About the Blog Author-John R. Hughes, MD
John R. Hughes, MD is Professor of Psychiatry, Psychology and Family Practice at the University of Vermont. Dr. Hughes is board certified in Psychiatry and Addiction Psychiatry. His major focus has been clinical research on tobacco use. Dr. Hughes received the Ove Ferno Award for research in nicotine dependence and the Alton Ochsner Award Relating Smoking and Health. He is a co-founder and past president of the Society for Research on Nicotine and Tobacco, and the Association for the Treatment of Tobacco Use and Dependence. Dr. Hughes has been Chair of the Vermont Tobacco Evaluation and Review Board which oversees VT’s multi-million dollar tobacco control programs. He has over 400 publications on nicotine and other drug dependencies and is one of the world’s most cited tobacco scientist. Dr. Hughes has been a consultant on tobacco policy to the World Health Organization, the U.S. Food and Drug Administration, and the White House. His current research is on how tobacco users and marijuana users stop or reduce use on their own, novel methods to prompt quit attempts by such users, whether smoking cessation reduces reward sensitivity and whether stopping e-cigarettes causes withdrawal. Dr Hughes has received fees from companies who develop smoking cessation devices, medications and services, from governmental and academic institutions, and from public and private organizations that promote tobacco control.
Many of us see smokers who want to quit but are not quite ready (about 80% of smokers). The USPHS recommends using the 5 A’s algorithm with such clients: i.e. “Ask about tobacco use, Advise to quit, Assess willingness to make a quit attempt, Assist in quit attempt and Arrange followup.” If a smoker is not ready to quit, it recommends the 5 R’s: discuss their Relevant reason to quit, their Risks of smoking, their Rewards from quitting, their Roadblocks to quitting, and Repeat. When I teach medical students, residents and doctors I vary from these 10 strategies in two ways. First, the USPHS guidelines recommends discussing treatment options only if the smoker states he/she is willing to quit in the next few weeks. In ...