Behavioral tobacco cessation treatments: yesterday's news or tomorrow's headlines?

Abstract

This article reviews behavioral treatments (broadly defined) for tobacco use, discusses cessation treatments for cancer patients, and predicts the future direction of behavioral interventions. During the past decade, progress in behavioral treatments for tobacco use has not kept pace with progress made in the development of pharmacotherapies. Nevertheless, the efficacy and cost-effectiveness of behavioral treatments compare favorably with the pharmacotherapies. Intensive behavioral interventions with empirical support are reviewed, and the difficulty of attracting smokers to intensive smoking clinics is discussed. Because there has been little research on tobacco cessation interventions designed specifically for cancer patients, clinicians should follow the Five A's suggested in the recent Clinical Practice Guidelines: Ask, Advise, Assess, Assist, and Arrange. The future of behavioral treatments will likely emphasize both minimal interventions (via telephone, Internet, and written materials) designed for broad impact and intensive interventions targeted to particular subgroups of smokers with the need and motivation for them (eg, the heavily nicotine-dependent, pregnant women, depression-prone smokers, and medical patients). A blurring of the distinctions between behavioral interventions, pharmacotherapies, and community-oriented approaches is also likely as multidimensional cessation strategies are developed.