Addiction Medicine: Closing the Gap between Science and Practice

Brief interventions for smoking cessation should
include a follow-up visit scheduled shortly after
a patient’s quit date.^68

A more simple approach that is gaining traction
is to restrict the brief intervention to the first two
“A’s”--Ask and Advise--and then refer the
patient, usually to a telephone quitline or a
smoking cessation service, where the other three
“A’s” are performed.^69 A recent review of
research found that compared to just providing
advice, physicians who offered assistance in
quitting* to all patients who smoke regardless of
their stated willingness to quit, could prompt an
additional 40 percent to 60 percent of smokers to

try quitting.^70

There is some evidence to suggest that shorter
interventions for smoking cessation may be
more successful than longer ones, perhaps
because of the direct, instructional nature of the
brief intervention. A study of smokers with
addiction involving alcohol enrolled in an
addiction treatment program found that 35
percent of those who received a 10-minute brief
intervention for tobacco use were abstinent a
month later compared to only 13 percent of
those who received a more extensive, 50-minute

• In the form of counseling or nicotine replacement

therapy (see Chapter V).

motivational interview session.† The brief

advice session directly told patients to quit

smoking and assisted participants in accessing

additional information or help to reach that goal.

In contrast, the more extensive motivational

interview focused on the advantages and

disadvantages of smoking, imagining life

without smoking, providing personalized

feedback and setting stage-specific goals.^71

Alcohol and Other Drugs .............................................................................................

Based on screening results, brief interventions

for alcohol and other drug use begin with

feedback about the quantity and frequency of a

patient’s substance use, and the potential

consequences the patient may face as a result.^72

Brief interventions typically involve the

counseling technique of motivational

interviewing.‡ 73

Health care practitioners trained in providing

brief intervention services try to help patients

decide to change their substance use behavior in

light of the adverse medical and social

consequences of risky use of addictive

substances and the many ways in which it may

conflict with their values and goals, and then

offer advice on how patients may do so.^74

The advice for adults§ may include:

 Setting a specific limit on consumption;

 Learning to recognize the antecedents of

substance use and developing skills to avoid

use in those situations;

† After six months, the abstinence rates of both

groups had fallen to 13 percent and two percent,

respectively.

‡ See Chapter V.

§ Given the dangers of substance use during the

vulnerable period of brain development that

continues into young adulthood, the advice for

adolescents and young adults who have not reached

the legal ages for smoking or drinking alcohol,

should focus less on limiting risky use and more on

abstaining from use of all addictive substances.

The “Five R’s”

Employing an empathetic counseling style,

practitioners should:

 Relevance: Encourage patients to indicate

why quitting is personally relevant.

 Risks: Help patients identify the acute,

long-term and environmental risks they take

by continuing to smoke.

 Rewards: Help point out the rewards that

will come with cessation.

 Roadblocks: Ask patients to identify any

roadblocks they may face during their

attempt to quit and suggest potential

solutions for each.

 Repetition: Repeat this process every time

they see the patient.