Office evaluation and treatment of the dependent smoker.

Nicotine addiction is the most prevalent of all substance dependence, resulting in profound medical, social, and psychologic costs. Evidence supporting the addictive nature of nicotine is compelling. Recognition of this addiction has opened treatment options not currently available, including pharmacologic options. Physicians can contribute to cessation success even with minimal interventions. For those interested in stronger interventions, careful assessment of the smoker is essential. This assessment should identify the degree of nicotine dependence, the presence of negative affect related to cessation, and the pervasiveness of meaning of tobacco in the patient's life. Treatment options include white knuckle or will power quitting, guided self-treatment, referral, and office cessation with or without pharmacologic support. A four-visit protocol that includes (1) recruitment, (2) assessment, (3) treatment, and (4) relapse prevention is described.