Patients with this result are at high risk for adverse outcomes related to tobacco use and are highly likely to meet DSM-5 criteria for a Tobacco Use Disorder.
Tobacco Use Resources
- U.S. Department of Health & Human Services: Treating Tobacco Use and Dependence: 2008 Update
- Agency for Healthcare Research and Quality: Helping Smokers Quit: A Guide for Clinicians
The suggested intervention for this risk level is to confirm diagnosis through a clinical interview either using questions from the Fagerstrom Test for Nicotine Dependence or DSM-5 Tobacco Use Disorder criteria.
- Express concern and recommend cessation;
- Use the FRAMES components and motivational interviewing techniques (see references for specific resources) to encourage engagement in treatment.
- Consider prescribing medications to treat moderate to severe tobacco dependence (nicotine replacement, bupropion SR, varenicline).
- Offer a referral to support groups or counseling for tobacco cessation.
- Arrange follow-up.