Assessment of Nicotine Dependence

Stages of Change

1. Pre-contemplation. Smokers think about quitting
2. Contemplation. Smokers want to do something about it e.g. because of health scare, or sick of SOB/Cough
3. Determination. Smokers prepare to quit E.g. Set date, develop personalised plan
4. Action. Where smokers work the hardest. Cold turkey, cut down on cigarettes, NRT, Bupropion, Varenicline, Behavioural therapy
5. Maintenance. This phase can last for months or years, and is where people work to prevent relapse. They need to remind themselves why they quit
6. Termination. Successful in quitting smoking


5As Smoking Cessation Guideline

1. Ask

Identify patients with risk factors
If suffered from mental conditions such as depression, anxiety etc. in the past see GP before quitting


2. Assess

Readiness/Determination to change
  • Health concerns
  • Incentives (Health, Financial)
  • Previous attempts

The most important step to smoking cessation is for smokers to acknowledge that smoking is a problem
Only those that are committed are likely to succeed


Smoking Habit/Dependence severity
  • Number of cigarettes/day
  • Time to first cigarette after waking
  • Attempts to stop
  • Confidence to quit


3. Advice

Provide written information on how to quit
Advice on treatment options
Lifestyle advice

Be supportive but non-ambiguous

If they fail its not the end of the world - Get them to analyse their relapse
"What went wrong?"
"What have you learnt?"

Most people who succeed to quitting take 5-8 serious attempts before they succeed


4. Assist

Support for self monitoring


5. Arrange

Referral to special services
Social Support Groups
Phone information/counselling services
Follow up with GP