Treatment Recommendations for Smokeless Tobacco

Treatment for smokeless tobacco (ST) dependence differs from the treatment of tobacco dependence for smoking. In general, there are three reasons why treatments that work for cigarette use do not always work for smokeless tobacco use:

  • First, a normal dip or chew contains from 3.6 to 4.5 mg. of nicotine. A cigarette contains 1.8 mg. of nicotine.
  • Second, when an individual takes a drag from a cigarette, it takes approximately seven seconds for the nicotine to reach the lungs and for dopamine to be released. This provides a quick satisfaction to their craving. With ST, once a dip or chew is placed into the mouth, it takes up to 30 minutes to receive the same satisfaction.
  • And third, when a cigarette is extinguished, the individual is no longer receiving nicotine. However, with ST, nicotine continues to be absorbed for up to 60 minutes after the tobacco is removed.

Behavioral treatment and nicotine replacement therapy in combination is found to be the most effective way of treating smokeless tobacco dependence.


As with cigarette smokers, it is important to encourage behavioral counseling in addition to pharmacologic therapy. This typically includes identifying use triggers and modifying behaviors that increase the risk for relapse.

Smokeless Tobacco Treatment Medications Recommendation








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American Cancer Society - The STOP Guide: Smokeless Tobacco Cessation Accessed at:
Treating Spit Tobacco (ST) Dependence: What You Need to Know as a Primary Care Provider
Jon O. Ebbert, MD, MSc
Assistant Professor of Medicine Lowell C. Dale, MD
Associate Professor of Medicine
Mayo Clinic College of Medicine