Center for Addiction Medicine

01/08/2007 - Treating Tobacco Use and Dependence "Part I"

Physician's Guide to Helping Patients Break the Habit

Doctors can play an important role in helping millions of smokers break the nicotine habit each year. In fact, data shows that most smokers are interested in quitting, clinicians are frequently in contact with smokers, and clinicians have high credibility with smokers. As such, medical professionals may be the most effective motivation for smokers to quit.

For patients that are ready to make an attempt to quit smoking, the Public Health Service Clinical Practice Guideline Treating Tobacco Use and Dependence suggests the 5 A's for clinicians.

Ask about tobacco use.

It is important for doctors to ask every patient about tobacco use at every visit. The best way to accomplish this is to document tobacco use status as part of the patient's vital signs. For example:


VITAL SIGNS

Blood Pressure: ______________________________________

Pulse: ____________________ Weight: _________________

Temperature: ________________________________________

Respiratory Rate: _____________________________________

Tobacco Use: Current Former Never
(circle one)

Advise to quit.

Once tobacco use status has been identified and documented, clinicians should advise all tobacco users to quit. Even brief advice to quit given by a medical professional results in greater quit rates. In fact, smokers report a doctor's advice to quit as an important motivator for attempting to stop smoking.

A simple, but strong and clear message, can help prompt tobacco user's to quit: "As your doctor, I feel I should tell you that the most important thing you can do for your health is quit smoking."

Assess willingness to make a quit attempt.

After advising patients to quit smoking, the next step is to determine whether or not the patient is willing to quit at this time.

One way to accomplish this is to follow up the advice with the direct question, " Are you willing to try to quit at this time?"

For those patients willing to try, the next step is assistance. For those smokers who are not ready to attempt quitting, the clinician should remind patients of the risk of continued smoking and outline the benefits of quitting. A tear sheet of reasons to quit smoking might be a valuable tool to integrate cessation into a patient's health care.

Assist in quit attempt.

The primary role of the medical professional in smoking cessation is helping the patient develop a quit plan that includes a personalized treatment that will most effectively treat nicotine dependence. The quit plan should include a set quit date, as well as reviewing past attempts to quit and challenges that may arise.

Treatment plans may include:

• Counseling
• Support groups
• Clinical use of Bupropion SR
• Use of Nicotine Gum, Nicotine Inhaler, Nicotine Nasal Spray, Nicotine Patch, or
Nicotine Lozenges
• Referral to a physician specializing in addiction treatment

Arrange for follow-up.
Follow-up contact is the final step in treating tobacco use. The physician should schedule a follow-up visit soon after the patient's quit date, preferably within the first week. This early follow-up is recommended because the majority of those attempting to quit smoking relapse within the first two weeks.

Many patients relapse, which is consistent with the chronic nature of tobacco dependence, rather than a personal failure. Remind patients that a relapse should be viewed as a learning experience to understand what will help or harm the next quit attempt.

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