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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 the face (Figure 236-1). She has tried unsuccessfully to stop smoking on 3 different occasions using nicotine replacement therapy (patches and gum) and bupropion. She has no history of a psychiatric or seizure disorder. She would like to try stopping smoking using varenicline. 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 236-1)

Figure 236-1

55-year-old woman with premature wrinkling from years of heavy smoking. Note the numerous lines around her mouth and lips. (Courtesy of Richard P. Usatine, MD.)

Table 236-1 The “5 A's” Model for Treating Tobacco Use and Dependence

Half of all deaths (more than 440,000) in the United States are attributed to tobacco addiction, including those caused by passive smoking. Tobacco addiction is a chronic disease, often developed during adolescence and early adulthood, that requires ongoing assessment and repeated intervention. There are effective treatments that can significantly increase rates of long-term abstinence. There are also effective preventive interventions that can prevent the initiation of tobacco use and reduce its ...

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