Smoking, diabetes, and the consultation
Essentially the degree of addiction can be judged by the
- number of cigarettes smoked/day
- the time to light the first cigarette first thing in the morning
- "The best thing you can do for your health is to stop smoking, and I would advise you to stop as soon as possible."
- "Tobacco is very addictive, so it can be very difficult to give up, and many people have to try several times before they succeed. Your chances of succeeding are much greater if you make use of counselling support, which I can arrange for you, and either nicotine replacement therapy or the antismoking drug Zyban [bupropion], which I can prescribe for you if you wish."
- "If you are ready to try to give up smoking now, then the best thing is to see a counsellor as soon as possible, and I can arrange that for you. If not, then I'd like you to take home this leaflet and read it, or ring the NHS smokers' helpline, to get further information."
- "The best thing is to get counselling from experts, but if this isn't possible, you should make sure that you have good information on the health effects of smoking and some tips on ways of stopping smoking and that you know where to turn for further help and support."
- "How do you feel about your smoking?"
- "How do you feel about tackling your smoking now?"
- Review smoking history—number smoked per day, time of first cigarette in the day. Ask smoker to keep diary of activities that coincide with smoking
- Review smoking behaviour—past quit attempts, what helped, and reasons for failure
- Emphasise need for total abstinence
- Emphasise need to combat psychological and physical nicotine addiction, where appropriate
- Identify triggers to smoking and encourage smoker to develop strategies for countering these (for example, avoid places or activities associated with smoking)
- If relevant, encourage smoker to develop strategies for avoiding relapse when drinking alcohol
- Encourage appropriate action: set quit date, inform or enlist support of peer group or family, and prescribe nicotine addiction treatment
- Follow up to review progress and prescribe or issue nicotine addiction treatment
Guiding style is best BMJ:
- Ask about smoking at every opportunity
- Assess smokers' interest in stopping
- Advise against smoking
- Assist smokers to stop
- Arrange follow up
- smokefree.nhs.uk professional resources
- supporting smoking cessation BMJ 14
- nicotine replacment therapy