Notes from a smoking cessation clinic.

T he availability of nicotine polacrilex as an adjunct to smoking cessation offers another way for primary care and chest physicians to become involved in one of the most important aspects of preventive medicine in our time. While accompanying package information and literature are helpful, there are many unanswered questions regarding actual practical applications. The following relates my recent experience with use of nicotine polacrilex in a smoking cessation program. New ideas and approaches, especially regarding behavioral modifications and stress management, are continually incorporated into the smoking cessation effort. New approaches to smoking cessation, such as the use of nicotine gum, garner considerable public interest. This is to be expected since such a high percentage of the population smokes. Unfortunately, much of this interest is coupled with a superficial desire to quit smoking. It is important and helpful to give information on the goals, costs, scope, and limitations ofa smoking cessation program when patients ask for information. This serves to discourage impulsive quitting and gives the patient a chance to reflect on his current degree of motivation to quit smoking. Because the approach to smoking cessation is similar between one patient and another, I have found it convenient to deal with groups of four to five persons. As the people in the group get to know each other, they support each other and, to some extent, provide peer pressure. Small groups also enable me to see more people/week in a smaller period of time. As my smoking cessation program developed, it became apparent that frequent visits are necessary in the early stages ofquitting. Typically, four weekly visits are followed by three to six follow-up visits (or telephone conversations) at two-week intervals. The first four visits are used to introduce use of the nicotinecontaining medication and the following visits are for reinforcement of nonsmoking and tapering off the medication (Table 1).