoking. 60

7.12.4 Barriers to be overcome when quitting

People with mental health problems face a number of unique barriers to quitting, including misperceptions regarding the safety of stopping smoking, higher levels of nicotine dependence and withdrawal, lower degree of participation in programs, misperceptions of low motivation to quit, socio-economic factors, and systematic barriers to quitting in mental healthcare settings. A systematic review identified smoking for stress management, lack of support from health and other service providers, the high prevalence and acceptability of smoking in vulnerable communities, and the maintenance of mental health as perceived barriers among those with mental illness. 61 An Australian study of smoking behaviours among institutionalised psychiatric populations found systematic barriers to quitting, including cigarettes being the currency by which economic, social and political exchange took place and complex processes of reinforcement to smoke. Escape from the smoking culture of the settings appeared to be extremely difficult for clients and staff. 62

There is a common false belief within mental health settings that quitting smoking interferes with recovery from mental illness, eliminates a coping strategy, and leads to decompensation in mental health functioning. 56 People with mental illness also report similar concerns, which can hinder quit attempts. 63 However, several major reviews have found that quitting does not lead to deterioration in symptoms of schizophrenia, depression, or severe mental illness, 64, 65 and is in fact associated with improvements in mental health among people with psychiatric disorders. 7 Smoking cessation also does not exacerbate anxiety or PTSD symptoms, or lead to psychiatric hospitalisation or increased use of alcohol or illicit drugs. 39, 66 Indeed, smoking cessation interventions during addictions treatment appear to enhance rather than compromise long-term sobriety. 67  Two studies examining whether the treatment of ADHD can enhance response to smoking cessation intervention found no association overall between abstinence and change in ADHD symptoms, 68, 69 and another found that quitting can reduce anxiety and depressed mood in smokers with ADHD. 70 Quitting is also associated with a decreased likelihood of suicide attempt. 52 Lifetime history of major depression does not appear to be an independent risk factor for failure in smoking cessation treatment. 71

Another common misperception is that people with mental illness do not want to quit, which can lead to a lack of encouragement and support to do so. 72 A study of mental health centres found that the most common barrier to staff implementing smoking cessation treatment was a perceived lack of patient interest in quitting. 73 Although the co-presence of mental illness can make quit attempts more challenging 74 and less successful, 75 smokers with mental health disorders are motivated to quit. 9 Studies involving patients recruited from outpatient and inpatient psychiatric settings suggest that they are just as likely as the general population to want to quit smoking. 39 Further, contrary to common beliefs, greater psychiatric symptoms have been shown to predict greater, not lesser, motivation to quit smoking. 76  In British surveys, about half of smokers with mental illness have expressed an interest in quitting when asked. 77 In the US, 20–25% of smokers with mental illness report that they intend to quit smoking in the next 30 days, and another 40% say they intend to do so in the next six months. 56  Another population-level study in the US found that smokers with mental illness were more likely than those without mental illness to attempt quitting, and just as likely to use cessation treatment. 78 Inpatients with mental health disorders appear to be no less motivated to stop smoking than those without mental health disorders and their use of NRT during hospitalisation is similar. 79 One Victorian study of consumers at a psychiatric disability rehabilitation and support service found that while smoking rates were almost four times higher than the general population, there was high interest in quitting and cutting down. 80 US research found that, among a sample of women with PTSD symptomatology and serious mental illness, readiness and intention to quit smoking was high. 81  Smokers with mental illness cite similar reasons for wanting to quit as the general population. For example, one study found that health concerns (73%), cost (71%), advice from a doctor (54%), and advice from others (64%) prompted a desire to quit, while social support from family and friends (58%), direction from a doctor (46%), use of NRT (31%), and the advice of friend who had quit (23%) were factors that enabled quitting. 82

7.12.5 Interventions for reducing smoking for those with a mental health problem

Smoking has a disproportionate impact on the mental and physical health of people with mental illness, therefore treating nicotine dependence should be a high priority and form part of routine care. 8 However, progress in the development of cessation treatments for people with mental health problems has traditionally been slow, in part because smokers with a current mental disorder have been excluded from most smoking cessation trials. 83 Given the growing body of evidence showing that quitting is typically not detrimental to psychiatric symptoms and, in fact, may lead to improvements in mental health and wellbeing, 7,  84 cessation should be encouraged and supported among smokers with comorbid mental disorders as it is among smokers in the general population. 6 However, as with any other stressor, the stress of cessation could temporarily affect symptoms; 39 therefore, monitoring of patients’ psychiatric status during the quitting process is warranted. 6 Nonetheless, people with a mental illness should be offered the same smoking cessation interventions that have been shown to be effective in the general population, 85 with optimal treatment comprising behavioural and pharmacotherapy interventions, alone or in combination. 86 Smokers with chronic mental illness can successfully quit with standard cessation approaches, and longer maintenance on pharmacotherapy can reduce the typically high rates of relapse without detrimental effects on psychiatric symptoms. 57

An important consideration in treating nicotine dependence is the impact of smoking on psychiatric treatment. Smoking complicates the treatment and course of psychiatric disorders through its profound effect on the metabolism of pharmacotherapies, and is therefore one of the factors that leads to individual differences in drug responses. 6 For example, smoking can interfere with the medications taken for schizophrenia and depression, therefore the doses of some psychotropic medications may need to be decreased following cessation. 85, 87   Patients with mental illness can be offered the same cessation medications as the general population, 88  but should be monitored closely. The typically higher levels of nicotine dependence among smokers with mental illness mean that larger doses of NRT, combination pharmacotherapy, and a longer duration of therapy may be necessary. 8  Australian research found that cessation support after discharge from an inpatient psychiatric facility was effective in encouraging quit attempts and reducing cigarette consumption up to 6 months post-discharge. 89

SANE Victoria and Quit SA, in collaboration with the Tobacco and Mental Illness project in South Australia, have each developed resources to help long-term psychiatric clients to quit, and resources for carers and mental health workers to use as well as a group program for smoking cessation. 90,91  Similar programs have been run in other states. 92 All state and territory Quitline services adhere to protocols for tailoring assistance to callers with mental illness. As well as training Quitline counsellors in the special issues for people with mental illness, they co-ordinate intervention with the person’s healthcare professionals. 93 Depression

Compared to people without depression, people with depression are about twice as likely to be smokers, and are less likely to succeed in quit attempts. 94, 95   They are also more nicotine dependent, more likely to suffer from negative mood changes after nicotine withdrawal, more likely to relapse, and experience disproportionate morbidity and mortality from smoking-related disease. 94 Depression is also related to psychosocial characteristics that make it more difficult to stop smoking, for example, lower self-esteem and self-efficacy for quitting, and greater likelihood of unemployment, poorer social support networks and poorer physical health. 96 Recent findings from the Four Country (Canada, US, UK, and Australia) International Tobacco Control Study showed that smokers with depressive symptoms or diagnosis make more quit attempts than people without depression, but they were also more likely to relapse in the first month. 97 Despite this, meta-analyses suggest that a lifetime history of major depressive disorder, in itself, does not predict failure to quit smoking. 71  A 2015 review of depression and smoking concluded that: depressed smokers are motivated to quit; smoking cessation does not exacerbate symptoms of depression; depression does not have a negative impact on smoking cessation outcomes; and the self-medication hypothesis does not account for tobacco dependence and depression co-morbidity. 98 Indeed, a growing body of evidence supports the beneficial role of quitting in reducing depression. 7 99

A meta-analysis of treatment trials in smokers with depression published in 2010 concluded that NRT was more effective than placebo, and that adding behavioural mood management to cessation counselling improved treatment outcomes. Notably, only three trials included smokers with current depression, therefore the findings were most relevant to smokers with a history of depression. 100  A 2013 Cochrane review evaluated the effectiveness of smoking cessation interventions in smokers with current or past depression. It concluded that adding a psychosocial mood management component to a standard smoking cessation intervention increases long-term cessation rates in smokers with both current and past depression when compared with the standard intervention alone. Bupropion was beneficial for smokers with a history of depression, but there was a lack of evidence regarding its use with smokers with current depression. There was not enough evidence regarding the effectiveness of other antidepressants for quitting in current or past depression, nor for the effectiveness of standard smoking treatments that do not target depression, such as nicotine replacement therapy and psychosocial smoking cessation interventions. 94  A placebo controlled trial published in 2013 examined the effects of varenicline on smoking in people with stable current or past major depression. Findings showed that varenicline significantly increased continuous abstinence during the last month of treatment and up to a year, without exacerbating depression or anxiety; therefore, it appears to be a well-tolerated and effective treatment for smoking cessation in people with depression. 101  A 2017 systematic review and meta-analysis concluded that smoking cessation interventions, particularly pharmacological treatments, appear to increase short-term and long-term smoking abstinence in individuals with current depression, although noted that the evidence is weak. 99 Anxiety

Despite the high rates of smoking among those with anxiety disorders, there is a dearth of evidence regarding effective cessation interventions for this population. 6 A randomised controlled trial published in 2011 found that anxiety diagnoses were common among treatment-seeking smokers and were related to increased motivation to smoke, elevated withdrawal, lack of response to pharmacotherapy, and impaired ability to quit smoking. 102 Another study found that smokers with social anxiety disorder experienced higher levels of craving and urge to smoke during quit attempts, which could explain their worse cessation outcomes. Such smokers would likely benefit from additional treatment aimed at managing or reducing their social anxiety symptoms, and NRT also seemed to help alleviate the relationship between social anxiety and cravings. 103 Overall, further research is needed on how best to support quitting among people with anxiety disorders. 6 Attention-deficit/hyperactivity disorder (ADHD)

ADHD is one of the most common psychiatric disorders, and is associated with a wide range of impairments and risks into adulthood. 104 Smoking is one such risk, with young people with ADHD beginning smoking earlier, and being two to three times more likely to smoke, compared to those without ADHD. The substantially higher prevalence of smoking persists into adulthood, and adults with ADHD are also less likely to be successful at quitting. 105-107

There is a growing body of evidence that stimulant medication, which is a front-line treatment of ADHD, may influence smoking-related outcomes. 105 Nicotine and stimulant medications operate on the same pathways in the brain, and both appear to help alleviate some of the symptoms of ADHD, which may help explain the very high rates of smoking among this group. 108   ADHD medication (i.e., stimulant treatment) reduces smoking rates and smoking withdrawal, therefore early and consistent stimulant treatment of ADHD may reduce smoking risk. 105, 109  Bupropion, NRT, and possibly varenicline—approved smoking cessation medications—have also shown efficacy in treating symptoms of ADHD; 109, 110   however, further research is needed to examine its effectiveness in treating comorbid ADHD-smoking. 6 Non-pharmacological interventions, particularly cognitive-behavioural therapy, also show promise for the treatment of ADHD, and warrant further investigation for supporting cessation among this population. 6 Limited evidence also suggests that financial incentives may be a useful approach for promoting short-term cessation in adult smokers with ADHD. 111 Substance use disorders

