The 5 As

We have developed a series of treatment algorithms for quick navigation through the 5As counseling method, detailing approximate length of time to complete each step. Select to view the appropriate treatment algorithm for your patient:


Patients' motivation to quit smoking should be assessed at every visit. Patients not yet willing to quit should receive a motivational intervention. Readiness rulers   (i.e., “On a scale of 1 to 10, where 10 is very ready, how ready are you to quit smoking?”) and Stages of Change assessments are useful in addressing the extent to which a person is ready to change, which can change from visit to visit. Behavior change can be conceptualized into five progressive stages: precontemplation, contemplation, preparation, action, and maintenance (below).
Readiness Ruler

Although tailoring interventions to a patient's stage of change may not be necessary, these stages emphasize that not all patients are equally motivated to quit smoking. Motivation is malleable, and patients can be assisted toward behavior change through clinician intervention.

Another useful tool that is also motivational is the CO monitor. Tobacco smoke contains a significant amount of carbon monoxide (CO). The breath CO monitor can be used as a validating, motivational, and educational tool. CO testing is a billable outpatient service and can contribute to the sustainability of face to face tobacco use treatment services.