Evaluation and Assessment
Before formal intervention is undertaken, it is beneficial and important to perform a comprehensive evaluation to determine the biological, psychological and social factors that are most significant in the initiation and maintenance of nicotine use and dependence. Comprehensive evaluation of the patient is outlined in Table 42.1.
Assessment of the psychiatric history is also important. Numerous studies have shown the significance of current and past depression in relation to smoking, as well as the increased prevalence rates of cigarette smoking in patients with a variety of psychiatric disorders, such as MDD, schizophrenia, and alcohol and substance abuse. The presence of these comorbid disorders may also make successful smoking cessation less likely, especially if undiagnosed and untreated.
Assessing the patient for a history of current alcohol or other substance abuse is also important, as the prevalence of smoking in persons with alcohol dependence as well as in other substance abusers is much higher than in the general population. A careful medical history should also be obtained. The presence of significant tobacco-related medical illness can sometimes serve as crucial leverage to help motivate the individual to attempt ces-sation. Current medications and medical conditions may also be important considerations in determining the approach to cessa-tion, especially with regard to pharmacotherapy. For example, a history of seizures or an eating disorder is usually a contraindica-tion to the use of bupropion/Zyban (nonnicotine pill medication). The individual should be assessed for pulmonary symptoms and signs (cough), and if there is a long history of significant nicotine use, pulmonary function tests should be considered. The pres-ence of significant cardiovascular disease, especially a history of recent myocardial infarction, is especially relevant to planning psychopharmacological interventions. If the individual is already taking a psychiatric medication, consider it important to realize that quitting smoking may result in an increase in medication blood levels and side effects.