The majority of patients with schizophrenia currently smokes or has smoked in the past, at much higher rates than seen in the general population. Psychiatry needs to make smoking cessation a priority and help their patients quit smoking and remain quit. In this chapter, I discuss the assessment of smoking and treatment tools for successful smoking cessation for patients with serious mental disorders. Emphasis is placed on the use of pharmacotherapy, particularly varenicline, and opt-out care, with treatment being the default option in a chronic disease model. E-cigarettes may be a harm reduction option for patients seriously addicted to cigarettes.