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 Smoking: Smoking Cessation: A Guide for Primary Care Clinicians 
 

Skills training/problem-solving techniques—Should review previous quit successes and failures, anticipate relapse risk situations, and stress total abstinence starting on the quit day.

Followup

Schedule followup contact, either in person or by telephone

Timing:

  • First followup contact within 2 weeks of the quit date, preferably during the first week.

  • Second contact within the first month.

  • Further followup contacts as needed.

Actions during followup visits:

  • Congratulate success.
  • If a lapse occurred, ask for recommitment to total abstinence.

  • Remind the patient that a lapse can be used as a learning experience and review the circumstances that caused it. Suggest alternative behaviors.

  • Identify problems encountered and anticipate challenges in the immediate future.

All treatment strategies apply to adolescents who smoke. Clinicians should be empathetic and nonjudgmental and should personalize the encounter to the adolescent's individual situation. Nicotine replacement therapy may be considered in adolescents addicted to nicotine.

Prevent Relapse

To prevent relapse, offer ex-smokers reinforcement

  • Congratulate, encourage, and stress importance of remaining abstinent.

  • Review the benefits, including potential health benefits, to be derived from cessation.

  • Review the patient's success in quitting.

  • Inquire about problems encountered in maintaining abstinence and offer possible solutions.

  • Anticipate problems or threats to maintaining abstinence.

Discuss specific problems, such as:

  • Weight gain.

  • Negative mood/depression.

  • Prolonged nicotine withdrawal.

  • Lack of support for cessation.


Fear of weight gain is an impediment to smoking cessation. Inform smokers that many people gain weight when they stop smoking. Tell them that weight gain is a minor risk compared with the risks of continued smoking. Tell patients to tackle one problem at a time. First, be confident that they have quit smoking for good, then work on reducing weight gain. Nicotine gum may delay weight gain.

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