How can we help a smoker quit smoking?

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This page was last updated on February 11, 2004.

In order for a doctor to help smokers kick the habit, he must first identify them.

Less than 50% of M.D.s make a routine practice of taking a detailed smoking history from all patients.

It is important to ask how long the patient has been smoking and how many cigarettes a day he has been smoking ("pack-years"). This will help establish the risk of developing cancer and the approximate blood level of nicotine that the patient is experiencing.

The M.D. should then give an unqualified recommendation that the patient quit smoking, preferably in writing, and explain the risks to the patient's future health if he continues to smoke. I make a practice of filling out a prescription to emphasize that stopping smoking is as important as taking a medicine. Hearing this information from a doctor (the "white coat effect") has been shown to increase the chance that a person will quit smoking.

The MD should provide the patient with an appropriate replacement source of nicotine e.g. the patch or chewing gum, to help reduce the physiologic craving for nicotine, while he is trying to kick the habit.

(Smokers who can't afford, or don't want to spend the money on a medical visit can now get the patch without a prescription. Upjohn's Nicotrol was released by the FDA recently.)

A recent Journal of the American Medical Association reports the astonishing fact that only 2% of MD prescribe nicotine replacement to their smoking patients!

A follow up visit is important, since very few people will be able to quit smoking on the first attempt. If a person is unable to quit on his own, referral to a support group program is in order. Continued, persistent follow-up and support is very important.

These guidelines have been nicely summarized at the Indiana Tobacco Control Center Guide to Smoking Cessation. at URL http://iumeded.med.iupui.edu/tobacco/scguide.htm.

It is very important to keep in mind how difficult it is for the smoker to quit. Support and encouragement are beneficial. Carping criticism is counter- productive.

Yet another source of smoking cessation assistance can be found at this very well organized site written by Blair Price. http://www.chriscor.com/linkstoa.htm. (Note: I do not endorse any of the commercial products touted as being effective in smoking cessation here or on other web pages unless they have been proven effective in scientific studies and the relevant studies published in peer-reviewed medical journals.)

This is a commercial page, but it has some good information on nicotine gum Nicorette

Information on Smoking Cessation can be found at the Virtual Hospital

Sometimes is difficult to quit smoking because the smoker has problems with other substance abuse or addiction problems. To get more information on this aspect of nicotine addiction, visit Dr. Steve at his new web site. Dr. Steve is Steve Adelman MD, a board-certified addiction psychiatrist from Boston, Massachusetts, and the Medical Director of Substance Abuse Services for Harvard Vanguard Medical Associates..

A document that provides information for nurses who want to improve their skills in helping people quit smoking can be found at NIH