Clinical interventions for patients unwilling to quit cigarette smoking
Not all patients are willing to stop smoking cigarettes, and this issue needs to be adequately addressed. According to the recommendations for treating tobacco use published by the U.S. Department of Health and Human Services, the interventions for such patients should be aimed at motivating them to finally quit smoking (Fiore et al., 2008). In particular, clinicians should keep in mind some specific factors that may explain the lack of motivation. Among them is limited knowledge about the health effects of tobacco use, poor understanding of the benefits of stopping smoking, the fear of failure, or financial constraints (Fiore et al., 2008; Tovilla-Zárate et al., 2020). Being aware of these factors, clinicians can make more effective decisions regarding motivational interventions.
Clinical interventions for patients that demonstrate no readiness to positively change their habits should be organized using evidence-based methods. Specifically, such individuals may benefit from short-term interventions based on client-centered motivational interviewing. This approach has been shown to increase the number of quitting attempts in unmotivated tobacco users (Fiore et al., 2008). The use of motivational interviewing enables clinicians to take an individual approach to each client and explore a specific person’s beliefs about tobacco use and perceived barriers to stopping smoking. Thus, it adds to these clients’ motivation to quit this harmful habit.
The best strategies to help your clients quit smoking
Quitting smoking is not always easy, but there is evidence to point to the best strategies to help different subgroups of patients to quit smoking. To start with, according to several meta-analytical studies conducted in the 1990s, brief physician advice focused on the benefits of smoking cessation (less or about 5 minutes) increases the proportion of patients quitting smoking (Fiore et al., 2008). Regarding the most effective formats of therapeutic communication to promote smoking cessation, they include up to seven proactive telephone calls initiated by counselors (Fiore et al., 2008; Heffner et al., 2016). Effective counseling strategies can be aimed at individuals and even groups of people. The strategies listed above are mainly based on increasing people’s motivation and knowledge through communication, which makes them applicable to different populations, including my clients from different age groups.
Apart from counseling and providing patients with support, the guidelines mention effective strategies involving the use of medications. Some first-line medications recommended by the panel are presented by bupropion, as well as nicotine inhalers and nicotine gum for safe and effective nicotine replacement therapy (Fiore et al., 2008). These strategies can be beneficial for reducing tobacco withdrawal symptoms in adults that present the majority of my clients.
Smoking cessation recommendations for special populations
Along with multiple health-related characteristics, a person’s age should be taken into account when selecting the best approaches to smoking cessation. When it comes to smokers aged 65 and older, the analysis of data conducted by the panel demonstrates that this subgroup can benefit from all treatment strategies recommended for use in the general population. More specifically, the strategies include pharmaceutical treatment and counseling (Fiore et al., 2008). At the same time, the authors of the guidelines place emphasis on the promising nature of telephone-based interventions in the elderly (Fiore et al., 2008). It is because the issues related to mobility disproportionately affect the representatives of this age group.
The guidelines also discuss the use of smoking cessation methods in teenagers. According to the panel’s conclusions, despite the reported effectiveness of counseling in adolescent smokers, the heterogeneity of research studies on the topic and the presence of contradictory findings make counseling a grade B recommendation (Fiore et al., 2008). It is also recommended to provide the parents of adolescents with information on the health effects of tobacco and second-hand smoking (Fiore et al., 2008). The abovementioned first-line medications are not recommended to be included in smoking cessation interventions for adolescents despite some research results indicating their effectiveness (Fiore et al., 2008). Overall, when it comes to adolescents, tobacco use treatments are still associated with substantial knowledge gaps.
References
Fiore M. C., Jaén, C. R, Baker, T.B., Bailey, W. C., Benowitz, N. L., Curry, S. J., Dorfman, S. F., Froelicher, E. S., Goldstein, M. G., Healton, C. G., Henderson, P. N., Heyman, R. B., Koh, H. K., Kottke, T. E., Lando, H. A., Mecklenburg, R. E., Mermelstein, R. J., Mullen, P. D., Orleans, C. T.,… Wewers, M. E. (2008). Treating tobacco use and dependence: 2008 update. Clinical practice guideline. U.S. Department of Health and Human Services.
Heffner, J. L., Kealey, K. A., Marek, P. M., Bricker, J. B., Ludman, E. J., & Peterson, A. V. (2016). Proactive telephone counseling for adolescent smokers: Comparing regular smokers with infrequent and occasional smokers on treatment receptivity, engagement, and outcomes. Drug and Alcohol Dependence, 165, 229-235.
Tovilla-Zárate, C. A., Robles-García, R., Juárez-Rojop, I. E., González-Castro, T. B., López-Narváez, M. L., Genis-Mendoza, A. D., Mejia, L. S., & Fresán, A. (2020). From planning to action in smoking cessation: Demographic and psychological symptom dimensions related to readiness to quit smoking. International Journal of Mental Health and Addiction, 1-12.