Treatment

Interventions

Clinician

While nurses, physicians, dentists, social workers and psychologists are all effective providers of cessation treatment, the use of multiple providers is associated with higher rates of cessation. It is recommended that medical/health care clinicians provide important information about the health risks of smoking, benefits of cessation, and proper administration of nicotine replacement. In addition, nonmedical clinicians, such as psychologists and social workers, can be effective providers of psychosocial and behavioral treatment methods.

Program Format

Both individual and group formats are effective ways to deliver tobacco cessation interventions. The use of self-help materials is optional since their effectiveness has not been shown. Whatever format is chosen, the use of follow-up treatment sessions is highly recommended. Programs that deliver a one-time intervention ONLY have not been shown to be effective.

Program Intensity

Whether the format is individual or group, there is a strong dose- response relationship between intensity and success. Recommendations for program intensity include:

1. Session length: 20-30 minutes
2. Number of sessions: 4-7
3. Length: At least 2 weeks, preferably more than 8

Program Content

All programs should address the 4 R's:

1. Relevance of quitting to the individual smoker, motivation may include: family, costs, role-modeling.
2. Risk of continued smoking,perhaps smoking-related diseases are present.
3. Rewards of quitting, perhaps I will have less hassle from family and co-workers, and more freedom from the drug.
4. Repetition, clinicians must repeat numbers 1, 2, and 3 with each contact.

In addition, the following content areas have been shown to improve cessation rates:

• General problem solving skills examples such as: anticipating and avoiding danger situations, accomplishing lifestyle changes, learning cognitive strategies that will reduce negative moods:
  1. Alternative ways of managing stress, such as distraction, deep breathing,exercise.
  2. Skills training: avoiding high risk situations, asking others not to smoke around you, making a plan of action.
  3. Relapse prevention: recognizing that a slip does NOT mean failure.
• Supportive component from clinician examples such as:
  1. Note that effective cessation treatments are now available.
  2. Note that half of all people who have ever smoked, have now quit.
  3. Commmunicate belief in patient's ability to quit.
  4. Ask about how patient feels about quitting.
  5. Directly express concern and willingness to help.
  6. Be open to the patient's expression of fears of quitting, difficulties experienced, and ambivalent feelings.
  7. Direct reinforcement from clinician that indicates concern and confidence that the person can successfully stop smoking.

The Agency for Healthcare Research and Quality provides many resources for Clinicians and consumers to help aid in smoking cessation.

Tobacco Control Program Guidelines and Data provided by the CDC

Quick Reference Guide for Clinicians, this guide provides information about how to conduct a brief intervention with a patient.

Smoke Free Families provide a list of "5A's" for a brief intervention for use with a pregnant women.

Clinical Guidelines for Prescribing Pharmacotherapy for Smoking Cessation as a brief intervention.