Lori A. Pbert, Ph.D.; Judith K. Ockene, Ph.D., M.Ed.



Assessment of and intervention with the smoker are closely integrated because gathering information about the person's smoking history and current smoking patterns increases self-awareness in a way that facilitates behavior change. To guide the clinician, the U.S. Public Health Service (PHS) has developed the "Treating Tobacco Use and Dependence" clinical practice guideline (Fiore et al. 2000). This guideline provides an assessment and intervention model for the treatment of nicotine dependence, as well as evidence-based treatment strategies that incorporate the National Cancer Institute's "five As" strategies: Ask, Advise, Assess, Assist, and Arrange follow-up. In the model proposed by the PHS (Figure 16C–1), it is recommended that smoking status be routinely assessed and documented at every clinical contact (Ask). All current smokers should be given clear, strong, and personalized advice to stop smoking (Advise) and at each contact assessed for their willingness to quit (Assess). For those smokers who are willing to quit, further assessment should occur, taking into account the physiological, psychological, and social factors maintaining their smoking behavior, and brief intervention with follow-up should be provided (Assist and Arrange). When appropriate, the clinician may refer the patient for more intensive treatment. Smokers who are not willing to quit should receive a brief motivational intervention to facilitate motivation and future quitting efforts. Additionally, individuals who have recently quit should be provided intervention to prevent relapse.

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Figure 16C–1. Model for nicotine dependence assessment and treatment.Source. Adapted from Fiore MC, Bailey WC, Cohen SJ, et al. "Treating Tobacco Use and Dependence." Clinical Practice Guideline. Rockville, MD, U.S. Department of Public Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, June 2000. This document is in the public domain and may be used and reprinted without special permission.
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Table 16C–1. Strategies for assisting smokers who are ready to quit
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Figure 16C–2. Fagerstrom Test for Nicotine Dependence.
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Table 16C–2. First-line medications for treating nicotine dependence 
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Table 16C–3. Common elements of practical counseling (problem-solving skills training)
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Table 16C–4. Potential responses to patient-reported problems that threaten abstinence during prescriptive relapse prevention


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