Many people fail to quit smoking because they do not use existing treatments, or don’t use them in the most effective way, according to a report published in the Journal of the American Medical Association. Combining behavioral support with medication improves the chances of success, the report notes.

Only one-third of smokers who try to quit smoking use either behavioral support or medication, Drug Store News reports. Even fewer smokers combine both types of treatment, even though studies have shown this approach to be more effective than using either treatment alone.

“Many smokers believe they have tried and failed all treatments because they — and their physicians — have not used existing treatments in the most effective way,” report author Nancy Rigotti, Director of the Tobacco Research and Treatment Center of the Massachusetts General Hospital Department of Medicine, said in a news release. “Outdated product labeling by the Food and Drug Administration (FDA) for nicotine replacement therapy contributes to this problem, as does the fear of possible side effects of FDA-approved medications. As a result, some smokers consider using newer, untested and unregulated products like electronic cigarettes.”

Rigotti said that the nicotine patch provides steady and prolonged relief from symptoms of nicotine withdrawal, but does not help reduce sudden cravings that can be triggered by cues such as seeing someone else smoke. Nicotine gums or lozenges can help reduce those cravings, she adds.

Certain types of combined smoking cessation therapies are recommended in the 2008 U.S. Public Health Service Clinical Practice Guideline for treating tobacco use and dependence, Rigotti points out. However, the product labels currently approved by the FDA warn smokers not to combine different nicotine replacement products, she says.