An integrated approach to the treatment of nicotine dependence in a medical center setting: description of the initial experience.

A nicotine-dependence treatment program can be implemented in a medical center setting by using a model that involves physician, patient, and nicotine-dependence counselor. The physician-referred and counselor-directed consultations are followed by a systematic relapse-prevention program. The counselors utilize behavioral approaches, the philosophy and principles of the addictive disorders field, and adjunctive pharmacologic therapy. The patients are chronic, heavy smokers who have had many previous quit attempts and are highly nicotine-dependent. Important factors include: 1) referral by physicians, 2) physicians' active role in the intervention, 3) expertise of the counselors, 4) structured relapse-prevention program, and 5) provision of services in a smoke-free medical center.