Physicians should take advantage of each contact with smokers to encourage and support smoking cessation. Once a patient is identified as a smoker, tools are available to assess readiness for change. Using motivational interviewing techniques,
the
physician can help the patient move from the precontemplation stage through the contemplation stage to the preparation stage, where plans are made for the initiation of quitting smoking. Continued motivational techniques and support are needed in
the
action stage, when the patient stops smoking. Major treatment guidelines emphasize that three treatment elements in particular are effective for smoking cessation intervention : nicotine replacement therapy, social support for cessation, and
skills
training/problem solving. Guidelines emphasize the dose-response relationship between the intensity and duration of treatment and its effectiveness. In general, the more intense the treatment, the more effective it is in producing long-term
abstinence
from tobacco. Group or individual behavioral counselling can facilitate smoking cessation and improve the cessation rates. A plan should be in place for recycling the patient through the appropriate stages if relapse should occur.
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