After using the Smoking Reduction+NRT treatment for three months, the patient was willing to make a quit smoking attempt at a subsequent visit. In addition to providing practical advice on quitting on such a visit (Table 1), the clinician should encourage adjuvant counseling through a State quitline (1-800-QUIT NOW) and an on-line resource such as www.smokefree.gov or www.women.smokefree.gov. The clinician should also discuss the pros and cons of various medications and educate the patient regarding beliefs that smoking cessation medications are as harmful or addictive as smoking. After discussing the two most effective medication options (varenicline or combination NRT) with regard to effectiveness, contraindications, side effects, and costs, combination NRT (the nicotine patch and lozenge) was recommended because this treatment has been shown to be highly effective, the patient had already achieved some success using NRT as part of the Smoking Reduction+NRT intervention, and NRT has been shown to be safe and effective in persons with depressive symptoms48 and in persons with high levels of nicotine dependence (e.g., smoking within 5 minutes of awakening 49). Counseling dispelled medication myths, stressed
