A 55-year-old woman presents for follow-up of hypertension. She has been smoking 1.5 packs of cigarettes per day since her late teens and reports that she is now ready to stop smoking. She realizes that smoking is bad for her health and does not like how smoking causes more wrinkles on her face (Figure 248-1). She has tried unsuccessfully to stop smoking on multiple occasions. Her efforts have included stopping "cold turkey"; using nicotine replacement therapy (patches and gum); 12 weeks of bupropion; and most recently, trying electronic cigarettes (though this was not recommended by her physician). She has no history of psychiatric disorders and does not have unstable cardiovascular disease. She would like to try stopping smoking with varenicline and is interested in setting a quit date. She is also willing to return for 4 follow-up sessions at weekly intervals. She agrees to call a stop smoking telephone helpline (1-800-QUIT-NOW) for counseling help. The patient tolerates the varenicline well and is able to stop successfully without any adverse effects. Two years after treatment she continues to be abstinent and very glad of this outcome. The clinician used elements of the "5 A's" model for treating tobacco use and dependence to successfully help this patient quit smoking (Table 248-1).
55-year-old woman with premature wrinkling from years of heavy smoking. Note the numerous lines around her mouth and lips. (Reproduced with permission from Richard P. Usatine, MD.)
TABLE 248-1The "5 A's" Model for Treating Tobacco Use and Dependence |Favorite Table|Download (.pdf) TABLE 248-1 The "5 A's" Model for Treating Tobacco Use and Dependence
|Ask about tobacco use. ||Identify and document tobacco use status for every patient at every visit. |
|Advise to quit. ||In a clear, strong, and personalized manner, urge every tobacco user to quit. |
|Assess willingness to make a quit attempt. ||Is the tobacco user willing to make a quit attempt at this time? |
|Assist in quit attempt. || |
For the patient willing to make a quit attempt, offer medication and provide or refer for counseling or additional treatment to help the patient quit.
For patients unwilling to quit at the time, provide interventions designed to increase future quit attempts.
|Arrange follow-up. || |
For the patient willing to make a quit attempt, arrange for follow-up contacts, beginning within the first week after the quit date.
For patients unwilling to make a quit attempt at the time, address tobacco dependence and willingness to quit at next clinic visit.
Tobacco use is the leading cause of preventable death across the world.1 In the United States, ...