Health Care
Treating Tobacco Use & Dependence
Treating Tobacco Use & Dependence - Using the 5 A's and the 5 R's
The 5 A's Approach:
The "5 A's" should be used during every interaction with a client in order to determine current status of tobacco use and readiness to quit. By conducting an assessment with each patient, you can better assist a smoker who is willing to quit.
- Ask
Identify and document tobacco use status for every patient at every visit. (You may wish to develop your own vital signs sticker). Implement an office wide system that ensures that for every patient at every clinic visit, tobacco-use status is queried and documented.
- Advise
In a clear, strong and personalized manner, urge every tobacco user to quit.
- Assess
Ask every tobacco user if he or she is willing to make a quit attempt at this time (e.g., within the next 30 days).
- Assist
For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him or her quit.
- Arrange
Schedule follow-up contact with the patient, in person or by telephone, preferably within the first week after the quit date.
The 5 R's Approach
The "5 R's" were designed to encourage smokers who are unwilling to quit. Smokers may be unwilling to quit due to misinformation, concern about the effects of quitting, or demoralization because of previous unsuccessful quit attempts. Therefore, after asking about tobacco use, advising the smoker to quit, and assessing the willingness of the smoker to quit, it is important to provide the "5 R's" motivational intervention.
- Relevance
Encourage the patient to indicate why quitting is personally relevant, being as specific as possible. Motivational information has the greatest impact if it is relevant to a patient's current disease status, family or social situation, health concerns, and personal characteristics such as age, gender and so on.
- Risks
The clinician should ask the patient to identify potential negative consequences of tobacco use. The clinician may suggest and highlight those that seem most relevant to the patient. Examples of risks could be acute risks such as shortness of breath, exacerbation of asthma and harm to pregnancy, as well as long term risks such as heart attacks, strokes, lung and other cancers.
- Rewards
The clinician should ask the patient to pinpoint potential benefits of stopping tobacco use. The clinician may recommend and emphasize those that seem most pertinent to the patient. Examples of rewards could be improved health, improved sense of smell and improved performance in physical activities.
- Roadblocks
The physician should ask the patient to identify hurdles to quitting and pin down specific elements of treatment that would address those barriers. Classic barriers might include withdrawal symptoms, weight gain, depression, lack of support and enjoyment of tobacco.
- Repetition
The motivational involvement should be repeated each time an unmotivated patient visits the clinic setting. Several motivational sessions may have to be undertaken before tobacco users can be convinced of a need to quit. Users who have failed to quit multiple times must be told that most people make repeated quit attempts before they are successful.
Copyright 2008, Hamilton County Tobacco-Free Partnership
Funded by Ohio Tobacco Use Prevention and Control Foundation
and The Hamilton County General Health District