Smoking prevalence among people with substance use disorders is substantially higher than the general population, 36, 112, 113  and many people who successfully overcome their substance use disorder will go on to die from a smoking-related disease. 114  People with substance or alcohol use disorders have: greater lifetime and current smoking, nicotine dependence, and non-cigarette tobacco use; lower quitting; and differences in quit attempts and withdrawal symptoms compared with people without such disorders. 115 Many health risks for dual use of alcohol and tobacco are multiplicative rather than simply additive. For example, the risk of oesophageal cancer is greater among heavy alcohol users as a result of alcohol allowing tobacco toxins to penetrate more deeply to basal layers. 116  Similarly, there is evidence that smoking cannabis is a risk factor for many of the same illnesses as tobacco. 117-119  Cannabis poses unique problems for users since it is often mixed with tobacco, potentially inducing double dependence. In 2016, 32% of smokers in Australia reported recent use of cannabis, compared to 7% of non-smokers.(see Chapter 1,  Section 1.10) Most people who seek treatment for substance use disorders smoke tobacco as well. 120  Smoking rates among people in addiction treatment are more than double those of people with similar demographic characteristics. 113  Australian research in the early 2000s found that smoking prevalence in this population ranged from 68–98% 121, 122  and the 2014–15 National Health Survey also showed extremely high prevalence of smoking among those with harmful use or dependence on alcohol or drugs (see Section 7.12.1). One US review highlights consistently extremely high smoking rates and subsequent comorbid health risk among people with alcohol and drug use disorders, with rates being greatest among those enrolled in methadone maintenance and in-patient addiction treatment. 123

Treatment centres for substance use disorders have traditionally not prioritised treating nicotine addiction due to lack of staff training, lack of integration into usual care, and because of the common misperception that quitting may be detrimental to the treatment of alcohol or other drug use. 124, 126  Substance abuse counsellors often have limited knowledge of the smoking cessation medications available for those trying to quit 127  and their implementation of tobacco cessation guidelines is inconsistent. 128  A study of staff and management attitudes and practices in Australia found smoking received little systematic attention, with concerns about possible negative impact on other treatments, absence of policy, and lack of training being major impediments. 129  Research in the US found that smokers with a substance use disorder who had undergone addiction treatment were less likely to quit smoking than those who had never received such treatment, possibly due to false beliefs about smoking as a coping strategy and staff attitudes that may discourage cessation. 130  Some centres may even endorse occasional smoking by staff with clients 131  or rely on cigarettes to stabilise mood in their patients. 39, 132

Contrary to staff perceptions, smokers with substance use disorders are motivated to quit. 133 However, despite this motivation to quit, there appears to be a wide variation in readiness to seek help to do so, 39, 67, 132, 134  which may be due to a lack of confidence in or wariness of quitting multiple substances at once. 134  Research in the US showed that when provided with a tobacco free treatment environment, patients with substance abuse and mental illness can and do make the decision to quit tobacco and maintain their abstinence, which in turn helps them to remain sober. 135  While negative affect can hinder quit attempts, patients in an addictions treatment setting can successfully quit smoking regardless of current depressive symptoms. 136 In the US, despite being lower than for people without the disorders, the smoking quit rates for people with alcohol use disorders has increased over time. 36

Perhaps most importantly, smoking interventions and cessation during substance use treatment appear to enhance rather than compromise long-term abstinence from other addictive drugs. 9, 137, 139  Including cessation interventions in the course of addiction treatment can increase quit attempts among smokers. 140, 141  A 2015 systematic review of smoking cessation interventions for adults in substance abuse treatment or recovery concluded that NRT, behavioural support, and combination approaches appear to increase smoking abstinence in those treated for substance use disorders. However, the authors note that higher quality studies are needed to strengthen the evidence base. 142  Some research indicates that drug treatment clients can successfully quit smoking at rates similar to the general population when given access to an intensive intervention. 143  Several studies suggest that varenicline may promote smoking changes and concurrently help reduce heavy drinking in people with alcohol use disorders. 144-146 However, use of bupropion by abstinent alcoholic smokers does not appear to increase long-term smoking cessation. 147 For methadone maintenance patients, varenicline 148 and NRT 149  may be effective for promoting tobacco abstinence. 

Several studies have explored the role of contingency management (i.e., financial incentives) in promoting abstinence. One study found that contingency management was associated with more short-term abstinence and lowered nicotine addiction among current and former injecting drug users. 150  Another study found that contingent vouchers had limited effects on long-term smoking abstinence among smokers in residential drug treatment, but the effects were improved when vouchers were combined with motivational interviewing. 151  A randomised trial similarly found that adding contingency management to an evidence-based smoking cessation treatment that included medication and behavioural counselling doubled the quit rate at the end of treatment among smokers with alcohol abuse or dependence. 152  Contingency management may also promote smoking reduction in more severe substance abusers, such as those in residential services and opioid-maintained patients. 153-155  Such interventions appear to increase abstinence self-efficacy among residential substance abuse treatment patients. 156  Increasing tolerance for withdrawal and abstinence discomfort, addressing expectations, and increasing motivation may also be important when implementing incentive programs. 157  Other strategies include brief advice plus NRT, which appears to be a cost-effective way to reduce smoking for smokers in residential alcohol treatment. 158  A small study found that methadone users responded positively to a computer-based education program highlighting the hazards of smoking. 159

As with mental health and correction services, public health experts have identified a need for policy and training initiatives to address past neglect of tobacco-control issues. 160, 161 Systematic intervention around the 5As framework, tailored to the needs of client groups, would provide a good foundation for this work. Factors promoting smoking cessation programs within substance abuse clinics include supportive systems and integration within other treatments, educating providers about the beneficial effects of cessation for their clients, staff training, and encouraging and assisting staff to quit. 132  One study found that an intervention based on organisational change helped to shift the treatment system culture and increase tobacco services in a residential addiction treatment setting. 161

Future clinical research in this area and its translation into practice may be improved by recruiting and retaining a broader range of people with drug dependencies, particularly those who are not currently being reached through mainstream interventions, and by longer-term follow-up. 162  Research as to the role of social bonding around tobacco use and its normalisation in drug treatment settings may be useful in guiding future practice. 134 Post-traumatic stress disorder (PTSD)

The prevalence of current smoking in individuals with PTSD is substantially greater than that for the general population, and is estimated to be about 45%. A systematic review concluded that there appears to be a causal relationship between PTSD and smoking that may be bidirectional. PTSD, rather than trauma exposure itself, appears to have a greater influence on a person’s risk of smoking, and specific PTSD symptoms may contribute to smoking and disrupt cessation attempts. 163  Evidence suggests that people with PTSD smoke to cope with negative affect and anxiety, 57  and PTSD is associated with higher levels of consumption (i.e., more cigarettes smoked per day). 164  Despite the higher smoking and lower quit rates, there is relatively little research on effective cessation interventions for this population. 163

To date, there have only been a very small number of randomized clinical trials examining smoking cessation interventions in smokers with PTSD. 57  Two studies focused on integrating cessation treatment into ongoing mental healthcare, and both found that the integrated care group achieved significantly higher long-term abstinence. 165, 166  Such integration also appears to be cost-effective. 167  A pilot study with 15 veterans found that bupropion was well-tolerated and effective in helping the participants to quit, with 40% maintaining abstinence. 168  Another small study (N=22) examined the effects of combining contingency management (i.e., monetary rewards) with counselling sessions, NRT, and bupropion. Abstinence rates were higher among the group that received rewards, however the difference was non-significant. This may have been due to the very small sample size, therefore larger studies may help determine the effectiveness of this intervention. 169  A larger randomised controlled trial concluded that integrating motivational interviewing into a PTSD home telehealth care management program is an effective method to help veterans with PTSD quit smoking. 170  A number of case studies suggest that combining cognitive processing therapy with evidence-based smoking cessation interventions may improve both cessation outcomes and PTSD symptoms. 171 Bipolar disorder

People with bipolar disorder are about three and a half times more likely to smoke than the general population, and have much lower quit rates than smokers without a comorbid condition. 172, 173  In addition to contributing to increased morbidity and mortality, smoking has also been implicated in the progression of bipolar disorder. 174  However, despite these high rates of comorbidity and related morbidity, there is only a modest field of research focusing on smoking among individuals with bipolar disorder. 175  To date, there have only been a small number of clinical studies on cessation interventions among smokers with bipolar disorder. Researchers have highlighted challenges in recruitment and low eligibility rates as significant hurdles to such studies, and have noted that many health professionals remain wary of encouraging cessation among people with bipolar disorder. 173  Nonetheless, recent research has attempted to address this gap.

Two very small studies found that buproprion 176  and varenicline 177  were well-tolerated and led to reduced smoking. Subsequent larger studies have also supported the effectiveness of varenicline. The largest study included 247 smokers with schizophrenia or bipolar disorder. Participants received 12-week treatment with both varenicline and cognitive behavioural therapy, and those who had 2 weeks or more of continuous abstinence at week 12 (n=61) were randomly assigned to receive cognitive behavioural therapy and varenicline or placebo from weeks 12 to 52. After a year, those treated with varenicline were more than six times more likely to be abstinent (60%) than those treated with placebo (19%). Importantly, there were no impacts on psychiatric symptoms. 178  Another randomised controlled trial of varenicline included 60 smokers with bipolar disorder. At 3 months (end of treatment), significantly more participants quit smoking with varenicline (48.4%) than with placebo (10.3%). At 6 months, about 19% of those treated with varenicline remained abstinent compared to about 7% assigned to placebo. Psychopathology scores remained stable, although varenicline-treated participants reported significantly more abnormal dreams. The authors call for medication trials of longer duration, and vigilance for neuropsychiatric adverse events. 179 Schizophrenia

Schizophrenia is a chronic and severe mental illness that affects about one in 100 people. 180  People with schizophrenia are more than five times more likely to smoke than the general population, 21 and tobacco-related conditions are responsible for about half of total deaths in people with schizophrenia. 181  Rates of cessation for smokers with schizophrenia are half those for the general population, partly because of their lower motivation to quit, fewer cessation attempts, increased level of nicotine dependence, and reduced access to treatments. 182  They may also perceive themselves to be at lower risk of smoking related-disease. 183  Healthcare services have traditionally condoned or encouraged smoking and failed to offer tobacco cessation interventions to patients with schizophrenia, mainly due to beliefs about the benefits of smoking to symptoms, stigma, lack of information, or perceived hopelessness regarding abstinence. 184, 185  However, in recent times there has been considerable interest in developing effective smoking treatment for this population, 6 and guidelines have been published that include cessation interventions for smokers with schizophrenia. 85  Smokers with a psychotic disorder are capable of long-term reduction and abstinence with appropriate intervention and support. 186  Once people with schizophrenia have successfully quit, the use of antipsychotics may need to be reviewed, as tobacco smoke can differentially affect drug metabolism and the effects of antipsychotic medications. 8 187

A 2013 Cochrane review of interventions for smoking cessation and reduction in individuals with schizophrenia concluded that bupropion increases smoking abstinence rates in smokers, without any deterioration of mental state. Varenicline may also improve smoking cessation rates, but the authors noted a possibility of adverse psychiatric effects, such as increased suicidality. There is some evidence that contingent reinforcement (i.e., monetary rewards) may help people with schizophrenia to quit and reduce smoking in the short term. 185 Building on the Cochrane review, a 2015 systematic review and meta-analysis examined the evidence regarding varenicline for smoking cessation in people with schizophrenia. It concluded that while there did not appear to be any adverse psychiatric outcomes, varenicline was not found to be superior to placebo for quitting. 188  Another 2015 review of smoking cessation in people with schizophrenia concluded that the most promising evidence is for bupropion, and that pharmacological interventions do not appear to increase adverse events. It suggested that the lack of evidence for NRT and varenicline may be due to the paucity of research. Behavioural and psychosocial interventions are also promising, particularly when combined with pharmacotherapy. The authors highlight the importance of carefully monitoring antipsychotic levels, and suggest that encouraging physical activity may help to negate potential weight gain and diabetes risk following cessation. 189  A further review of the evidence recommended that people with schizophrenia should receive varenicline or bupropion with or without nicotine replacement therapy in combination with behavioural treatment. Maintenance pharmacotherapy for 1 year appears to improve sustained abstinence rates. 190

