As a primary care physician, I commonly encounter patients who smoke cigarettes. Most people, including those who smoke, are aware of the long-term health risks posed by smoking. Of course, as a physician who cares about their current and future health, I want these patients to embrace the goal of smoking cessation. As someone who has never been a smoker myself, I admit I cannot fully understand the struggle of this task. However, the data suggest that quitting smoking can be extremely difficult. I find it helpful to understand some basic psychology when it comes to smoking cessation.

In the 1970s, a duo of scientists named Prochaska and Diclemente, after studying subjects who smoked and their likelihood of successfully quitting, developed the Transtheoretical Model of Stages of Change. This model is widely used today to assess readiness for change when it comes to smoking and other lifestyle changes such as diet, exercise, alcohol, and other substance use. The following explains each stage and how we can apply them to help with smoking cessation:

Precontemplative stage: A person has no intention of changing their behavior soon. In this case, I “plant the seed” by providing some basic education and encouraging the patient to think about it before the next visit. Pushing or forcing change at this stage is not likely to be fruitful.

Contemplative stage: A person is thinking about making a change, perhaps in the next six months, but they may not be ready for a definitive plan. I offer specific education about quitting and ensure follow up to help with planning when they are ready.

Preparation stage: A person is ready to implement change in the next 30 days. Time to cheer on my patient and set them up for success! We might set a quit date together, consider referral to the Quitline, and discuss more specific strategies, including medication or nicotine replacement.

Action stage: This is the first six months of the big change, during which patients have a high risk of relapse. It is crucial that the patient check in often with me, their Quitline counselor, and other support people.  

Maintenance stage: After the action stage, risk of relapse decreases but does not go away. I offer my patients a safe place to discuss their urge to smoke and encourage them to stay tobacco-free. If they do slip up, I remind them not to give up. I help them focus on the hard work they’ve already done and stay successful.

Quitting smoking can be difficult, but it is truly one of the best things a person can do for their long-term health. There is support out there, starting with your primary care provider. When you are ready, ask for help!

Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc®. For free and easy access to the entire Prairie Doc® ® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook. Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota.