Smoking Cessation: How to Address Each Stage

Smoking cessation is the most relevant health action in terms of prevention. Its first step is to recognize the stage every smoker is in the quitting process.
Smoking Cessation: How to Address Each Stage

Last update: 02 March, 2020

According to the latest WHO report on global tobacco use trends, more than 1.3 million people are addicted to smoking. Therefore, health intervention in smoking cessation has become the standard of preventive measures.

Data from the World Health Organization show that, every year, more than 8 million people die as a result of tobacco use. This figure makes smoking the leading cause of preventable death and disease worldwide. Thus, health intervention is crucial to ensure people quit smoking.

For such an intervention to be effective, it must be able to handle the physical and psychological dependence on tobacco, break the automatism associated with the act of smoking, and modulate the influence of the social environment of each person on their consumption. To do this, the first step is to recognize the stage every smoker is at in the quitting process.

The stages of smoking cessation

A woman who decided to quit smoking.

When we talk about smoking cessation, we must necessarily adhere to what’s known as the transtheoretical model of behavior change, a model created in 1977 by psychologists Prochaska and DiClemente in order to understand and promote the process of change regarding specific behaviors.

It consists of six stages with very specific characteristics, taking into account that a person doesn’t necessarily have to go through all of them. Also, relapse is taken into account, not as a failure but as an opportunity to improve and increase the likelihood of success in a new attempt.

In most cases, the final change occurs after having gone through each of the stages of the model several times.

In this regard, the health professional’s mission will be to identify the stage of change the smoker is at and adjust the interventions to motivate the person to progress within the process. Then, they delve deeper into each of the stages of smoking cessation.

Precontemplation stage

At this stage, even though the person knows that smoking isn’t a healthy habit, they still aren’t aware of the problem it poses. Therefore, neither do they recognize the need to quit smoking. Generally, the people who are at this stage are those who go to a consultation for another reason. In addition, they may do so because they were pressured by their families.

At this point, the professional’s goal will be to make the patient become aware of the problem and understand the importance of quitting. To do this, it would be appropriate to assess how much they know about the risks of tobacco use, inform them accordingly, and highlight the benefits they’d enjoy if they quit.

Contemplation stage

During this stage, the patient is aware they have a problem and that they need to quit smoking. However, although it seems that they want to do it in less than six months, they have mixed feelings about it or don’t know how to accomplish this goal. In other words, although they’re aware of the problem, they have doubts about their ability to fix it.

At this point, for the smoker to progress in the smoking cessation process, the health professional has to help them in their ambivalence. To do this, it’s essential to analyze and talk about the following aspects:

  • The importance of quitting smoking
  • The confidence that smoker has in themselves to accomplish this goal. During this stage, it’s fundamental to facilitate self-efficacy by helping the patient remember their other achievements.
  • The risks associated with tobacco use and the reasons why the person wants to continue smoking
  • Benefits of quitting and the difficulties to achieve this goal

Smoking cessation: preparation stage

A woman cutting some cigarettes.

The preparation stage begins when the person has firmly decided that they want to quit smoking. The person is convinced that they want to quit and is willing to make a serious attempt in less than one month. Here, the professional must:

  • Congratulate the patient and emphasize that quitting smoking is probably the best decision they’ve ever made for their health and the health of those around them.
  • Select a date from which the patient will no longer smoke (“D-Day”). If the patient has chosen a gradual reduction, they should start it beforehand so they can completely quit smoking on “D-Day”.
  • Encourage the patient to communicate their decision to all their friends and family. The more people know, the better.
  • Report on the manifestation of possible difficulties (cravings, irritability, anxiety, nervousness, fatigue, changes in sleep patterns, increased appetite, constipation, headache, difficulty concentrating, and the negative influence of the social environment, among others) and talk about useful strategies to mitigate them.

At this stage, the priority is to prepare the patient to quit smoking. Here, it’s essential to make them consider the process positively. Also, they need to understand that they can quit smoking because they have the necessary strategies to successfully face any adversity.

Action stage for smoking cessation

At this point, the patient has already stopped smoking and their main goal is to avoid relapses. To do so, the health professional should assess the difficulties the patient is facing and consolidate the strategies that will be useful to effectively mitigate them.

In addition, it’s important to remember that withdrawal syndrome begins to disappear from the seventh day. The doctor will talk about the feeling of emptiness that appears around the tenth day after quitting, and warn of the false sense of security that manifests between day 15 and 30 after quitting.

Keeping going: tobacco-free for six months

A person saying no to smoking.

The maintenance stage begins when the person hasn’t smoked for six months. However, they won’t be considered ex-smokers until they’ve been tobacco-free for 12 months. In this stage, the health professional should re-evaluate possible difficulties and consolidate strategies to cope with them.

In addition, it might be useful to help the patient remember why they quit smoking. Also, they should review the benefits that already manifested and those to come. Similarly, it may be necessary to help the patient remember the disadvantages associated with tobacco use.

Smoking cessation: Relapse

There’s talk of relapse when a patient smokes again after having quit. At this point, it’s critical that the health professional show empathy, provide support, abstain from any punitive behaviors, and make the patient understand that relapsing is an opportunity to learn and try again, as they’ll be more likely to succeed.

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