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June 2, 1999

Adding Behavioral Therapy to Medication for Smoking Cessation

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(21):1983-1985. doi:10.1001/jama.281.21.1983

To the Editor: The article by Dr Hughes and colleagues1 summarizing the recent advances in the pharmacotherapy of smoking was a much-needed update to the medical literature and provided valuable information for clinical physicians. However, an aspect that needs clarification is the most efficacious implementation strategy for adjunctive counseling used in a tobacco cessation program. Hughes et al suggest that behavioral therapy strategies with patients by telephone can be used rather than traditional face-to-face counseling. The Agency for Health Care Policy and Research meta-analytic review of tobacco cessation programs clearly stated that there is a dose-response relationship between the duration and length of counseling, and suggested a 20 min/wk session for at least 4 weeks. Lichtenstein et al2 suggest that telephone counseling can be effective but do not suggest it is as effective as face-to-face counseling. To our knowledge, there is no published empirical evidence directly comparing the 2 modalities for smoking cessation.