Behavioral counseling

Behavioral interventions play an integral role in
smoking cessation treatment, either alone or in con-
junction with pharmacotherapy. These interven-
tions, which include a variety of methods ranging
from self-help materials to individual cognitive–
behavioral therapy, enable individuals to more ef-
fectively recognize high-risk smoking situations, de-
velop alternative coping strategies, manage stress,
improve problem-solving skills, and increase social
support [113]. The Clinical Practice Guideline out-
lines a five-step framework that clinicians can apply
when assisting patients with quitting. Health care
providers should: (a) systematically identify all to-
bacco users, (b) strongly advise all tobacco users to
quit, (c) assess readiness to make a quit attempt, (d)
assist patients in quitting, and (e) arrange follow-up
contact. The steps have been described as the 5 A’s:
Ask, Advise, Assess, Assist, and Arrange follow-up
(Table 1.3). Due to the possibility of relapse, health
care providers should also provide patients with
brief relapse prevention treatment. Relapse preven-
tion reinforces the patient’s decision to quit, reviews
the benefits of quitting, and assists the patient in re-
solving any problems arising from quitting [112].
The outlined strategy has been termed the 5 R’s
(Table 1.3): Relevance, Risks, Rewards, Roadblocks,
and Repetition. In the absence of time or expertise
for providingmore comprehensive counseling, clin-
icians are advised to (at a minimum), ask about to-
bacco use, advise tobacco users to quit, and refer
these patients to other resources for quitting, such
as a toll-free tobacco cessation quitline (1-800-QUIT
NOW, in the US).