The 5A's is a systematic approach that health professionals can use to identify smokers, assess their readiness to quit, and assist the smoker with cessation. This intervention uses 5 quick simple steps: 

• ASK about smoking status
• ADVISE the client to quit
• ASSESS willingness to make a quit attempt within the next 30 days
• ASSIST the client with ways to quit
• ARRANGE for follow-up

The Clinical Practice Guidelines, 'Treating Tobacco Use and Dependence', recommend ASKing every patient about smoking status, at every visit.  Since tobacco dependence is a chronic condition, several interventions may be necessary before a person is able to quit for good. [If a patient is unwilling to quit, or has relapsed, the health professional may use a motivational intervention such as the 5R's.]

ADVICE urging the patient to quit should be clear, strong and personalized.  

When a smoker is identified, ASSESS if (s)he is willing to make a quit attempt in the next 30 days. If ready to make a quit attempt, ASSIST by developing a quit plan and setting a quit date. ARRANGE for follow up contact soon after the quit date, preferably during the first week. Schedule additional follow up contacts soon after the quit date.

 Tobacco Users Unwilling To Quit

 The 5R's provide a simple guide that you may use as motivational intervention:

• RELEVANCE to quit
• RISKS of continuing to smoke for the patient and people around them
• REWARDS of quitting
• ROADBLOCKS that present barriers to quitting
• REPEATING the message at every opportunity with the patient.

Motivational information is most effective when it is RELEVANT to the patient's individual situation. Ask the patient to identify the negative RISKS (s)he is taking by continuing to smoke.  Ask him/her to identify what potential REWARDS he or she might enjoy as a result of quitting. Highlight the risks and rewards that seem to be the most relevant to the patient.

Once the patient has identified the pros and cons of quitting, you may ask the patient to identify what he or she believes to be ROADBLOCKS or barriers that will prevent quitting. This is a good time to point our how treatment can address many of the barriers typically experienced during the quitting process.  Again, making the discussion relevant to the individual patient.

Finally, REPETITION of this motivational intervention with unmotivated patients will encourage eventual success. Most tobacco users make repeated quit attempts before they are successful.

For more information on the 5A's and 5R's visit the Surgeon General's web site.

Online CME course for clinicians to provide tobacco use cessation counseling based on the PHS Clinical Practice Guideline 'Treating Tobacco Use and Dependence.'