Results from a large randomised controlled trial were published in 2016, which found that varenicline was more effective than bupropion and nicotine patch in smokers both with and without psychiatric disorders (including schizophrenia), whereas bupropion and nicotine patch were similarly effective, and both more so than placebo. The authors also examined the safety of the medications, and concluded that they can be used safely by psychiatrically stable smokers; there was no increase in neuropsychiatric adverse events attributable to varenicline or bupropion relative to nicotine patch or placebo. 88  In September 2016, the FDA released a preliminary review of this trial, suggesting a number of problems with the study. The review supported similar conclusions about the relative rates of events: in patients without prior psychiatric history, events did not seem to be more frequent in varenicline, bupropion, or NRT-treated patients than in placebo-treated patients. The review also found that among patients attempting to quit, events were more common in those with psychiatric history than those without, regardless of which treatment they received. Of concern however, was a possible increased risk of neuropsychiatric events in patients with psychiatric history in the varenicline or bupropion group compared to placebo. This trended toward statistical significance, but was not observed in NRT-treated patients. 191

Additional recent randomised controlled trials 192, 193  and a systematic review and meta-analysis 194  have supported the safety and efficacy of varenicline for reducing smoking in people with schizophrenia. A 2017 review recommends that smokers with schizophrenia should receive varenicline, bupropion with or without NRT, or NRT, all in combination with behavioural treatment for at least 12 weeks. Maintenance pharmacotherapy may reduce relapse and improve sustained abstinence rates. It notes that controlled trials in smokers with schizophrenia consistently show no greater rate of neuropsychiatric adverse events with pharmacotherapies than with placebo. 195

7.12.6 Role of health professionals and health settings

Medical and mental health professionals often overlook the importance of addressing tobacco use with their patients. 38, 196 Smoking is often not asked about or recorded as a standard part of psychiatric assessment, and even when it is, inclusion of smoking cessation in treatment planning is often inconsistent. 38, 197-199 This may be partly due to the erroneous beliefs held by some mental health workers that smoking is one of the few pleasures clients have, that smoking reduces stress and anxiety, 44, 200  that those with mental illness are not motivated to quit, 72  or that there are more pressing concerns for patients with acute psychiatric symptoms. 56

International evidence suggests that cessation support for inpatient smokers by staff is likely to be severely compromised by low levels of knowledge and awareness of tobacco dependence. 201  Several Australian surveys have found strong support for the provision of smoking cessation treatment among mental health service staff; 202, 203 however staff report significant barriers to providing such care. 202 Commonly cited barriers include inadequate resources, cultural norms, client resistance, and lack of training and confidence. 204-206   More experienced staff, and those with tobacco cessation training, are more likely to help their clients quit smoking. 207,  199,   208

Healthcare professionals, including physicians, psychiatrists, and psychologists, have an important role in the recognition and treatment of tobacco use disorders in patients with psychiatric illnesses, and providing cessation treatment for all patients with a co-occurring tobacco use disorder should form part of routine care. 8,  209, 210  A 2015 systematic review and meta-analysis concluded that while there has been progress, offering smoking cessation advice should receive a higher priority in everyday clinical practice for patients with a mental health diagnosis. 211  Encouraging longitudinal research in the US found that smokers who had seen mental health professionals for mental health problems had higher odds of having made attempts to quit in the past year, and were more likely to have used cessation assistance. 212  However, another longitudinal US study looking only at psychiatrists found that they are screening for tobacco use at declining rates, and the proportion of smokers provided with treatment remains low. 213

As in the general population, people with mental illness should be given advice and support to quit using the 5As framework. 214  Given that people with mental illness are often highly nicotine dependent, and are more likely to socialise with smokers, more intensive interventions may have greater success. This might involve NRT or other pharmacotherapies, as well as referral to a specialised individual program, such as the Quitline, or a group program. The integration of cessation treatment into existing care by health professionals results in greater engagement, greater use of cessation pharmacotherapy, and increased likelihood of abstinence. 165  Quit Victoria has suggested a number of strategies that mental health services could implement to reduce smoking-related harms, including:

  • routinely asking clients about their smoking and recording responses
  • referring clients and staff to Quitline, a doctor, or a local quit smoking program
  • establishing or reviewing smokefree policy
  • encouraging staff to complete further training in smoking cessation
  • displaying posters and print resources
  • referring staff and clients to the Quit website for information on services and smoking care medications. 215

An important part of providing smoking cessation support for those with mental health disorders is for mental health services to develop comprehensive policy on smokefree environments, documenting tobacco use, and continuing support on discharge. This requires leadership from management, staff training, and consistency across services. 216,  217  An audit of an Australian psychiatric hospital found that the setting did not conform to current clinical practice guidelines as it often failed to document smoking status, despite nicotine dependence being the most commonly diagnosed psychiatric disorder. 218  Another Australian study of public psychiatric inpatient units found that over one-third of inpatients started smoking during their admission, and that staff often provided cigarettes to patients. Only half of respondents reported that all patients were assessed for smoking status. The study suggests that failure of psychiatric services to provide smoking care is systematic and not related to particular types of services. 219

Some psychiatric services have become smokefree 220  and there is evidence that hospitalisation in a smokefree environment is associated with increases in patients’ expectancies about quitting and staying a non-smoker, 221  and with reduction in cigarette consumption. 222  A systematic review concluded that smokefree psychiatric hospitalisation may have a positive impact on patients' smoking-related behaviours, motivation, and beliefs, both during admission and up to 3 months post discharge. 223  During smokefree psychiatric hospitalisations, offering patients NRT directly on admission, educating patients on the benefits of NRT, and increasing the dosage for more dependent smokers can help with managing nicotine withdrawal. 224  Community support post-discharge may also help smokers to maintain abstinence. 225  Psychiatric hospitals in the US that voluntarily adopted such bans have documented little-to-no disturbance in patients’ behaviour and time savings for staff members. 56  A study in France found that staff members of a psychiatric facility were exposed to substantially lower levels of secondhand smoke post-ban. 226  However, an Australian study published in 2015 found that adherence to smokefree policy in an inpatient psychiatric facility was poor, with more than four in five smokers still smoking, and only about half perceiving staff to be supportive of the policy. 227  Two Australian studies have found that about only about half of psychiatric patients feel positively about bans, 227, 228  while another found that only about one quarter of mental health staff agreed with a total smoking ban. 229  Some patients also perceive the restrictions to be a form of punishment. 230  There have been debates recently regarding the ethics of implementing complete smoking bans in psychiatric hospitals; proponents argue that the ‘smoking culture’ creates disproportionate harm among people with mental illness, while opponents argue that it is unethical to deprive patients of autonomy and impose treatment. 231, 232

Together, evidence suggests that there is a critical need to engage healthcare providers, policy-makers, and mental health advocates in the effort to increase access to:

  • evidence-based tobacco treatment for smokers with mental health disorders
  • smokefree environments for mental health treatment
  • training for clinicians in cessation treatment
  • systems for routinely identifying patients who smoke, advising cessation and providing treatment or referral. 56

Relevant news and research

For recent news items and research on this topic, click  here. ( Last updated March 2021)


1. US Department of Health and Human Services. Smoking cessation. A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, 2020. Available from: https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf.

2. Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, and Lancaster T. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews, 2018; 5:CD000146. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29852054

3. Howes S, Hartmann-Boyce J, Livingstone-Banks J, Hong B, and Lindson N. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews, 2020; 4:CD000031. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32319681

4. Cahill K, Lindson-Hawley N, Thomas KH, Fanshawe TR, and Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, 2016; 5(5):CD006103. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27158893

5. Lindson N, Chepkin SC, Ye W, Fanshawe TR, Bullen C, et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 2019; 4(4):CD013308. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30997928

6. Cahill K, Stevens S, Perera R, and Lancaster T. Pharmacological interventions for smoking cessation: An overview and network meta-analysis. Cochrane Database of Systematic Reviews, 2013; 5(5):CD009329. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23728690

7. Fix BV, Hyland A, Rivard C, McNeill A, Fong GT, et al. Usage patterns of stop smoking medications in Australia, Canada, the United Kingdom, and the United States: Findings from the 2006-2008 international tobacco control (ITC) four country survey. International Journal of Environmental Research and Public Health, 2011; 8(1):222-33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21318025

8. Narayanan S, Ebbert JO, and Sood A. Gender differences in self-reported use, perceived efficacy, and interest in future use of nicotine-dependence treatments: A cross-sectional survey in adults at a tertiary care center for nicotine dependence. Gender Medicine, 2009; 6(2):362-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19682663

9. Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 2012; 11:CD000146. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23152200

10. Pharmaceutical Benefits Advisory Committee. March 2008 meeting, positive recommendations.  2008. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/pbacrec-mar08-positive.

11. Pharmaceutical Benefits Advisory Committee. Letter concerning listing of NRT patches for Indigenous smokers, The Cancer Council Australia, Editor 2008: Sydney.

12. Australian Government Department of Health. Australian register of therapeutic goods, medicines 2019. Available from: https://www.ebs.tga.gov.au/.

13. Australian Government Department of Health. Pharmaceutical benefits scheme – what are the current patient fees and charges?  2020. Available from: http://www.pbs.gov.au/info/about-the-pbs#What_are_the_current_patient_fees_and_charges.

14. US Department of Health and Human Services. The health consequences of smoking: Nicotine addiction. A report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health, 1988. Available from: https://stacks.cdc.gov/view/cdc/22014/cdc_22014_DS1.pdf.

15. Hughes JR. The future of smoking cessation therapy in the United States. Addiction, 1996; 91(12):1797-802. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8997761

16. Fant RV, Buchhalter AR, Buchman AC, and Henningfield JE. Pharmacotherapy for tobacco dependence. Handbook of Experimental Pharmacology, 2009; (192):487-510. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19184660

17. Paul C, Walsh R, and Girgis A. Nicotine replacement therapies over the counter: Real life use in the Australian community. Australian and New Zealand Journal of Public Health, 2003; 27(5):491–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14651392

18. Henningfield JE, Fant RV, Buchhalter AR, and Stitzer ML. Pharmacotherapy for nicotine dependence. CA: A Cancer Journal for Clinicians, 2005; 55(5):281-99; quiz 322-3, 5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16166074

19. Kraiczi H, Hansson A, and Perfekt R. Single-dose pharmacokinetics of nicotine when given with a novel mouth spray for nicotine replacement therapy. Nicotine and Tobacco Research, 2011; 13(12):1176-82. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21849415

20. Hansson A, Hajek P, Perfekt R, and Kraiczi H. Effects of nicotine mouth spray on urges to smoke, a randomised clinical trial. BMJ Open, 2012; 2(5):e001618. Available from: https://bmjopen.bmj.com/content/bmjopen/2/5/e001618.full.pdf

21. Lindblom EN. Effectively regulating e-cigarettes and their advertising—and the first amendment. Food and Drug Law Journal, 2015; 70:57–94. Available from: http://www.law.georgetown.edu/oneillinstitute/news/documents/March10-LindblomFDLJ_001.pdf

22. Therapeutic Goods Administration. Nicotine e-cigarettes. Australian Government Department of Health, 2021. Available from: https://www.tga.gov.au/nicotine-e-cigarettes.

