Intended for healthcare professionals

Clinical Review ABC of smoking cessation

Assessment of dependence and motivation to stop smoking

BMJ 2004; 328 doi: (Published 05 February 2004) Cite this as: BMJ 2004;328:338
  1. Robert West, professor of health psychology
  1. Cancer Research UK Health Behaviour Unit, University College London


Whether a smoker succeeds in stopping smoking depends on the balance between that individual's motivation to stop smoking and his or her degree of dependence on cigarettes. Clinicians must be able to assess both of these characteristics. Motivation is important because “treatments” to assist with smoking cessation will not work in smokers who are not highly motivated. Dependence is especially important in smokers who do want to stop smoking, as it influences the choice of intervention. It is also important to bear in mind that:

  • Motivation to stop and dependence are often related to each other: heavy smokers may show low motivation because they lack confidence in their ability to quit; lighter smokers may show low motivation because they believe they can stop in the future if they wish

  • Motivation to stop can vary considerably with time and be strongly influenced by the immediate environment

  • What smokers say about their wish to stop, especially in a clinical interview, may not accurately reflect their genuine feelings.

Measuring dependence in smokers

Qualitative methods

The simplest approach to measuring dependence on cigarettes is a basic qualitative approach that uses questions to find out whether the smoker has difficulty in refraining from smoking in circumstances when he or she would normally smoke or whether the smoker has made a serious attempt to stop in the past but failed.

Clinical intervention goals for smoking according to dependence and …

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