Then the smoker's spouse asks the smoker to stop then his/her kids ask then his/her friends ask then a year after the clinician first gave advice, the smoker's uncle who is dying of lung cancer asks and the smoker decides to quit. A clinician asks a smoker to stop and the smoker does not. Most requests to stop smoking may appear to have little or no effect however, consider the scenario in Figure 1, Scenario 1. At any given time, only about 10% of smokers are planning to quit in the next month, 30% are contemplating to quit in the next 6 months, 30% plan to quit at some unknown time, and 30% have no plans to quit 10 thus, the large majority of clinician interventions involve motivating smokers to try to stop. Helping smokers to quit involves 2 processes-motivating them to attempt to quit and helping them to stop once they try. 8 Some clinicians fear they may embarrass their patients by discussing the topic however, exit polls suggest that most smokers state doctors who do not ask about their smoking habits are less competent doctors. 8, 9 Some clinicians do not believe they have the time to provide advice however, the major role clinicians play is to motivate smokers to quit, which can take as little as 3 minutes ( Table 1). 7 Some clinicians do not believe brief advice is effective however, many randomized trials indicate that even brief advice increases quit rates. 5Ī related statement is that “95% of all smokers who quit do so on their own.” In fact, with all the new treatments, one-third of smokers who quit now do so via treatment, 6 a rate of treatment use greater than that for alcoholism or obesity. We now know that many persons with these problems are able to “self-cure,” but also that many are unable to improve without treatment. One misperception by clinicians, smokers, and nonsmokers is “all smokers can quit smoking, if they are just motivated enough.” This statement is similar to statements made about alcohol and depression problems in the early 1900s. The writing of this article was supported in part by Senior Scientist Award DA-00450 from the National Institute on Drug Abuse. These are as effective as medications and are effective via individual counseling, group, and telephone formats. The proven psychosocial therapies are behavioral and supportive therapies. These medications are equally effective and safe and the incidence of dependence is very small. Proven second-line medications are clonidine, nicotine nasal spray, and nortriptyline. Scientifically proven, first-line medications are nicotine gum, inhaler, lozenge, and patch plus the nonnicotine medication bupropion. All smokers should be encouraged to use both medications and counseling. Such advice should include a clear request to quit, reinforcing personal risks of smoking and their reversibility, offering solutions to barriers to quitting, and offering treatment. Repeated, brief, diplomatic advice increases quit rates. Smokers try to quit only once every 2 to 3 years and most do not use proven treatments.
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