23. Polosa R and Benowitz NL. Treatment of nicotine addiction: Present therapeutic options and pipeline developments. Trends in Pharmacological Sciences, 2011; 32(5):281-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21256603

24. World Health Organization. Tools for advancing tobacco control in the xx1st century: Policy recommendations for smoking cessation and treatment of tobacco dependence. Tools for public health. Geneva: World Health Organization, 2003. Available from: http://www.wpro.who.int/NR/rdonlyres/8D25E4D3-BB81-479E-8DF5-7BAF674DB104/0/PolicyRecommendations.pdf.

25. Beaver JD, Long CJ, Cole DM, Durcan MJ, Bannon LC, et al. The effects of nicotine replacement on cognitive brain activity during smoking withdrawal studied with simultaneous fmri/eeg. Neuropsychopharmacology, 2011; 36(9):1792-800. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21544072

26. Stanley TD and Massey S. Evidence of nicotine replacement's effectiveness dissolves when meta-regression accommodates multiple sources of bias. Journal of Clinical Epidemiology, 2016; 79:41-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27079846

27. Hughes JR, Fanshawe TR, and Stead LF. Is nicotine replacement really ineffective? A reply to stanley and massey. Journal of Clinical Epidemiology, 2017; 81:143-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27663610

28. Stanley TD. Yes, nicotine replacement therapy's effectiveness is much lower than often reported. Journal of Clinical Epidemiology, 2017; 81:144-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27650384

29. Green G. Nicotine replacement therapy for smoking cessation. American Family Physician, 2015; 92(1):24A-B. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26132134

30. Mishra A, Maiti R, Mishra BR, and Jena M. Comparative efficacy and safety of pharmacological interventions for smoking cessation in healthy adults: A network meta-analysis. Pharmacological Research, 2021; 166:105478. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33549729

31. Etter JF and Stapleton JA. Nicotine replacement therapy for long-term smoking cessation: A meta-analysis. Tobacco Control, 2006; 15(4):280-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16885576

32. Shiffman S. Effect of nicotine lozenges on affective smoking withdrawal symptoms: Secondary analysis of a randomized, double-blind, placebo-controlled clinical trial. Clinical Therapeutics, 2008; 30(8):1461-75. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18803988

33. Pack QR, Jorenby DE, Fiore MC, Jackson T, Weston P, et al. A comparison of the nicotine lozenge and nicotine gum: An effectiveness randomized controlled trial. WMJ, 2008; 107(5):237-43. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18777992

34. Shiffman S, Ferguson SG, Rohay J, and Gitchell JG. Perceived safety and efficacy of nicotine replacement therapies among US smokers and ex-smokers: Relationship with use and compliance. Addiction, 2008; 103(8):1371–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18855827

35. Perkins KA, Briski J, Fonte C, Scott J, and Lerman C. Severity of tobacco abstinence symptoms varies by time of day. Nicotine and Tobacco Research, 2009; 11(1):84-91. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19246445

36. Brokowski L, Chen J, and Tanner S. High-dose transdermal nicotine replacement for tobacco cessation. American Journal of Health-System Pharmacy, 2014; 71(8):634-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24688036

37. Fucito LM, Bars MP, Forray A, Rojewski AM, Shiffman S, et al. Addressing the evidence for FDA nicotine replacement therapy label changes: A policy statement of the association for the treatment of tobacco use and dependence and the society for research on nicotine and tobacco. Nicotine and Tobacco Research, 2014; 16(7):909-14. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24919399

38. Schneider NG, Cortner C, Gould JL, Koury MA, and Olmstead RE. Comparison of craving and withdrawal among four combination nicotine treatments. Human Psychopharmacology, 2008; 23(6):513-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18438964

39. Piper ME, Smith SS, Schlam TR, Fiore MC, Jorenby DE, et al. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Archives of General Psychiatry, 2009; 66(11):1253-62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19884613

40. Gonzales D. Nicotine patch plus lozenge gives greatest increases in abstinence from smoking rates at 6 months compared with placebo; smaller effects seen with nicotine patch alone, bupropion or nicotine lozenges alone or combined. Evidence-Based Medicine, 2010; 15(3):77-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20522682

41. Prochazka AV. Acp journal club. Nicotine patch plus nicotine lozenges increased smoking cessation rate more than placebo. Annals of Internal Medicine, 2010; 152(10):JC5-2. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20479019

42. Windle SB, Filion KB, Mancini JG, Adye-White L, Joseph L, et al. Combination therapies for smoking cessation: A hierarchical bayesian meta-analysis. American Journal of Preventive Medicine, 2016; 51(6):1060-71. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27617367

43. Carpenter MJ, Jardin BF, Burris JL, Mathew AR, Schnoll RA, et al. Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: A review of the literature. Drugs, 2013; 73(5):407-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23572407

44. The Royal Australian College of General Practitioners. A bold plan to help more Australians to quit smoking. RACGP,  2020. Available from: https://www.racgp.org.au/gp-news/media-releases/2020-media-releases/january-2020/a-bold-plan-to-help-more-australians-to-quit-smoki

45. Le Foll B and George T. Treatment of tobacco dependence: Integrating recent progress into practice. Canadian Medical Association Journal, 2007; 177(11):1373–80. Available from: http://www.cmaj.ca/cgi/content/full/177/11/1373

46. Fiore MC, Jaén M, Carlos Roberto, Baker TB, Bailey WC, Benowitz NL, et al. Treating tobacco use and dependence. Clinical practice guidelines. Rockville, MD: US Department of Health and Human Services, 2008. Available from: http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/index.html.

47. Ferguson SG and Shiffman S. Effect of high-dose nicotine patch on the characteristics of lapse episodes. Health Psychology, 2010; 29(4):358-66. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20658822

48. Cunningham JA, Kushnir V, Selby P, Tyndale RF, Zawertailo L, et al. Effect of mailing nicotine patches on tobacco cessation among adult smokers : A randomized clinical trial. JAMA Internal Medicine, 2016; 176(2):184–90. Available from: http://dx.doi.org/10.1001/jamainternmed.2015.7792

49. Hughes JR, Shiffman S, Callas P, and Zhang J. A meta-analysis of the efficacy of over-the-counter nicotine replacement. Tobacco Control, 2003; 12(1):21-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12612357

50. West R and Zhou X. Is nicotine replacement therapy for smoking cessation effective in the 'real world'? Findings from a prospective multinational cohort study. Thorax, 2007; 62(998-1002). Available from: http://www.ncbi.nlm.nih.gov/pubmed/17573444

51. Schnoll RA, Patterson F, Wileyto EP, Heitjan DF, Shields AE, et al. Effectiveness of extended-duration transdermal nicotine therapy: A randomized trial. Annals of Internal Medicine, 2010; 152(3):144-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20124230

52. Zwar N, Richmond R, Borland R, Stillman S, Cunninghan M, et al., Smoking cessation guidelines for Australian general practice: Practice handbook. Vol. 4 July 2004.Canberra: Department of Health and Ageing; 2004. Available from: http://www.health.gov.au/pubhlth/publicat/document/smoking_cessation.pdf.

53. Shiffman S, Khayrallah M, and Nowak R. Efficacy of the nicotine patch for relief of craving and withdrawal 7-10 weeks after cessation. Nicotine and Tobacco Research, 2000; 2(4):371-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11197318

54. Hajek P, McRobbie H, and Gillison F. Dependence potential of nicotine replacement treatments: Effects of product type, patient characteristics, and cost to user. Preventive Medicine, 2007; 44(3):230-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17207524

55. Berrettini WH and Lerman CE. Pharmacotherapy and pharmacogenetics of nicotine dependence. American Journal of Psychiatry, 2005; 162(8):1441-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16055765

56. Zhang B, Cohen JE, Bondy SJ, and Selby P. Duration of nicotine replacement therapy use and smoking cessation: A population-based longitudinal study. American Journal of Epidemiology, 2015; 181(7):513-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25740789

57. Livingstone-Banks J, Norris E, Hartmann-Boyce J, West R, Jarvis M, et al. Relapse prevention interventions for smoking cessation. Cochrane Database of Systematic Reviews, 2019; 2(2):CD003999. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30758045

58. Zapawa LM, Hughes JR, Benowitz NL, Rigotti NA, and Shiffman S. Cautions and warnings on the US otc label for nicotine replacement: What's a doctor to do? Addictive Behaviors, 2011; 36(4):327-32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21220188

59. Ferguson SG, Gitchell JG, and Shiffman S. Continuing to wear nicotine patches after smoking lapses promotes recovery of abstinence. Addiction, 2012; 107(7):1349-53. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22276996

60. Mersha AG, Eftekhari P, Bovill M, Tollosa DN, and Gould GS. Evaluating level of adherence to nicotine replacement therapy and its impact on smoking cessation: A systematic review and meta-analysis. Arch Public Health, 2021; 79(1):26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33663575

61. Beard E, Bruguera C, McNeill A, Brown J, and West R. Association of amount and duration of NRT use in smokers with cigarette consumption and motivation to stop smoking: A national survey of smokers in England. Addictive Behaviors, 2015; 40:33-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25218069

62. Borland R, Cooper J, McNeill A, O'Connor R, and Cummings KM. Trends in beliefs about the harmfulness and use of stop-smoking medications and smokeless tobacco products among cigarettes smokers: Findings from the ITC four-country survey. Harm Reduction Journal, 2011; 8:21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21859499

63. Balmford J, Borland R, Hammond D, and Cummings KM. Adherence to and reasons for premature discontinuation from stop-smoking medications: Data from the ITC four-country survey. Nicotine and Tobacco Research, 2011; 13(2):94-102. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21147894

64. Burns E and Levinson A. Discontinuation of nicotine replacement therapy among smoking-cessation attempters. American Journal of Preventive Medicine, 2008; 34(3):212–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18312809

65. Raupach T and van Schayck CP. Pharmacotherapy for smoking cessation: Current advances and research topics. CNS Drugs, 2011; 25(5):371-82. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21476609

66. Shiffman S, Rolf CN, Hellebusch SJ, Gorsline J, Gorodetzky CW, et al. Real-world efficacy of prescription and over-the-counter nicotine replacement therapy. Addiction, 2002; 97(5):505-16. Available from: https://pubmed.ncbi.nlm.nih.gov/12033652/

67. Tonnesen P, Nørregaard J, Mikkelsen K, Jorgensen S, and Nilsson F. A double-blind trial of a nicotine inhaler for smoking cessation. JAMA, 1993; 269(10):1268-71. Available from: https://doi.org/10.1001/jama.1993.03500100066029

68. Shiffman S. Use of more nicotine lozenges leads to better success in quitting smoking. Addiction, 2007; 102(5):809-14. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2007.01791.x

69. Vogt F, Hall S, and Marteau TM. Understanding why smokers do not want to use nicotine dependence medications to stop smoking: Qualitative and quantitative studies Nicotine and Tobacco Research, 2008; 10(8):1405–13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18686189

70. Campbell K, Coleman-Haynes T, Bowker K, Cooper SE, Connelly S, et al. Factors influencing the uptake and use of nicotine replacement therapy and e-cigarettes in pregnant women who smoke: A qualitative evidence synthesis. Cochrane Database of Systematic Reviews, 2020; 5:CD013629. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32441810

71. Weiss SM and Smith-Simone SY. Consumer and health literacy: The need to better design tobacco-cessation product packaging, labels, and inserts. American Journal of Preventive Medicine, 2010; 38(3 Suppl):S403-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20176315

72. Schneider N, Cortner C, Justice M, Gould J, Amor C, et al. Preferences among five nicotine treatments based on information versus sampling. Nicotine and Tobacco Research, 2008; 10(1):179–86. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18188758

73. Canadian Agency for Drugs and Technologies in Health. Nicotine replacement therapy for smoking cessation or reduction: A review of the clinical evidence. CADTH Rapid Response Reports, 2014. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24741730

