The “5 As”—Ask, Advise, Assess, Assist, and Arrange—are designed to be used with smokers who are willing to quit (49). The Assist component typically includes first-line pharmacotherapy with bupropion or nicotine replacement in the form of gum, inhaler, nasal spray, or patch. In addition, ongoing visits for counseling and support are essential and may include practical counseling and assistance with problem-solving skills and social support during and after treatment. Relapse prevention is important, with congratulations for any successes and encouragement to remain abstinent. Patients who use tobacco but are unwilling to quit at the time of the visit should be treated with the “5 Rs” motivational intervention: Relevance, Risks, Rewards, Roadblocks, and Repetition (48).
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