Tobacco is one of the most widely used drugs of abuse, and represents the single most preventable cause of death. Physicians should take every opportunity to encourage their patients who smoke to quit. Most smokers are aware of the health hazards of smoking and want to quit. Smokers also need to be made aware of the health and economic benefits of a tobacco free life. Several pharmacological agents are available to help the patient who is committed to quitting. Nicotine replacement (patch, gum, lozenge, inhaler) is the most widely used, is available over the counter, and has a success rate about twice that of placebo. Bupropion (Zyban, Wellbutrin) has a slightly higher success rate, and can be used in conjunction with nicotine replacement. Varenicline (Chantix) probably provides the best success rates. Support and self-help groups are also a very useful resource for many patients.