74. Hammond D, Reid JL, Driezen P, Cummings KM, Borland R, et al. Smokers' use of nicotine replacement therapy for reasons other than stopping smoking: Findings from the ITC four country survey. Addiction, 2008; 103(10):1696–703. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18821877

75. Zwar N, Bell J, Peters M, Christie M, and Mendelsohn C. Nicotine and nicotine replacement therapy – the facts. Australian Pharmacist, 2006; 25(12):969–73. Available from: www.psa.org.au/site.php?id=1458

76. Fant RV, Owen LL, and Henningfield JE. Nicotine replacement therapy. Primary Care, 1999; 26(3):633-52. Available from: https://www.ncbi.nlm.nih.gov/pubmed/10436291

77. Stead LF and Lancaster T Interventions to reduce harm from continued tobacco use. Cochrane Database of Systematic Reviews, 2007  DOI: 10.1002/14651858.CD005231.pub2. Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005231/frame.html

78. Stepanov I, Carmella S, Han S, Pinto A, Strasser A, et al. Evidence for endogenous formation of n'-nitrosonornicotine in some long-term nicotine patch users. Nicotine and Tobacco Research, 2009; 11(1):99–105. Available from: http://ntr.oxfordjournals.org/cgi/content/full/ntn020v1

79. Etter JF. Addiction to the nicotine gum in never smokers. BMC Public Health, 2007; 7(147):159. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17640334

80. Perkins KA. Nicotine self-administration. Nicotine and Tobacco Research, 1999; 1 Suppl 2(suppl. 2):S133-7; discussion S9-40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11768171

81. Pharmacia Australia. Product information. Nicorette chewing gum. 2mg & 4mg.  [leaflet], July 2003, Pharmacia Australia Pty Limited: Rydalmere, NSW.

82. Pharmacia Australia. Product information. Nicorette inhaler.  [leaflet] July 2003, Pharmacia Australia Pty Limited: Rydalmere, NSW.

83. Pharmacia Australia. Product information. Nicorette microtab. 2mg sublingual tablets.  [leaflet], October 2003, Pharmacia Australia Pty Limited: Rydalmere, NSW.

84. Shiffman S, Dresler CM, Hajek P, Gilburt SJ, Targett DA, et al. Efficacy of a nicotine lozenge for smoking cessation. Archives of Internal Medicine, 2002; 162(11):1267-76. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12038945

85. GlaxoSmithKline. Nicobate cq lozenges 2/4mg.  [leaflet]. January Ermington NSE: GlaxoSmithKline, 2002.

86. Mills EJ, Wu P, Lockhart I, Wilson K, and Ebbert JO. Adverse events associated with nicotine replacement therapy (NRT) for smoking cessation. A systematic review and meta-analysis of one hundred and twenty studies involving 177,390 individuals. Tob Induc Dis, 2010; 8(1):8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20626883

87. Agboola S, McNeill A, Coleman T, and Leonardi Bee J. A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers. Addiction, 2010; 105(8):1362-80. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20653619

88. England LJ, Aagaard K, Bloch M, Conway K, Cosgrove K, et al. Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products. Neuroscience and Biobehavioral Reviews, 2017; 72:176-89. Available from: https://pubmed.ncbi.nlm.nih.gov/27890689

89. McEvoy CT and Spindel ER. Pulmonary effects of maternal smoking on the fetus and child: Effects on lung development, respiratory morbidities, and life long lung health. Paediatric Respiratory Reviews, 2017; 21:27-33. Available from: https://pubmed.ncbi.nlm.nih.gov/27639458

90. Bansal MA, Cummings KM, Hyland A, and Giovino GA. Stop-smoking medications: Who uses them, who misuses them, and who is misinformed about them? Nicotine and Tobacco Research, 2004; 6 Suppl 3(suppl. 3):S303-10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15799593

91. US Department of Health and Human Services. The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Available from: http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf.

92. Zheng Y, Ritzenthaler J, Roman J, and Han S. Nicotine stimulates human lung cancer cell growth by inducing fironectin expression. American Journal of Respiratory Cell and Molecular Biology, 2007; 28. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17600315

93. Wong H, Yu L, Lam E, Tai E, Wue W, et al. Nicotine promotes colon tumour growth and angiogenesis through beta-adrenergic activation. Toxicological Sciences, 2007; 97(2):279–87. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17369603

94. Shiffman S. Nicotine replacement therapy for smoking cessation in the "real world". Thorax, 2007; 62(11):930–1. Available from: http://thorax.bmj.com/cgi/content/full/62/11/930

95. Shiffman S and Ferguson SG. Nicotine patch therapy prior to quitting smoking: A meta-analysis. Addiction, 2008; 103(4):557-63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18339101

96. Shiffman S, Ferguson S, and Strahs K. Quitting by gradual smoking reduction using nicotine gum: A randomized controlled trial. American Journal of Preventive Medicine, 2009; 36(2):96–104.e1. Available from: http://www.ajpm-online.net/article/S0749-3797(08)00891-X/fulltext

97. Dalack GW and Meador-Woodruff JH. Acute feasibility and safety of a smoking reduction strategy for smokers with schizophrenia. Nicotine and Tobacco Research, 1999; 1(1):53-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11072388

98. Bolliger CT, Zellweger JP, Danielsson T, van Biljon X, Robidou A, et al. Smoking reduction with oral nicotine inhalers: Double blind, randomised clinical trial of efficacy and safety. BMJ, 2000; 321(7257):329-33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/10926587

99. Fagerstrom KO, Tejding R, Westin A, and Lunell E. Aiding reduction of smoking with nicotine replacement medications: Hope for the recalcitrant smoker? Tobacco Control, 1997; 6(4):311-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9583629

100. Moore D, Aveyard P, Connock M, Wang D, Fry-Smith A, et al. Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: Systematic review and meta-analysis. BMJ, 2009; 338:b1024. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19342408

101. Etter JF and Laszlo E. Postintervention effect of nicotine replacement therapy for smoking reduction: A randomized trial with a 5-year follow-up. Journal of Clinical Psychopharmacology, 2007; 27(2):151-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17414237

102. Wang D, Connock M, Barton P, Fry-Smith A, Aveyard P, et al. 'Cut down to quit' with nicotine replacement therapies in smoking cessation: A systematic review of effectiveness and economic analysis. Health Technology Assessment, 2008; 12(2):1–135. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18093448

103. Quit Victoria. Nicotine replacement products. 2016. Available from: http://www.quit.org.au/preparing-to-quit/choosing-best-way-to-quit/nicotine-replacement-products

104. Winstanley M, Woodward S, and Walker N, Tobacco in Australia; facts and issues 1995; 2nd edition. Vol. 2.Carlton South: Victorian Smoking and Health Program; 1995. Available from: http://www.quit.org.au/quit/FandI/welcome.htm.

105. Carter S, Borland R, and Chapman C. Finding the strength to kill your best friend–smokers talk about smoking and quitting. Sydney: Australian Smoking Cessation Consortium and GlaxoSmithKline Consumer Healthcare, 2001. Available from: http://tobacco.health.usyd.edu.au/site/supersite/resources/pdfs/killbestfriend.pdf.

106. Chapman S, Relapse and other realities: An update on smoking cessation rates in Australia. SmithKline Beecham; (World No Tobacco Day) 2000.

107. Richmond R and Zwar N. Review of bupropion for smoking cessation. Drug and Alcohol Review, 2003; 22(2):203-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12850907

108. Therapeutic Goods Administration. Australian product information: Zyban sr (bupropion hydrochloride) sustained release tablets.  2021. Available from: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2013-PI-01138-1.

109. Lancaster T, Stead L, and Cahill K. An update on therapeutics for tobacco dependence. Expert Opinion on Pharmacotherapy, 2008; 9(1):15-22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18076335

110. Kotlyar M, Drone D, Thuras P, Hatsukami DK, Brauer L, et al. Effect of stress and bupropion on craving, withdrawal symptoms, and mood in smokers. Nicotine and Tobacco Research, 2011; 13(6):492-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21378081

111. Paterson NE. Behavioural and pharmacological mechanisms of bupropion's anti-smoking effects: Recent preclinical and clinical insights. European Journal of Pharmacology, 2009; 603(1-3):1-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19101536

112. Hughes JR, Stead LF, Hartmann-Boyce J, Cahill K, and Lancaster T. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews, 2014; 1(1):CD000031. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24402784

113. Culbertson CS, Bramen J, Cohen MS, London ED, Olmstead RE, et al. Effect of bupropion treatment on brain activation induced by cigarette-related cues in smokers. Archives of General Psychiatry, 2011; 68(5):505-15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21199957

114. Fucito LM, Toll BA, Salovey P, and O'Malley SS. Beliefs and attitudes about bupropion: Implications for medication adherence and smoking cessation treatment. Psychology of Addictive Behaviors, 2009; 23(2):373-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19586156

115. Hawk LW, Jr., Ashare RL, Rhodes JD, Oliver JA, Cummings KM, et al. Does extended pre quit bupropion aid in extinguishing smoking behavior? Nicotine and Tobacco Research, 2015; 17(11):1377-84. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25589680

116. Tomaz PR, Santos JR, Issa JS, Abe TO, Gaya PV, et al. Cyp2b6 rs2279343 polymorphism is associated with smoking cessation success in bupropion therapy. European Journal of Clinical Pharmacology, 2015; 71(9):1067-73. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26153084

117. Zwar N, Nasser A, Comino E, and Richmond R. Short-term effectiveness of bupropion for assisting smoking cessation in general practice. Medical Journal of Australia, 2003; 177(5):277–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12197829

118. Kittle J, Lopes RD, Huang M, Marquess ML, Wilson MD, et al. Cardiovascular adverse events in the drug-development program of bupropion for smoking cessation: A systematic retrospective adjudication effort. Clinical Cardiology, 2017; 40(10):899-906. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28605035

119. Anthenelli RM, Benowitz NL, West R, St Aubin L, McRae T, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (eagles): A double-blind, randomised, placebo-controlled clinical trial. Lancet, 2016; 387(10037):2507-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27116918

120. Holmes S, Zwar N, Jimenez-Ruiz C, Ryan P, Browning D, et al. Bupropion as an aid to smoking cessation: A review of real-life effectiveness. International Journal of Clinical Practice, 2004; 58(3):285−91. Available from: http://www3.interscience.wiley.com/journal/118807867/abstract

121. Roddy E. Bupropion and other non-nicotine pharmacotherapies. BMJ, 2004; 328(7438):509-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/14988194

122. McDonough M. Update on medicines for smoking cessation. Aust Prescr, 2015; 38(4):106-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26648633

123. Pfizer Australia Pty Ltd. Product information champix® (varenicline as tartrate) pfpchamt10108. Canberra 2008. Available from: http://www.pbs.gov.au/pi/pfpchamt10108.pdf.

