Many smokers lack the motivation to make a quit attempt, but several interventions have been shown to increase quit attempts and successful quitting in previously unmotivated patients. One such intervention is motivational interviewing, in which the clinician uses nonconfrontational counseling to resolve the patient’s ambivalence about quitting by encouraging choices consistent with the patients’ important long-term goals22,23 (see Table 1). A meta-analysis of 14 RCT’s23 showed that in comparison with brief advice or usual care, motivational interviewing increased 6-month cessation rates by about 30%. Two of these studies used primary care physicians as counselors and across these studies about 8% of previously unwilling smokers achieved long-term cessation in the motivational interviewing condition, while only about 2% quit in the control conditions23. Clinicians in these studies typically received 2 hours or more of training in this technique. In addition, across the 14 studies there was a relation between counseling intensity and outcome, with patients doing better if they received 2 or more sessions (vs. 1), and if the sessions lasted more than 20 minutes. The 2008 PHS Guideline3 used motivational interviewing
