Counseling is an essential component
In one of the meta-analyses on which the guideline was based, the combination of counseling and medication proved to be more effective than either intervention alone. Individual, group, and telephone counseling were all effective (odds ratios [ORs], 1.7, 1.3, and 1.2, respectively), provided they included practical help that emphasized problem solving and skills training, as well as social support. The benefits of a team-based approach were evident from the finding that counseling provided by more than one type of clinician had higher effect sizes (OR, 2.5 when two different clinical disciplines were involved and 2.4 for three or more disciplines).4
The guideline also found state-sponsored quit lines, accessible at no charge via 800-QUIT-NOW, are an effective option. (For more information about this and other resources, see Table W1.) For patients who aren’t ready to stop smoking, the guideline recommends motivational interviewing4—a direct, patient-centered technique used to explore and work through ambivalence. Further information about this method is available at www.motivational interviewing.org.
In counseling patients who are considering a quit attempt, it is important to present all options. A smoking history is needed, too, because factors such as the number of cigarettes smoked per day, how long a patient is typically awake before smoking the first cigarette of the day, and level of dependence are important factors in determining medication and dosage. Consider the advantages and disadvantages of the various medications (see Table 3) or methods used for prior quit attempts and reasons for relapse, if appropriate, as well as patient preference.4,6,7
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