124. Williams JM, Steinberg MB, Steinberg ML, Gandhi KK, Ulpe R, et al. Varenicline for tobacco dependence: Panacea or plight? Expert Opinion on Pharmacotherapy, 2011; 12(11):1799-812. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21644843

125. Brandon TH, Drobes DJ, Unrod M, Heckman BW, Oliver JA, et al. Varenicline effects on craving, cue reactivity, and smoking reward. Psychopharmacology, 2011; 218(2):391-403. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21559801

126. Faessel HM, Obach RS, Rollema H, Ravva P, Williams KE, et al. A review of the clinical pharmacokinetics and pharmacodynamics of varenicline for smoking cessation. Clinical Pharmacokinetics, 2010; 49(12):799-816. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21053991

127. Franklin T, Wang Z, Suh JJ, Hazan R, Cruz J, et al. Effects of varenicline on smoking cue-triggered neural and craving responses. Archives of General Psychiatry, 2011; 68(5):516-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21199958

128. Fedota JR, Sutherland MT, Salmeron BJ, Ross TJ, Hong LE, et al. Reward anticipation is differentially modulated by varenicline and nicotine in smokers. Neuropsychopharmacology, 2015; 40(8):2038-46. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25742873

129. Loughead J, Ray R, Wileyto EP, Ruparel K, Sanborn P, et al. Effects of the alpha4beta2 partial agonist varenicline on brain activity and working memory in abstinent smokers. Biological Psychiatry, 2010; 67(8):715-21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20207347

130. Pascual FP, Fontoba Ferrandiz J, Gil Sanchez MC, Ponce Lorenzo F, and Botella Estrella C. Two-year therapeutic effectiveness of varenicline for smoking cessation in a real world setting. Substance Use and Misuse, 2016; 51(2):131-40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26829065

131. Ebbert JO, Hughes JR, West RJ, Rennard SI, Russ C, et al. Effect of varenicline on smoking cessation through smoking reduction: A randomized clinical trial. JAMA, 2015; 313(7):687-94. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25688780

132. Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, et al. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: A randomized controlled trial. JAMA, 2006; 296(1):47-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16820546

133. Howard P, Knight C, Bolar A, and Baker C. Cost-utility analysis of varenicline versus existing smoking cessation strategies using the benesco simulation model: Application to a population of US adult smokers. Pharmacoeconomics, 2008; 26(6):497–511. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18489200

134. Annemans L, Nackaerts K, Bartsch P, Prignot J, and Marbaix S. Cost effectiveness of varenicline in belgium, compared with bupropion, nicotine replacement therapy, brief counselling and unaided smoking cessation: A benesco markov cost-effectiveness analysis. Clinical Drug Investigation, 2009; 29(10):655-65. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19715382

135. Bae JY, Kim CH, and Lee EK. Evaluation of cost-utility of varenicline compared with existing smoking cessation therapies in South Korea. Value in Health, 2009; 12 Suppl 3:S70-3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20586986

136. Bolin K, Mork AC, and Wilson K. Smoking-cessation therapy using varenicline: The cost-utility of an additional 12-week course of varenicline for the maintenance of smoking abstinence. Journal of Evaluation in Clinical Practice, 2009; 15(3):478-85. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19536915

137. Igarashi A, Takuma H, Fukuda T, and Tsutani K. Cost-utility analysis of varenicline, an oral smoking-cessation drug, in Japan. Pharmacoeconomics, 2009; 27(3):247-61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19354344

138. Jimenez-Ruiz C, Berlin I, and Hering T. Varenicline: A novel pharmacotherapy for smoking cessation. Drugs, 2009; 69(10):1319-38. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19583451

139. Keiding H. Cost-effectiveness of varenicline for smoking cessation. Expert Review of Pharmacoeconomics and Outcomes Research, 2009; 9(3):215-21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19527093

140. Fagerstrom K and Hughes J. Varenicline in the treatment of tobacco dependence. Neuropsychiatr Dis Treat, 2008; 4(2):353-63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18728741

141. Fagerstrom K, Nakamura M, Cho HJ, Tsai ST, Wang C, et al. Varenicline treatment for smoking cessation in asian populations: A pooled analysis of placebo-controlled trials conducted in six asian countries. Current Medical Research and Opinion, 2010; 26(9):2165-73. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20666691

142. Ebbert JO, Croghan IT, North F, and Schroeder DR. A pilot study to assess smokeless tobacco use reduction with varenicline. Nicotine and Tobacco Research, 2010; 12(10):1037-40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20724382

143. Ebbert J, Montori VM, Erwin PJ, and Stead LF. Interventions for smokeless tobacco use cessation. Cochrane Database of Systematic Reviews, 2011; 2(2):CD004306. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21328266

144. Bolliger CT, Issa JS, Posadas-Valay R, Safwat T, Abreu P, et al. Effects of varenicline in adult smokers: A multinational, 24-week, randomized, double-blind, placebo-controlled study. Clinical Therapeutics, 2011; 33(4):465-77. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21635992

145. Boudrez H, Gratziou C, Messig M, and Metcalfe M. Effectiveness of varenicline as an aid to smoking cessation: Results of an inter-European observational study. Current Medical Research and Opinion, 2011; 27(4):769-75. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21294601

146. Ebbert JO, Croghan IT, Hurt RT, Schroeder DR, and Hays JT. Varenicline for smoking cessation in light smokers. Nicotine and Tobacco Research, 2016; 18(10):2031-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27117285

147. Anthenelli RM, Morris C, Ramey TS, Dubrava SJ, Tsilkos K, et al. Effects of varenicline on smoking cessation in adults with stably treated current or past major depression: A randomized trial. Annals of Internal Medicine, 2013; 159(6):390–400. Available from: http://dx.doi.org/10.7326/0003-4819-159-6-201309170-00005

148. Williams JM, Anthenelli RM, Morris CD, Treadow J, Thompson JR, et al. A randomized, double-blind, placebo-controlled study evaluating the safety and efficacy of varenicline for smoking cessation in patients with schizophrenia or schizoaffective disorder. Journal of Clinical Psychiatry, 2012; 73(5):654-60. Available from: https://pubmed.ncbi.nlm.nih.gov/22697191/

149. Pachas GN, Cather C, Pratt SA, Hoeppner B, Nino J, et al. Varenicline for smoking cessation in schizophrenia: Safety and effectiveness in a 12-week, open-label trial. Journal of Dual Diagnosis, 2012; 8(2):117-25. Available from: https://pubmed.ncbi.nlm.nih.gov/22888309

150. Jorenby DE, Hays JT, Rigotti NA, Azoulay S, Watsky EJ, et al. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: A randomized controlled trial. JAMA, 2006; 296(1):56-63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16820547

151. Potts LA and Garwood CL. Varenicline: The newest agent for smoking cessation. American Journal of Health-System Pharmacy, 2007; 64(13):1381-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17592002

152. Aubin H, Bobak A, Britton J, Oncken C, Billing C, et al. Authors’ reply. Thorax, 2008; 63:752–3 Available from: http://thorax.bmj.com/cgi/content/full/63/8/752

153. Nides M, Glover ED, Reus VI, Christen AG, Make BJ, et al. Varenicline versus bupropion sr or placebo for smoking cessation: A pooled analysis. American Journal of Health Behavior, 2008; 32(6):664-75. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18442345

154. Hind D, Tappenden P, Peters J, and Kenjegalieva K. Varenicline in the management of smoking cessation: A single technology appraisal. Health Technology Assessment, 2009; 13 Suppl 2( Suppl 2):9-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19804684

155. Cahill K, Stead L, and Lancaster T. A preliminary benefit-risk assessment of varenicline in smoking cessation. Drug Safety, 2009; 32(2):119-35. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19236119

156. Kotz D, Brown J, and West R. Prospective cohort study of the effectiveness of varenicline versus nicotine replacement therapy for smoking cessation in the "real world". BMC Public Health, 2014; 14:1163. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25392075

157. Gray KM, McClure EA, Baker NL, Hartwell KJ, Carpenter MJ, et al. An exploratory short-term double-blind randomized trial of varenicline versus nicotine patch for smoking cessation in women. Addiction, 2015; 110(6):1027-34. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25727442

158. Baker TB, Piper ME, Stein JH, Smith SS, Bolt DM, et al. Effects of nicotine patch vs varenicline vs combination nicotine replacement therapy on smoking cessation at 26 weeks: A randomized clinical trial. JAMA, 2016; 315(4):371-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26813210

159. Lee JH, Jones PG, Bybee K, and O'Keefe JH. A longer course of varenicline therapy improves smoking cessation rates. Preventive Cardiology, 2008; 11(4):210-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19476573

160. Keating GM and Lyseng-Williamson KA. Varenicline: A pharmacoeconomic review of its use as an aid to smoking cessation. Pharmacoeconomics, 2010; 28(3):231-54. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20108995

161. Burke MV, Hays JT, and Ebbert JO. Varenicline for smoking cessation: A narrative review of efficacy, adverse effects, use in at-risk populations, and adherence. Patient Prefer Adherence, 2016; 10:435-41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27099479

162. Hajek P, Tonnesen P, Arteaga C, Russ C, and Tonstad S. Varenicline in prevention of relapse to smoking: Effect of quit pattern on response to extended treatment. Addiction, 2009; 104(9):1597-602. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19686530

163. Bohadana A, Freier-Dror Y, Peles V, Babai P, and Izbicki G. Extending varenicline preloading to 6 weeks facilitates smoking cessation: A single-site, randomised controlled trial. EClinicalMedicine, 2020; 19:100228. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32055787

164. Gonzales D, Hajek P, Pliamm L, Nackaerts K, Tseng LJ, et al. Retreatment with varenicline for smoking cessation in smokers who have previously taken varenicline: A randomized, placebo-controlled trial. Clinical Pharmacology and Therapeutics, 2014; 96(3):390-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24911368

165. Hajek P, McRobbie H, Myers Smith K, Phillips A, Cornwall D, et al. Increasing varenicline dose in smokers who do not respond to the standard dosage: A randomized clinical trial. JAMA Intern Med, 2015; 175(2):266-71. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25545858

166. Jung JW, Jeon EJ, Kim JG, Yang SY, Choi JC, et al. Clinical experience of varenicline for smoking cessation. Clinical Respiratory Journal, 2010; 4(4):215-21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20887344

167. Grassi MC, Enea D, Ferketich AK, Lu B, Pasquariello S, et al. Effectiveness of varenicline for smoking cessation: A 1-year follow-up study. Journal of Substance Abuse Treatment, 2011; 41(1):64-70. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21349681

168. Rocha Santos J, Tomaz PR, Issa JS, Abe TO, Krieger JE, et al. Chrna4 rs1044396 is associated with smoking cessation in varenicline therapy. Front Genet, 2015; 6:46. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25774163

169. Pharmaceutical Benefits Scheme. Varenicline. Available from: https://www.pbs.gov.au/medicine/item/5469W-9128K-9129L

170. Zwar N, Richmond R, Borland R, Peters M, Stillman S, et al. Smoking cessation pharmacotherapy: An update for health professionals. Melbourne: Royal Australian College of General Practitioners, 2007. Available from: http://www.treatobacco.net/en/uploads/documents/Treatment%20Guidelines/Australia%20treatment%20guidelines%20-%20pharmacotherapy%20in%20English%202007.pdf.

171. Therapeutic Goods Administration. Australian product information - champix®.  2021. Available from: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-06102-3.

172. Garrison GD and Dugan SE. Varenicline: A first-line treatment option for smoking cessation. Clinical Therapeutics, 2009; 31(3):463-91. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19393839

173. Kasza KA, Cummings KM, Carpenter MJ, Cornelius ME, Hyland AJ, et al. Use of stop-smoking medications in the United States before and after the introduction of varenicline. Addiction, 2015; 110(2):346-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25331778

174. von Wartburg M, Raymond V, and Paradis PE. The long-term cost-effectiveness of varenicline (12-week standard course and 12 + 12-week extended course) vs. Other smoking cessation strategies in Canada. International Journal of Clinical Practice, 2014; 68(5):639-46. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24472120

175. Galanti LM. Tobacco smoking cessation management: Integrating varenicline in current practice. Vasc Health Risk Manag, 2008; 4(4):837-45. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19066000

176. The Royal Australian College of General Practitioners, Supporting smoking cessation: A guide for health professionals.  2nd edn edEast Melbourne, Vic: RACGP; 2019. Available from: https://www.racgp.org.au/getattachment/00185c4e-441b-45a6-88d1-8f05c71843cd/Supporting-smoking-cessation-A-guide-for-health-professionals.aspx.

