Skip to main content
Log in

Motivating and helping smokers to stop smoking

  • Perspectives
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Smokers try to quit only once every 2 to 3 years and most do not use proven treatments. Repeated, brief, diplomatic advice increases quit rates. Such advice should include a clear request to quit, reinforcing personal risks of smoking and their reversibility, offering solutions to barriers to quitting, and offering treatment. All smokers should be encouraged to use both medications and counseling. Scientifically proven, first-line medications are nicotine gum, inhaler, lozenge, and patch plus the nonnicotine medication bupropion. Proven second-line medications are clonidine, nicotine nasal spray, and nortriptyline. These medications are equally effective and safe and the incidence of dependence is very small. The proven psychosocial therapies are behavioral and supportive therapies. These are as effective as medications and are effective via individual counseling, group, and telephone formats.

The writing of this article was supported in part by Senior Scientist Award DA-00450 from the National Institute on Drug Abuse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Center for Disease Control and Prevention. Cigarette smoking among adults—United States, 1998. Morb Mortal Wkly Rep. 2000;49:881–4.

    Google Scholar 

  2. Cohen S, Lichtenstein E, Prochaska JO, et al. Debunking myths about self-quitting. Am Psychol. 1989;44:1355–65.

    Article  PubMed  CAS  Google Scholar 

  3. Hughes JR. The evidence for hardening. Is the target hardening? NCI Smoking and Tobacco Control Monograph. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2001.

    Google Scholar 

  4. Hughes JR, Gulliver SB, Fenwick JW, et al. Smoking cessation among self-quitters. Health Psychol. 1992;11:331–4.

    Article  PubMed  CAS  Google Scholar 

  5. Hughes JR. Four beliefs that may impede progress in the treatment of smoking. Tob Control. 1999;8:323–6.

    Article  PubMed  CAS  Google Scholar 

  6. Hughes JR, Burns DM. Impact of medications on smoking cessation. In: Population Based Smoking Cessation. Proceedings of a Conference on What Works to Influence Cessation in the General Population, Smoking and Tobacco Control, Monograph No. 12. Bethesda, MD: National Cancer Institute; 2001;155–64.

    Google Scholar 

  7. Klingemann H, Sobell L, Barker J, et al. Promoting Self-Change from Problem Substance Use: Practical Implications for Policy, Prevention and Treatment. Dordrecht, The Netherlands: Kluwer Academic Publications; 2001.

    Google Scholar 

  8. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: Public Health Service; 2000.

    Google Scholar 

  9. Silagy C, Ketteridge S. Physician Advice for Smoking Cessation. The Cochrane Library, Issue 4 Updated Software; 1999.

  10. Etter JF, Perneger TV, Ronchi A. Distributions of smokers by stage: international comparison and association with smoking prevalence. Prev Med. 1997;26:580–5.

    Article  PubMed  CAS  Google Scholar 

  11. Emmons KM, Rollnick S. Motivational interviewing in health care settings. Opportunities and limitations. Am J Prev Med. 2001;20:68–74.

    Article  PubMed  CAS  Google Scholar 

  12. Prochaska JO, Goldstein MG. Process of smoking cessation: implications for clinicians. Clin Chest Med. 1991;12:727–35.

    PubMed  CAS  Google Scholar 

  13. Burns DM, Anderson C, Major J, Vaughn J, Shanks T. Cessation and cessation measures among adult daily smokers: national and state-specific data. In: Population Impact of Smoking Cessation. Proceedings of a Conference on What Works to Influence Cessation in the General Population, Smoking and Tobacco Control, Monograph No. 12. Bethesda, MD: National Cancer Institute; 2000;25–98.

    Google Scholar 

  14. Hughes JR. Harm reduction approaches to smoking: the need for data. Am J Prev Med. 1998;15:78–9.

    Article  PubMed  CAS  Google Scholar 

  15. Hughes JR, Goldstein MG, Hurt RD, Shiffman S. Recent advances in the pharmacotherapy of smoking. JAMA. 1999;281:72–6.

    Article  PubMed  CAS  Google Scholar 

  16. Benowitz NL. Nicotine Safety and Toxicity. New York: Oxford University Press; 1998.

    Google Scholar 

  17. Shiffman S, Dresler CA, Hajek P, Gilburt SJA, Targett DA, Strahs KR. Efficacy of a nicotine lozenge for smoking cessation. Arch Intern Med. 2002;162:1267–76.

    Article  PubMed  CAS  Google Scholar 

  18. Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med. 1999;340:685–91.

    Article  PubMed  CAS  Google Scholar 

  19. Benowitz NL, Gourlay SG. Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy. J Am Coll Cardiol. 1997;29:1422–31.

    Article  PubMed  CAS  Google Scholar 

  20. Hughes JR. Behavioral support programs for smoking cessation. Mod Med. 1994;62:22–7.

    Google Scholar 

  21. Lancaster T, Stead LF. Individual Behavioural Counselling for Smoking Cessation. The Cochrane Library, Issue 3, Updated Software; 2002.

  22. Stead LF, Lancaster T. Group Behaviour Therapy Programmes for Smoking Cessation. The Cochrane Library, Issue 3, Updated Software; 2002.

  23. Lancaster T, Stead LF. Self-help Interventions for Smoking Cessation. The Cochrane Library, Issue 3, Updated Software; 2002.

  24. Lichtenstein E, Glasgow RE, Lando HA, Ossip-Klein DJ. Telephone counseling for smoking cessation: rationales and review of evidence. Hlth Educ Res. 1996;11:243–57.

    Article  CAS  Google Scholar 

  25. Perkins KA. Weight gain following smoking cessation. J Consult Clin Psychol. 1993;61:768–77.

    Article  PubMed  CAS  Google Scholar 

  26. Hughes JR, Zarin DA, Pincus HA. Treating nicotine dependence in mental health settings. J Prac Psych Behav Hlth. 1997;250–4.

  27. Sussman S. Effects of sixty six adolescent tobacco use cessation trials and seventeen prospective studies of self-initiated quitting. Tob Induced Dis. 2002;1:35–81.

    Google Scholar 

  28. Warner KE, Luce BR. Cost-Benefit and Cost-Effectiveness Analyses in Health Care: Principles, Practice, and Potential. Ann Arbor, MI: Health Administration Press; 1983.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to John R. Hughes MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hughes, J.R. Motivating and helping smokers to stop smoking. J GEN INTERN MED 18, 1053–1057 (2003). https://doi.org/10.1111/j.1525-1497.2003.20640.x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1111/j.1525-1497.2003.20640.x

Key words

Navigation