Summary advice for general practitioners
Approximately 15 per cent of Australians over the age of 14 are daily smokers, although
the rate has been declining. There is some indication that rates of smoking are higher for
veterans (particularly for younger veterans) than for the general population. Smoking has multiple long-term health impacts, and is a major contributor to preventable disease burden for veterans and their families. Information, patient resources and assessment tools are available at www.at-ease.dva. screening for smoking readiness to quit
Useful questions to ask a veteran who is a current smoker include:• How do you feel about your smoking at the moment?• Are you ready to stop smoking now?If the patient has expressed an interest in quitting:“Quitting smoking can be difficult, however by using some basic strategies you can increase your chances of quitting successfully. Do you mind if we spend a few minutes going over these strategies?”If the patient has expressed they are not interested in quitting:“There are a number of ways to approach quitting that make it easier to stop, and we can discuss these when you feel ready to. If it’s OK with you, we can revisit your smoking at another time.”assessment
• Assess smoking history, readiness for change, past attempts to quit, other health
problems and special needs. If the patient is considering quitting then nicotine dependence can be assessed using the Fagerstrom Test for Nicotine Dependence (available from www.health.wa.gov.au/smokefree/docs/Fagerstrom_Test.pdf).
• The Smoking Cessation Framework (or the 5A’s Structure for Smoking Cessation) helps
structure the type of advice, support and treatment you provide the patient by taking into account their readiness to quit. More detailed information can be found in the Smoking Cessation Guidelines for General Practice, available at www.health.gov.au.
not ready to quit thinking about quitting / Ready to quit Unsure about quitting
Provide advice and support self-management. The advice and support you provide depends upon the veteran’s assessed readiness to quit. Continue to follow up readiness for change and quit attempts with the patient. Not ready to quit: Advise on the benefits of quitting, provide information on passive smoking, and let them know that you will follow up in the future. Thinking about quitting/unsure: Conduct motivational interviewing to explore ambivalence. Explore barriers to cessation and other mental or physical health issues of relevance. Provide with Quit Pack and/or referral to Quitline. Ready to quit: Affirm decision and encourage. Help the patient to develop quit plan including agreeing on a quit date. Provide the patient with a Quit Pack and/or referral to Quitline (13 7848). Recently quit: Congratulate efforts and review benefits of quitting. Offer continued support. See Self-management Resources on next page.
Pharmacological interventions are recommended for dependent smokers who express an interest in quitting, except where contraindicated. Slow-release nicotine replacement therapy (NRT)
is the preferred pharmacological intervention. The best results are achieved when used in combination with counselling and support.
or individual counselling, with counsellor trained in CBT-based strategies for
elements that you may consider during a consultation self-management
Practitioners can discuss basic self-management strategies that veterans can
use to manage their smoking. Depending on readiness to change, you may
encourage the patient to:• Select a quit date, ideally within the next two weeks. Arrange a follow up
appointment with the patient about one week and one month after the quit date.
• Read material on how to quit smoking, and the health consequences of
smoking (available from www.quitnow.gov.au and your state-based ‘Quit’ website).
• Use the Quitline (13 7848). • Utilise social supports e.g., family, friends and/or other veterans. • Weigh up the pros and cons of smoking with motivational interviewing
techniques. Refer to Psychological Treatment section following for more detailed information.
Summary advice for general practitioners
• The Quit website is a government initiative that provides self-help resources
(www.quitnow.gov.au) and an online counselling service (www.quitcoach.org.au).
• Telephone support, advise or counselling via the Quitline (13 7848). Services
• At Ease website (www.at-ease.dva.gov.au) for access to veteran-specific
information on mental health and wellbeing including the Wellbeing Toolbox, anxiety management and alcohol resources.
Brief psychological interventions, including motivational interviewing are
indicated for veterans who are thinking about quitting, or are ready to quit. Thinking about quitting/unsureGP administered brief motivational interviewing assists with resolving ambivalence about smoking, and prepares the veteran for change. Ambivalence should be acknowledged and discrepancies between smoking behaviour and person’s personal beliefs and goals should be discussed. Questions to ask include:• “What do you like about smoking? What are the things you don’t like about
• After summarising the patient’s pros and cons ask “Where does this leave us now?” to help shift motivation for behaviour change.
A useful resource is the Smoking Cessation Guidelines for Australian General
Practice: Desktop Guidelines and Patient Education Materials, available to
download from www.health.gov.au. Ready to quitReferral to group or individual counselling that uses cognitive behavioural therapy (CBT)-based strategies is recommended. Key components of treatment
include:• Assistance to identify high-risk smoking situations, and problem solving
strategies to deal with such situations.
• Strategies and skills to cope with cravings e.g., Delay, Deep breathe, Drink
• Encouraging the use of social support. Patient information on effective treatments is available online (www.at-ease. dva.gov.au) or in Appendix L. Pharmacological
Pharmacotherapy is recommended for all dependent smokers who express an
interest in quitting, except where contraindicated. It should be combined with support and counselling. • Nicotine replacement therapy (NRT; including patch, gum and inhaler
methods) has strong evidence in long-term cessation success. Slow-release NRT (i.e., patch) is preferred as quick-release preparations such as gum or lozenges can contribute to nicotine dependence.
• Veterans with severe nicotine dependence or a history of cessation failure
may benefit from the prescription of bupropion or varenicline as a short-term adjunctive therapy to slow-release NRT. Referral Options
• A Quitline GP smoking cessation referral form is available from
• Mental health professionals can be accessed through Medicare. A list of
psychologists can be found at www.psychology.org.au/findapsychologist. A list of mental health trained social workers can be found at www.aasw.asn.au/membersdirectory.
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