177. Leung LK, Patafio FM, and Rosser WW. Gastrointestinal adverse effects of varenicline at maintenance dose: A meta-analysis. BMC Clinical Pharmacology, 2011; 11:15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21955317

178. McIntosh J. Chantix could affect patients' alcohol tolerance, warn FDA. Medical News Today,  2015. Available from: http://www.medicalnewstoday.com/articles/290654.php?tw

179. Kotz D, Viechtbauer W, Simpson C, van Schayck OC, West R, et al. Cardiovascular and neuropsychiatric risks of varenicline: A retrospective cohort study. Lancet Respir Med, 2015; 3(10):761-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26355008

180. Mills EJ, Thorlund K, Eapen S, Wu P, and Prochaska JJ. Cardiovascular events associated with smoking cessation pharmacotherapies: A network meta-analysis. Circulation, 2014; 129(1):28-41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24323793

181. Sharma A, Thakar S, Lavie CJ, Garg J, Krishnamoorthy P, et al. Cardiovascular adverse events associated with smoking-cessation pharmacotherapies. Current Cardiology Reports, 2015; 17(1):554. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25410148

182. Wu Q, Gilbody S, Peckham E, Brabyn S, and Parrott S. Varenicline for smoking cessation and reduction in people with severe mental illnesses: Systematic review and meta-analysis. Addiction, 2016; 111(9):1554-67. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27043328

183. Carney G, Bassett K, Maclure M, Taylor S, and Dormuth CR. Cardiovascular and neuropsychiatric safety of smoking cessation pharmacotherapies in non-depressed adults: A retrospective cohort study. Addiction, 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32077187

184. Carney G, Maclure M, Malfair S, Bassett K, Wright JM, et al. Comparative safety of smoking cessation pharmacotherapies during a government-sponsored reimbursement program. Nicotine and Tobacco Research, 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32484873

185. Etter JF, Lukas RJ, Benowitz NL, West R, and Dresler CM. Cytisine for smoking cessation: A research agenda. Drug and Alcohol Dependence, 2008; 92(1-3):3-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17825502

186. Hajek P, McRobbie H, and Myers K. Efficacy of cytisine in helping smokers quit: Systematic review and meta-analysis. Thorax, 2013; 68(11):1037-42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23404838

187. Tutka P, Vinnikov D, Courtney RJ, and Benowitz NL. Cytisine for nicotine addiction treatment: A review of pharmacology, therapeutics and an update of clinical trial evidence for smoking cessation. Addiction, 2019; 114(11):1951-69. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31240783

188. Walker N, Howe C, Glover M, McRobbie H, Barnes J, et al. Cytisine versus nicotine for smoking cessation. New England Journal of Medicine, 2014; 371(25):2353-62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25517706

189. Leaviss J, Sullivan W, Ren S, Everson-Hock E, Stevenson M, et al. What is the clinical effectiveness and cost-effectiveness of cytisine compared with varenicline for smoking cessation? A systematic review and economic evaluation. Health Technology Assessment, 2014; 18(33):1-120. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24831822

190. Hatsukami DK, Jorenby DE, Gonzales D, Rigotti NA, Glover ED, et al. Immunogenicity and smoking-cessation outcomes for a novel nicotine immunotherapeutic. Clinical Pharmacology and Therapeutics, 2011; 89(3):392-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21270788

191. Cerny EH and Cerny T. Vaccines against nicotine. Human Vaccines, 2009; 5(4):200-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19276649

192. Casella G, Caponnetto P, and Polosa R. Therapeutic advances in the treatment of nicotine addiction: Present and future. Ther Adv Chronic Dis, 2010; 1(3):95-106. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23251732

193. Escobar-Chavez JJ, Dominguez-Delgado CL, and Rodriguez-Cruz IM. Targeting nicotine addiction: The possibility of a therapeutic vaccine. Drug Design, Development and Therapy, 2011; 5:211-24. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21607018

194. Havermans A, Vuurman EF, van den Hurk J, Hoogsteder P, and van Schayck OC. Treatment with a nicotine vaccine does not lead to changes in brain activity during smoking cue exposure or a working memory task. Addiction, 2014; 109(8):1260-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24894701

195. Tonstad S, Heggen E, Giljam H, Lagerback PA, Tonnesen P, et al. Niccine(r), a nicotine vaccine, for relapse prevention: A phase ii, randomized, placebo-controlled, multicenter clinical trial. Nicotine and Tobacco Research, 2013; 15(9):1492-501. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23471101

196. Fahim RE, Kessler PD, and Kalnik MW. Therapeutic vaccines against tobacco addiction. Expert Review of Vaccines, 2013; 12(3):333-42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23496672

197. Pentel PR and LeSage MG. New directions in nicotine vaccine design and use. Advances in Pharmacology, 2014; 69:553-80. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24484987

198. Hatsukami DK, Rennard S, Jorenby D, Fiore M, Koopmeiners J, et al. Safety and immunogenicity of a nicotine conjugate vaccine in current smokers. Clinical Pharmacology and Therapeutics, 2005; 78(5):456-67. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16321612

199. Maurer P and Bachmann MF. Vaccination against nicotine: An emerging therapy for tobacco dependence. Expert Opinion on Investigational Drugs, 2007; 16(11):1775-83. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17970637

200. Cerny EH and Cerny T. Anti-nicotine abuse vaccines in the pipeline: An update. Expert Opinion on Investigational Drugs, 2008; 17(5):691-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18447595

201. Cornuz J, Zwahlen S, Jungi WF, Osterwalder J, Klingler K, et al. A vaccine against nicotine for smoking cessation: A randomized controlled trial. PLoS ONE, 2008; 3(6):e2547. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18575629

202. Fattom AI, Hohenboken M, and Kalnik M, Nicvax®, a nicotine conjugate vaccine, aids smokers to quit smoking and stay quit: Animal and human data in support of a proposed mechanism of action. The eleventh annual conference on vaccine research Baltimore, MD 2008. Available from: http://www.nfid.org/pdf/conferences/vaccine08abstracts.pdf.

203. Lockner JW, Lively JM, Collins KC, Vendruscolo JC, Azar MR, et al. A conjugate vaccine using enantiopure hapten imparts superior nicotine-binding capacity. Journal of Medicinal Chemistry, 2015; 58(2):1005-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25493909

204. Chang PH, Chiang CH, Ho WC, Wu PZ, Tsai JS, et al. Combination therapy of varenicline with nicotine replacement therapy is better than varenicline alone: A systematic review and meta-analysis of randomized controlled trials. BMC Public Health, 2015; 15(1):689. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26198192

205. Vogeler T, McClain C, and Evoy KE. Combination bupropion sr and varenicline for smoking cessation: A systematic review. American Journal of Drug and Alcohol Abuse, 2016; 42(2):129-39. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26809272

206. Kotz D, Brown J, and West R. 'Real-world' effectiveness of smoking cessation treatments: A population study. Addiction, 2014; 109(3):491-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24372901

207. Patnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, et al. Behavioral counseling and pharmacotherapy interventions for tobacco cessation in adults, including pregnant women: A review of reviews for the u.S. Preventive services task force. Annals of Internal Medicine, 2015; 163(8):608-21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26389650

208. Stead LF, Koilpillai P, Fanshawe TR, and Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews, 2016; 3:CD008286. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27009521

209. Hartmann-Boyce J, Hong B, Livingstone-Banks J, Wheat H, and Fanshawe TR. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews, 2019; 6:CD009670. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31166007

210. Rose JE. Disrupting nicotine reinforcement: From cigarette to brain. Annals of the New York Academy of Sciences, 2008; 1141:233-56. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18991961

211. Butler K and Le Foll B. Novel therapeutic and drug development strategies for tobacco use disorder: Endocannabinoid modulation. Expert Opin Drug Discov, 2020:1-16. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32425077

212. Siu EC and Tyndale RF. Non-nicotinic therapies for smoking cessation. Annual Review of Pharmacology and Toxicology, 2007; 47:541-64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17209799

213. Cahill K and Ussher M Cannabinoid type 1 receptor antagonists (rimonabant) for smoking cessation. Cochrane Database of Systematic Reviews 2007  DOI: 10.1002/14651858.CD005353.pub3. Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005353/frame.html

214. Schmaal L, Berk L, Hulstijn KP, Cousijn J, Wiers RW, et al. Efficacy of n-acetylcysteine in the treatment of nicotine dependence: A double-blind placebo-controlled pilot study. European Addiction Research, 2011; 17(4):211-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21606648

215. Asevedo E, Mendes AC, Berk M, and Brietzke E. Systematic review of n-acetylcysteine in the treatment of addictions. Braz J Psychiatry, 2014; 36(2):168-75. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24676047

216. Frishman WH, Mitta W, Kupersmith A, and Ky T. Nicotine and non-nicotine smoking cessation pharmacotherapies. Cardiology in Review, 2006; 14(2):57-73. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16493243

217. Bagdas D, Muldoon PP, Zhu AZ, Tyndale RF, and Damaj MI. Effects of methoxsalen, a cyp2a5/6 inhibitor, on nicotine dependence behaviors in mice. Neuropharmacology, 2014; 85:67-72. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24859605

218. Alsharari SD, Siu EC, Tyndale RF, and Damaj MI. Pharmacokinetic and pharmacodynamics studies of nicotine after oral administration in mice: Effects of methoxsalen, a cyp2a5/6 inhibitor. Nicotine and Tobacco Research, 2014; 16(1):18-25. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23884323

219. Sofuoglu M, Poling J, Mouratidis M, and Kosten T. Effects of topiramate in combination with intravenous nicotine in overnight abstinent smokers. Psychopharmacology, 2006; 184(3-4):645-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16432681

220. Anthenelli RM, Blom TJ, McElroy SL, and Keck PE. Preliminary evidence for gender-specific effects of topiramate as a potential aid to smoking cessation. Addiction, 2008; 103(4):687–94. Available from: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1360-0443.2008.02148.x

221. Arbaizar B, Gomez-Acebo I, and Llorca J. Decrease in tobacco consumption after treatment with topiramate and aripiprazole: A case report. J Med Case Rep, 2008; 2:198. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18547425

222. Khazaal Y and Zullino DF. Topiramate for smoking cessation and the importance to distinguish withdrawal-motivated consumption and cue-triggered automatisms. Journal of Clinical Psychopharmacology, 2009; 29(2):192-3; author reply 3-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19512990

223. Oncken C, Arias AJ, Feinn R, Litt M, Covault J, et al. Topiramate for smoking cessation: A randomized, placebo-controlled pilot study. Nicotine and Tobacco Research, 2014; 16(3):288-96. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24057996

224. Lotfy N, Elsawah H, and Hassan M. Topiramate for smoking cessation: Systematic review and meta-analysis. Tob Prev Cessat, 2020; 6:14. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32548351

225. Byars JA, Frost-Pineda K, Jacobs WS, and Gold MS. Naltrexone augments the effects of nicotine replacement therapy in female smokers. Journal of Addictive Diseases, 2005; 24(2):49-60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15784523

226. David S, Lancaster T, Stead LF, and Evins AE Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews 2006  DOI: 10.1002/14651858.CD003086.pub2. Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003086/frame.html

