Elrashidi, Muhamad Y

Conventional cigarette smoking remains a leading preventable cause of morbidity and mortality despite declining prevalence, yet evidence-based treatments remain underused. This narrative review examines guideline-supported therapies and emerging approaches, including digital tools, neuromodulation, and harm-reduction strategies. Standard care typically combines FDA-approved pharmacotherapy with behavioral counseling. Digital interventions can extend access and support adherence, particularly when integrated with pharmacotherapy and follow-up. Repetitive transcranial magnetic stimulation (rTMS) can be considered as an adjunctive option for patients who do not respond to pharmacotherapy and is FDA-approved. For patients unable to quit, structured harm-reduction strategies may help reduce risk while supporting progression toward eventual abstinence. These approaches should be used alongside, not in place of, guideline-recommended pharmacotherapy and behavioral counseling, which remain the gold standard for care. This review outlines a pragmatic, primary care–oriented model that integrates stepped-care with harm-reduction strategies.