There is a consistent relation between counseling intensity and abstinence. One meta-analysis of some 35 randomized controlled trials3 shows that when patients received no counseling, only about 11% quit smoking successfully for 6 months or more. However, 6-month abstinence increased significantly with minutes of total counseling contact (which may have occurred across multiple sessions): about 14% for 1–3 min of counseling, 19% for 4–30 min of counseling, and 27% for 31–90 min of counseling. (Some studies supplied pharmacotherapy across all counseling conditions, so medication contributed to overall success rates3). Successful counseling boosts motivation to quit by personalizing the costs and risks of the patient’s tobacco use: e.g., tying it to the patient’s health, economic, and family situation. Counseling also warns of obstacles or hurdles to quitting, and encourages the patient to plan and use coping strategies to avoid and resist temptations or urges (Table 1). The clinician should assess and counsel regarding factors that pose especially great challenges to quitting3, such as living with a smoker, excessive alcohol use, and fear of gaining weight (Table 2)36. Counseling should be empathic
