If possible, I will spend extra time with the patient to help them reinforce their decision and offer psychological support. Other ways to address resistance to change include asking the patient's family members and close friends to participate in their treatment plan. If the patient has children, the children can volunteer information about how they feel about their parent smoking. The children can offer anything from "I don't like the way it smells" to "I'm worry about mommy dying."

Friends who have stopped smoking can be among the greatest sources of psychological and social support during this critical time in the treatment plan. A friend who can be there not just to provide advice but also as a role model is an invaluable asset. Moreover, friends who have stopped will not tempt the patient by smoking in front of them.

Patients with spouses, family members, or friends who still smoke will have more difficulties than patients who do not. Therefore, I would make sure to spend extra attention addressing and reinforcing reasons for quitting. Focusing on reasons to quit will help the patient who is still at the preparation stage (Guide Your Patients to a Smoke-Free Future: The Canadian Council for Tobacco Control, 1999). I may recommend smoking cessation support groups or hypnosis.

The patient who is in the preparation stage and who is ready to move towards the action and maintenance stage of quitting may need to know about the various pharmacological interventions available to them. I am available to provide that information for the patients, as well as provide access to those products and services. For example, the Columbia University College of Dental Medicine outlines the options available for patients who want to quit. Those options include the Nicotine Patch, Nicotine Gum, the Nicotine Lozenge called "Commit," Nicotine Inhaler, Nicotine Nasal Spray, Sustained Release Buproprion, and Varenicline.

I would need to ask patients about their smoking history and lifestyle habits to best determine which, if any, of these pharmacological interventions are necessary. For example, patients who smoke more than ten cigarettes a day and want to quit are eligible for the Nicotine Patch. Most of the above listed therapies are beneficial for any patient who smokes less than one...

Many of these interventions can be used in tandem with others, making it more likely that the patient will rely on the medications rather than return to their smoking habit. Finally, most patients may benefit from interventions like Sustained Release Buproprion and Varenicline. The lecture notes also point out that patients who have expressed a clear quit date are the most likely to benefit from pharmacological interventions that will help them stop for good.
Action and Maintenance

As the Canadian Council for Tobacco Control (1999) points out, it is important to be supportive of patients even if they relapse. After all, smoking cessation often takes years. Many people attempt to stop several times before they actually take their last puff (Canadian Council for Tobacco Control, 1999). I will tell this to my patients, who need support and not admonishment.

However, throughout the treatment process I will be checking in with the patient to ask how they are doing, when they are tempted, and if they are sneaking smokes. I will help them follow through with their drug therapies, and generally be there for them as a follow-up support system.

Stopping smoking involves a comprehensive Tobacco Cessation Treatment Plan. The plan begins with observation and simple awareness, helping to ease the patient into the idea of a life without cigarettes. At the early stage of intervention, it is best to suggest but not overtly give the information to the patient ( Canadian Council for Tobacco Control, 1999). However, by the time the patient is actively trying to quit, it is important to offer as much information and access to treatment services as possible. The interventions include both psychological and pharmacological treatments.

References

The American Cancer Society (2002). Smoking Cessation Products. ACS

The Canadian Council for Tobacco Control (1999). Guide Your Patients to a Smoke-Free Future.

Columbia University College of Dental Medicine. Tobacco Cessation.

Lecture Notes.

Tepper, LM. (1999). The Role of the Dental Profession in Tobacco Cessation. In D. Seidman and L. Covey (Eds), Helping the Hard Core Smoker: A Clinician's Guide. NY: Lawrence Earlbaum.