227. David SP, Chu IM, Lancaster T, Stead LF, Evins AE, et al. Systematic review and meta-analysis of opioid antagonists for smoking cessation. BMJ Open, 2014; 4(3):e004393. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24633528

228. David SP, Lancaster T, Stead LF, Evins AE, and Prochaska JJ. Opioid antagonists for smoking cessation. Cochrane Database of Systematic Reviews, 2013; 6(6):CD003086. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23744347

229. Invion. Invion successfully completes phase 2 study of inv102 (nadolol) to aid smoking cessation. 2015. Available from: http://inviongroup.com/invion-successfully-completes-phase-2-study-of-inv102-nadolol-to-aid-smoking-cessation/

230. Gourlay SG, Stead LF, and Benowitz NL Clonidine for smoking cessation. Cochrane Database of Systematic Reviews 2004  DOI: 10.1002/14651858.CD000058.pub2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15266422

231. Lancaster T and Stead LF. Silver acetate for smoking cessation. Cochrane Database of Systematic Reviews, 2012; 9(9):CD000191. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22972041

232. Drgon T, Johnson C, Walther D, Albino AP, Rose JE, et al. Genome-wide association for smoking cessation success: Participants in a trial with adjunctive denicotinized cigarettes. Molecular Medicine, 2009; 15(7-8):268-74. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19593411

233. David SP, Johnstone EC, Churchman M, Aveyard P, Murphy MF, et al. Pharmacogenetics of smoking cessation in general practice: Results from the patch ii and patch in practice trials. Nicotine and Tobacco Research, 2011; 13(3):157-67. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21330274

234. Sturgess JE, George TP, Kennedy JL, Heinz A, and Muller DJ. Pharmacogenetics of alcohol, nicotine and drug addiction treatments. Addiction Biology, 2011; 16(3):357-76. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21362114

235. Saccone NL, Baurley JW, Bergen AW, David SP, Elliott HR, et al. The value of biosamples in smoking cessation trials: A review of genetic, metabolomic, and epigenetic findings. Nicotine and Tobacco Research, 2018; 20(4):403-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28472521

236. Salloum NC, Buchalter ELF, Chanani S, Espejo G, Ismail MS, et al. From genes to treatments: A systematic review of the pharmacogenetics in smoking cessation. Pharmacogenomics, 2018; 19(10):861-71. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29914292

237. Nagelhout GE, Willemsen MC, van den Putte B, de Vries H, Willems RA, et al. Effectiveness of a national reimbursement policy and accompanying media attention on use of cessation treatment and on smoking cessation: A real-world study in the Netherlands. Tobacco Control, 2015; 24(5):455-61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24842854

238. Selby P, Brosky G, Oh P, Raymond V, Arteaga C, et al. A pragmatic, randomized, controlled study evaluating the impact of access to smoking cessation pharmacotherapy coverage on the proportion of successful quitters in a Canadian population of smokers motivated to quit (accessation). BMC Public Health, 2014; 14:433. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24885542

239. Reda AA, Kotz D, Evers SM, and van Schayck CP. Healthcare financing systems for increasing the use of tobacco dependence treatment. Cochrane Database of Systematic Reviews, 2012; (6):CD004305. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22696341

240. Department of Health, The extension of the listing of nicotine patches on the pharmaceutical benefits scheme from 1 February 2011. Australian Government; 2013. Available from: http://www.pbs.gov.au/info/publication/factsheets/shared/Extension_of_the_listing_of_nicotine_patches.

241. Australian Institute of Health and Welfare. National Drug Strategy Household Survey, 2013 [computer file], 2015, Australian Data Archive, The Australian National University: Canberra.

242. Cooper J, Borland R, and Yong HH. Australian smokers increasingly use help to quit, but number of attempts remains stable: Findings from the international tobacco control study 2002-09. Australian and New Zealand Journal of Public Health, 2011; 35(4):368-76. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21806733

243. An LC, Schillo BA, Kavanaugh AM, Lachter RB, Luxenberg MG, et al. Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy. Tobacco Control, 2006; 15(4):286–93. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16885577

244. Grigg M and Glasgow H. Subsidised nicotine replacement therapy. Tobacco Control, 2003; 12(2):238-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12773740

245. Tinkelman D, Wilson SM, Willett J, and Sweeney CT. Offering free NRT through a tobacco quitline: Impact on utilisation and quit rates. Tobacco Control, 2007; 16 Suppl 1(suppl. 1):i42-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18048631

246. Maher JE, Rohde K, Pizacani B, Dent C, Stark MJ, et al. Does free nicotine replacement therapy for young adults prompt them to call a quitline? Tobacco Control, 2007; 16(5):357-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17897996

247. Hollis JF, McAfee TA, Fellows JL, Zbikowski SM, Stark M, et al. The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tobacco Control, 2007; 16 Suppl 1(suppl. 1):i53-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18048633

248. Cummings KM, Fix B, Celestino P, Carlin-Menter S, O'Connor R, et al. Reach, efficacy, and cost-effectiveness of free nicotine medication giveaway programs. Journal of Public Health Management and Practice, 2006; 12(1):37-43. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16340514

249. Cummings KM, Hyland A, Fix B, Bauer U, Celestino P, et al. Free nicotine patch giveaway program 12-month follow-up of participants. American Journal of Preventive Medicine, 2006; 31(2):181-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16829336

250. Bauer JE, Carlin-Menter SM, Celestino PB, Hyland A, and Cummings KM. Giving away free nicotine medications and a cigarette substitute (better quit) to promote calls to a quitline. Journal of Public Health Management and Practice, 2006; 12(1):60–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16340517

251. Alberg AJ, Stashefsky Margalit R, Burke A, Rasch KA, Stewart N, et al. The influence of offering free transdermal nicotine patches on quit rates in a local health department's smoking cessation program. Addictive Behaviors, 2004; 29(9):1763-78. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15530720

252. O'Dea D. An economic evaluation of the quitline nicotine replacement therapy (NRT) service.  June 28, 2004. Available from: http://www.ndp.govt.nz/moh.nsf/pagescm/1007/$File/economicevaluationquitline.pdf.

253. Bush TM, McAfee T, Deprey M, Mahoney L, Fellows JL, et al. The impact of a free nicotine patch starter kit on quit rates in a state quit line. Nicotine and Tobacco Research, 2008; 10(9):1511-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19023843

254. Walker N, Howe C, Bullen C, Grigg M, Glover M, et al. Does improved access and greater choice of nicotine replacement therapy affect smoking cessation success? Findings from a randomized controlled trial. Addiction, 2011; 106(6):1176-85. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21371155

255. Miller N, Frieden TR, Liu SY, Matte TD, Mostashari F, et al. Effectiveness of a large-scale distribution programme of free nicotine patches: A prospective evaluation. Lancet, 2005; 365(9474):1849-54. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15924980

256. Watson D, Bullen C, Clover M, McRobbie H, Parag V, et al. Impact on quit attempts of mailed general practitioner 'brief advice' letters plus nicotine replacement therapy vouchers. Journal of Primary Health Care, 2010; 2(1):4-10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20690396

257. Jardin BF, Cropsey KL, Wahlquist AE, Gray KM, Silvestri GA, et al. Evaluating the effect of access to free medication to quit smoking: A clinical trial testing the role of motivation. Nicotine and Tobacco Research, 2014; 16(7):992-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24610399

258. Lundh A, Sismondo S, Lexchin J, Busuioc OA, and Bero L. Industry sponsorship and research outcome. Cochrane Database of Systematic Reviews, 2012; 12:MR000033. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23235689

259. Etter JF, Burri M, and Stapleton J. The impact of pharmaceutical company funding on results of randomized trials of nicotine replacement therapy for smoking cessation: A meta-analysis. Addiction, 2007; 102(5):815-22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17493109

260. Greene NM, Taylor EM, Gage SH, and Munafo MR. Industry funding and placebo quit rate in clinical trials of nicotine replacement therapy: A commentary on etter et al. (2007). Addiction, 2010; 105(12):2217-8; author reply 9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21054610

261. Moberg CA and Humphreys K. Exclusion criteria in treatment research on alcohol, tobacco and illicit drug use disorders: A review and critical analysis. Drug and Alcohol Review, 2017; 36(3):378-88. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27324921

262. Motschman CA, Gass JC, Wray JM, Germeroth LJ, Schlienz NJ, et al. Selection criteria limit generalizability of smoking pharmacotherapy studies differentially across clinical trials and laboratory studies: A systematic review on varenicline. Drug and Alcohol Dependence, 2016; 169:180-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27863344

263. Kotz D, Brown J, and West R. Prospective cohort study of the effectiveness of smoking cessation treatments used in the "real world". Mayo Clinic Proceedings, 2014; 89(10):1360-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25282429

264. Piper ME, Bullen C, Krishnan-Sarin S, Rigotti NA, Steinberg ML, et al. Defining and measuring abstinence in clinical trials of smoking cessation interventions: An updated review. Nicotine and Tobacco Research, 2020; 22(7):1098-106. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31271211

265. Benowitz NL, Bernert JT, Foulds J, Hecht SS, Jacob P, et al. Biochemical verification of tobacco use and abstinence: 2019 update. Nicotine and Tobacco Research, 2020; 22(7):1086-97. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31570931

266. Catz SL, Jack LM, McClure JB, Javitz HS, Deprey M, et al. Adherence to varenicline in the compass smoking cessation intervention trial. Nicotine and Tobacco Research, 2011; 13(5):361-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21350041

267. Hollands GJ, McDermott MS, Lindson-Hawley N, Vogt F, Farley A, et al. Interventions to increase adherence to medications for tobacco dependence. Cochrane Database of Systematic Reviews, 2015; 2(2):CD009164. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25914910

268. Hollands GJ, Naughton F, Farley A, Lindson N, and Aveyard P. Interventions to increase adherence to medications for tobacco dependence. Cochrane Database of Systematic Reviews, 2019; 8:CD009164. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31425618

269. Schlagintweit HE, Perry RN, Darredeau C, and Barrett SP. Non-pharmacological considerations in human research of nicotine and tobacco effects: A review. Nicotine and Tobacco Research, 2020; 22(8):1260-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31058286

270. Pacek LR, McClernon FJ, and Bosworth HB. Adherence to pharmacological smoking cessation interventions: A literature review and synthesis of correlates and barriers. Nicotine and Tobacco Research, 2018; 20(10):1163-72. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29059394

271. Fucito LM, Toll BA, Roos CR, and King AC. Smokers' treatment expectancies predict smoking cessation success. J Smok Cessat, 2016; 11(3):143-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27594921

272. Bailey SR, Fong DM, Bryson SW, Fortmann SP, and Killen JD. Perceived drug assignment and treatment outcome in smokers given nicotine patch therapy. Journal of Substance Abuse Treatment, 2010; 39(2):150-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20598833

273. Hughes J. Ethical concerns about non-active conditions in smoking cessation trials and methods to decrease such concerns. Drug and Alcohol Dependence, 2009; 100(3):187–93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19058924

274. Rosen L, Manor O, Engelhard D, and Zucker D. In defense of the randomized controlled trial for health promotion research. American Journal of Public Health, 2006; 96(7):1181-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16735622

275. Black N, Eisma MC, Viechtbauer W, Johnston M, West R, et al. Variability and effectiveness of comparator group interventions in smoking cessation trials: A systematic review and meta-analysis. Addiction, 2020; 115(9):1607-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32043675

276. Richter KP and Ellerbeck EF. It's time to change the default for tobacco treatment. Addiction, 2015; 110(3):381-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25323093

277. Ashcroft RE. The ethics of an opt-out default in tobacco treatment. Addiction, 2015; 110(3):389-90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25678286