The “5 A’s” model for treating tobacco use and dependence

Ask about tobacco use	Identify and document tobacco use status for every patient at every visit.
Advise to quit	In a clear, strong and personalized manner, urge every tobacco user to quit.
Assess willingness to make a quit attempt	Is the tobacco user willing to make a quit attempt at this time?
Assist in quit attempt	For the patient willing to make a quit attempt, offer medication and provide or refer for counseling or additional treatment to help the patient quit. Refer patient to the CT Quitline using the fax referral form link below.   For patients unwilling to quit at this time, provide interventions designed to increase future quit attempts.  (see table for 5 R’s)
Arrange follow-up	For the patient willing to make a quit attempt, arrange for follow-up contacts, beginning within the first week after the quit date.   For patients unwilling to make a quit attempt at this time, address tobacco dependence and willingness to quit at their next clinic visit.

For more detailed information regarding the 5 A’s review the US DHHS Clinical Practice Guideline, Treating Tobacco Use and Dependence.

Less intensive interventions, as simple as physicians advising their patients to quit smoking, can produce cessation rates of 5% to 10% per year. More intensive interventions, combining behavioral counseling and pharmacologic treatment, can produce 20% to 25% quit rates in
one year.

Patient not ready to make an attempt right now   Once a clinician has assessed a patient’s willingness to quit and the patient is not ready to make an attempt at this time, use brief intervention or Motivational Interviewing (MI) designed to educate and motivate the patient. MI techniques focus on exploring and resolving a tobacco user’s reasons for using and not wanting to attempt to quit tobacco. The content areas that should be addressed in a MI counseling intervention can be found in the “5R’s” table below.  For specific strategies of MI review the US DHHS Clinical Practice Guideline, Treating Tobacco Use and Dependence.

{doctor talking with patient}

The “5 R’s” for enhancing motivation to quit tobacco

Relevance	Encourage the patient to indicate why quitting is personally relevant- being as specific as possible. How does it relate to the patient’s disease status or risk, family or social situation (e.g. children at home), health concerns, age, gender and other characteristics important to the patient.
Risk	Ask the Tobacco user to identify potential negative consequences of tobacco use.  Suggest and highlight those that seem most relevant to the patient.
Rewards	Ask the patient to identify potential benefits of stopping tobacco use.  Suggest and highlight those that seem most relevant to the patient.
Roadblocks	Ask the tobacco user to identify barriers to quitting and suggest treatments that could address those barriers.  Common barriers are withdrawal symptoms, fear of failure, weight gain, lack of support, and enjoyment of tobacco.
Repetition	MI should be repeated every time the unmotivated patient visits the clinic setting.  Tobacco users who failed in a previous quit attempt should be told that most people make repeated attempts before they are successful.

For more detailed information regarding the 5 R’s review the US DHHS Clinical Practice Guideline, Treating Tobacco Use and Dependence.

Algorithm for Treating Tobacco Use

CT Quitline Fax Referral Form

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