Helping patients to stop smoking.

Cognitive-behavioural strategies can be used for smokers who request assistance in stopping smoking. These strategies are based on social learning theory, which defines smoking cessation as a process of breaking all of the emotional and situational ties that have been established with the act of smoking. To do this, the quitting smoker needs to understand the addiction process as well as conditioned responses to it in dealing with withdrawal symptoms and craving. The health worker can help the quitting smoker by providing techniques to understand what and how smoking reinforces itself, to enhance and maintain motivation to remain abstinent, to encourage using a social support system and to plan the coping techniques that might be used. Both acts (behaviours) and thinking (cognitions) can be powerful tools in persevering to cope with craving and to manage undesirable side-effects of cessation. These include identifying the antecedents (cues to use tobacco) and the consequences of using tobacco to identify critical emotions and situations where coping is most necessary, finding activities to replace the act of lighting a cigarette, mentally preparing for craving and keeping at bay unhelpful thoughts (such as 'I'll just take one last puff'). Mental preparation is also necessary to understand and to avoid or limit the side effects of cessation.