An algorithm for smoking cessation

An algorithm for physician-based treatment for smoking cessation is presented based on the following guidelines: (1) Smokers who are not contemplating cessation need motivational interventions. (2) Smokers who are contemplating cessation need information about treatments. (3) Smokers ready for action need to set a quit date. (4) Formal therapy for smoking cessation is indicated only after a failed attempt. (5) Nicotine withdrawal symptoms or high scores on the Fagerstrom Tolerance Scale are indications for pharmacotherapy. (6) Transdermal nicotine with or without nicotine polacrilex is the preferred first-step pharmacotherapy. (7) Among smokers receiving nicotine replacement, group behavioral therapy should be encouraged but not be required. (8) Nondependent smokers (those who do not need pharmacotherapy but need treatment) should participate in group behavioral therapy. (9) Those who fail to quit with nicotine replacement and/or group behavior therapy should be screened for psychiatric and alcohol and other drug problems and should be referred for individual therapy.