Tobacco Cessation

Clinical Guidelines and Recommendations

Treating Tobacco Use and Dependence

All health care providers, especially those with direct patient contact, have a unique opportunity to help tobacco users quit. Smokers cite a doctor's advice to quit as an important motivator for attempting to stop smoking.

The major steps to intervention are the "5 A's": Ask Advise, Assess, Assist and Arrange.

Ask – Implement a system in your clinic that ensures that tobacco use status is obtained and recorded at every patient visit.

Advise – Use clear, strong, and personalized language. For example ‘Quitting tobacco is the most important thing you can do to protect your health.

Assess – Ask every tobacco user if they are willing to quit at this time.

  • If willing to quit, provide resources and assistance
  • If unwilling to quit at this time, help motivate the patient
    • Identify reasons to quit in a supportive manner
    • Build patients confidence about quitting

Assist – Assist tobacco users with a plan.

  • Assist the smoker to:
    • set a quit date, ideally within two weeks,
    • remove tobacco products from their environment,
    • get support from family, friends, and coworkers,
    • review past quit attempts – what helped, what led to relapse,
    • anticipate challenges, particularly during the critical first few weeks, including nicotine withdrawal and
    • Identify reasons and benefits for quitting.
  • Give advice on successful quitting:
    • Total abstinence is essential – not even a single puff
    • Drinking alcohol is strongly associated with relapse
    • Allowing others to smoke in the household hinders successful quitting
  • Encourage use of medication:
    • Recommend use of over-the-counter nicotine patch, gum, or lozenge; or give prescription for varenicline, bupropion SR, nicotine inhaler, or nasal spray, unless contraindicated
  • Provide resources:
    • Recommend toll free 1-800-QUIT NOW (784-8669), the national access number to state-based quit line services
  • Refer to websites for helpful information:

Arrange – Schedule follow-up visits to review progress toward quitting.

  • If a relapse occurs, encourage repeat quit attempt:
    • Review circumstances that caused relapse, use relapse as a learning experience
    • Review medication use and problems
    • Refer to 1-800-QUIT NOW (784-8669)

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Reviewed 10/10/2024