• Both the nicotine patch and nicotine gum are effective pharmacotherapies for smoking cessation.

• The nicotine patch may be easier to use than the gum in most clinical settings.

Make culturally and educationally appropriate materials on cessation techniques readily available in your office.

Intensive Programs

Offer intensive smoking cessation programs

If your patient prefers intensive treatment or you think such a program is appropriate, refer him or her to an intensive smoking cessation program administered by a specialist. Always followup with the patient about quitting.

• Intensive programs are strongly correlated with cessation success.

• Information obtained in the assessment (e.g., comorbidity, stress level) is useful in counseling.

• Many different types of clinicians (e.g., nurses, dentists, psychologists) are effective in increasing quit rates.

• Intensive programs should offer 4-7 sessions, each at least 20-30 minutes in length, lasting at least 2 weeks.

• Counseling should offer problem solving and skills training as well as social support.

• Counseling should reinforce motivation to quit and relapse prevention. Individual and group counseling are both effective.

• Every smoker should be offered nicotine replacement therapy (patch or gum), except when medically contraindicated.

If a smoker doesn't want to quit, clinicians should ask questions at each visit that help the patient identify (1) reasons to quit and (2) barriers to quitting. Pledge to assist the patient when he or she is ready to quit.

Key Treatment Strategies

Three treatment strategies are particularly effective:

• Patch: Plan on 8 weeks of therapy. Starting on the quit day, place a new patch, each morning, on a relatively hairless place between the neck and the waist. Consult the package insert for dosing suggestions and precautions.

• Gum: Use for up to 3 months. Patients often do not use enough gum to get maximum benefit. Use one piece every 1-2 hours. Chew and "park" gum (between cheek and gum) intermittently for about 30 minutes to allow nicotine absorption. Use 4 mg (vs. 2 mg) dose for highly dependent smokers.

• Nasal Spray: Recently approved by FDA. Consult package insert for dosing and precautions.