The purpose is to ensure that the only time the patient smokes during the first phase of this treatment plan will be for the express purpose of administering the necessary "dose" of nicotine to address actual physical withdrawal symptoms. To help ensure that the only smoking will be for the purpose of addressing symptoms of physical withdrawal in the manner intended, the patient will be required to agree to conditions under which permissible smoking will occur. For example, if she determines that smoking is necessary because of actual symptoms of physical withdrawal, she will smoke a half of one cigarette standing on one leg in her backyard, or while standing and balancing a textbook on her head, or in other comparable mildly uncomfortable circumstances that remove any aspect of relaxation or enjoyment. The patient will not be allowed to smoke while sitting comfortably, while simultaneously talking on the phone, or in the company of others, especially other smokers.

Addressing Anticipated Issues

It is anticipated that the patient will initially have some difficulty recognizing and distinguishing behavioral motivations for smoking and physical cravings or bona-fide withdrawal symptoms. Those issues will be addressed by helping the patient understand and identify the factors associated with behavioral triggers that are not legitimately functions of physical withdrawal symptoms. It is also anticipated that the patient will be more reluctant to give up certain so-called "comfort" cigarettes or smoking in social situations. The practitioner will address those potential barriers by impressing on the patient that the only legitimate "excuse" for smoking during this smoking cessation program is that which is necessary to resolve actual symptoms of physical withdrawal and that failure to eliminate all other smoking is inconsistent with any...

Finally, it is anticipated that the patient may be legitimately confused by situations where both behavioral triggers and physical withdrawal symptoms exist concurrently. The practitioner will reinforce the significance of eliminating any aspect of comfort or enjoyment associated with smoking precisely for that purpose.
Incorporating Patient Management Skills and Providing Follow-up

The practitioner expects that the patient will have some difficulty making a good-faith distinction between behavioral triggers and physical withdrawal symptoms. Patient management and follow-up care will focus on that issue. Likewise, the practitioner expects that the patient will report difficulty religiously avoiding social smoking situations or adhering strictly to the prescribed circumstances of permissible smoking. Patient management and follow-up in that regard will consist of educating the patient about the fundamental importance of adhering to the parameters of the program if she is to be successful in her goal. Therefore, she will be counseled to avoid placing herself in social situations where she is unable or unwilling to forego sharing smoking breaks with others. With respect to adhering to the mechanisms designed to make smoking at home slightly unpleasant, the practitioner will assist the patient devise appropriate criteria that fulfill their purpose in ways to which she can adhere without deviation.

Ultimately, the goal of patient follow-up will be to help the patient completely eliminate all smoking other than that necessary to address actual physical symptoms of nicotine withdrawal so that she can transition to the final phase of substituting smoking with other forms of nicotine administration in conjunction with a schedule for eventually reducing and eliminating that form of nicotine consumption as well.