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02/06/2007 - Treating Tobacco Use and Dependence "Part II"
Physician’s Guide to Helping Patients Break the Habit
Tobacco is the number one agent in America responsible for avoidable illness and death. Despite this common knowledge, millions of Americans consume tobacco on a daily basis. Nearly half a million Americans face premature death from tobacco use, which also contributes to intense disability and pain. As a matter of fact, tobacco use is the chief avoidable cause of illness and death in our society, causing cancer, heart disease, stroke, complications of pregnancy and chronic obstructive pulmonary disease.
Some 70 percent of smokers report a desire to quit. Physicians are uniquely poised to help patients quit the tobacco cycle, as 70 percent of smokers see a doctor each year. In addition, a majority of smokers cite a physician’s advice to quit as an important motivator.
All drug addictions warrant clinical intervention. Tobacco dependence exhibits classic characteristics of drug dependence. Nicotine is psychoactive, tolerance producing and causes physical dependence characterized by withdrawal symptoms.
Additionally, tobacco dependence shows many features of a chronic disease. Most tobacco users persist in use for many years and typically cycle through multiple periods of relapse and remission.
By recognizing tobacco dependence as a chronic condition, physicians will better understand the relapsing nature of the ailment and the requirement for ongoing care.
In June 2000, the Public Health Service released the Clinical Practice Guideline Treating Tobacco Use and Dependence. The Guideline emphasizes the importance of treating tobacco-using patients at every medical clinic in the country to promote long-term abstinence. The first step in providing treatment is determining the tobacco use status of every patient.
According to the book, asking whether or not a patient uses tobacco products not only increases the rates of clinical intervention, but also increases abstinence rates.
Treating Smokers Willing to Quit – The 5 A’s
ASK every patient about tobacco use at every visit.
ADVISE to quit with clear, strong and personalized message.
ASSESS willingness to quit.
ASSIST in quit attempt by developing a quit plan.
ARRANGE for follow-up.
Treating Patients Who Are Not Ready to Make a Quit Attempt – The 5 R’s
RELEVANCE: Tailor advice and discussion to each individual patient.
RISKS: Outline the risks of continued tobacco use.
REWARDS: Discuss the benefits of quitting.
ROADBLOCKS: Identify barriers to quitting.
REPETITION: Reinforce the message at every visit.