Smoking Cessation

Components of an Intensive Intervention

Parts of an Intensive Intervention based on The 2008 US Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence

Strategies for an intensive intervention (see the Guideline, Chapter 4 Table 4.1¹)

There is a strong relation between the level of counseling and quitting success. Higher level treatments result in a higher likelihood that people will be able to stop tobacco use.
Many different types of providers can help to increase the likelihood that people will be able to stop; meeting with more than one provider can increase the likelihood of stopping even more.
Individual, group and telephone counseling are all ways to help stop tobacco use.
Certain types of counseling strategies can help the most. Counseling that explains how to address the problem (problem solving skills/training approaches) and that includes support from other people can improve the likelihood of people being able to stop tobacco use.
Medication-assisted therapy, such as bupropion SR, nicotine replacement therapies, and varenicline, can improve the likelihood that people will be able to stop tobacco use. Clinicians should encourage all smokers to use these medications except when it could harm the patient or for specific groups of people for which there isn’t enough evidence that it will help (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents). Sometimes, using more than one medication at the same time may be a good choice. Also, using both counseling and medication can help increase the likelihood that people will be able to stop.
Tobacco addiction treatments can help across many populations (e.g., populations varying in gender, age, and race/ethnicity).

Components of an intensive nicotine dependence intervention (see the Guideline, Chapter 4 Table 4.2¹)

Assessments should determine whether tobacco users are willing to try to stop tobacco use using an intensive treatment program. Other assessments can provide information that will help counseling (e.g., stress level, addiction; see the Guideline, Chapter 6A, Specialized Assessment¹).

Many types of clinicians can help and should be used. One way to counsel would be to have a medical/health care clinician talk intensely about quitting, provide information about health risks and benefits, and recommend and prescribe recommended medications. Nonmedical clinicians could then provide more counseling sessions.

A more intense program has a better chance of success; therefore, when possible, the intensity of the program should be:
- Session longer than 10 minutes
- 4 or more sessions

Either individual or group counseling may be used. Telephone counseling also can help and can supplement clinical treatments. Use of self-help materials and Web sites that promote stopping are optional. Follow up sessions should be scheduled (see the Guideline, Chapter 6B¹).

Counseling should include real-life counseling (problem-solving/skills training) (see the Guideline, Table 6.19¹) and support by individuals between sessions (see the Guideline, Table 6.20¹).

Every smoker should be offered medications endorsed in this Guideline, except when they may cause harm or have not been shown to help specific groups of people (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents; see the Guideline, Table 3.2 for clinical guidelines and Tables 3.3–3.11 for specific instructions and precautions ¹). The clinician should tell the person how medications can help people to stop tobacco use and how to reduce withdrawal. The most effective medications include: bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline. Using some medications together also can help. Using counseling and medication together can help people to stop tobacco use.

Intervention programs that use all of the actions may be used with all tobacco users who are willing to take part in such efforts.

Page Last Modified on 12/1/2015