In an effort to help doctors more effectively treat smokers who want to quit, a U.S. panel headed by a University of Wisconsin-Madison professor has released new guidelines to help fight tobacco dependence.

The recommendations, published recently in JAMA, the Journal of the American Medical Association, are based on a review of nearly 6,000 peer-reviewed medical studies. The guidelines encourage more physician participation and outline effective medical treatments to help fight the addiction. "The guidelines provide a blueprint for clinicians to help them treat their patients . . . who are committed to stopping their addiction," said Michael Fiore, chairman of the project and director of the UW Medical School's Center for Tobacco Research and Intervention. "They should also send a powerful message of hope to smokers that they can quit." According to the guidelines, doctors should begin each patient visit with the "five A's": Ask the patient whether he or she uses tobacco. Advise the patient to quit. Assess the patient's willingness to quit. Assist those willing to try quitting. Arrange for follow-up contact to prevent relapse. The panel also identified five "first-line" treatments that have been shown to work in the fight against addiction to nicotine: One, bupropion hydrochloride, is a non-nicotine prescription medication that can be used in conjunction with other nicotine replacement therapies to help deal with cravings. The nicotine patch, applied daily, provides a controlled and steady supply of nicotine through the skin, while nicotine chewing gum can provide the substance whenever people feel the urge to smoke. The nicotine inhaler and nasal spray also have been shown to be effective. Fiore, along with Timothy B. Baker, a UW professor of psychology, is a principal investigator for a five-year, $9.9 million grant from the National Cancer Institute and the National Institute on Drug Abuse that's aimed at explaining why it's so hard for people to quit smoking. Wisconsin is one of 46 states receiving money from the 1998 tobacco settlement that forced tobacco companies to pay billions of dollars over 25 years for public health and anti-smoking campaigns. The state will get $5.9 billion under the settlement, distributing $23.5 million each year to groups working to prevent or stop smoking. The medical school's Center for Tobacco Research and Intervention will be given $1 million each year to help fight the battle.

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