Smokers usually self-diagnose their nicotine dependence and nicotine withdrawal. Such questionnaires as the Fagerstrom Test for Nicotine Dependence (FTND), a short six-item assessment of cigarette use, help to determine the level of tobacco dependence. Physicians and mental health professionals are less concerned with diagnosis, which is usually straightforward, than with determining the physical and psychological factors in each patient that must be addressed for successful smoking cessation.
Most smokers want to quit; over 75% have tried to stop at least once. Each year, over 40% of smokers make at least one attempt to quit. Many people try a dozen times before they are successful in finding the right combination of medications, therapies, and support to achieve success. Even with repeated attempts, however, only half of all smokers are able to stop smoking completely and eliminate their dependence on nicotine.
Most people do not suddenly wake up one morning and decide to stop smoking. Instead, they go through several preparatory stages before taking action. First is the precontemplation stage, in which the smoker doesnçt even think about quitting. Precontemplation is followed by the contemplation stage, in which the smoker thinks about quitting, but takes no action. Contemplation eventually turns to preparation, often when counselors or family members encourage or urge the smoker to quit. Now the smoker starts making plans to quit in the near future. Finally the smoker arrives at the point of taking action.
Having decided to stop smoking, a person has many choices of programs and approaches. When mental health professionals are involved in smoking cessation efforts, one of their first jobs is to identify the physical and psychological factors that keep the person smoking. This identification helps to direct the smoker to the most appropriate type of program. Assessment examines the frequency of the person's smoking, his or her social and emotional attachment to cigarettes, commitment to change, available support system, and barriers to change. These conditions vary from person to person, which is why some smoking cessation programs work for one person and not another.
Tish Davidson A.M., The Gale Group Inc., Gale, Detroit,