Abstract
Smoking is one of the most crucially preventable behaviors against illness. However, social awareness was limited and the anti-smoking movement in Japan has not been a strong compared to Western countries. The real problem lies in the mechanism of nicotine dependence that smokers who are aware of the harmful effects cannot quit smoking. Smoking gives a pleasurable feeling to the smoker, which works as a reinforced behavior. For nonsmoking therapy, the approach of behavioral science is as crucial as drug therapy. For the smoker who has the intention to quit, a 5A behavioral counseling framework has therapeutic importance. In Japan, national medical insurance covers smoking cessation outpatient services. For the smoker who does not intend to quit, a 5R behavioral counseling framework focusing on motivation also has the therapeutic importance. For the non-smoker who has quit smoking recently, recurrence prevention treatment dealing with both medical and environmental factors can assist their chances to avoid a relapse. We clinicians should have the opinion that smokers have suffered from the tobacco industry and treat them accordingly. Additionally, we need to offer smokers the benefits of quitting smoking in their own way to maintain a high level of motivation for non-smoking.
