Last week I wrote about the 5 R’s of motivation to deal with alcoholism, this week I’d like to apply them to cigarette smoking. It’s an interesting quirk of history that our part of the world, the West Indies, first became important for producing both rum and tobacco, which are both now conceded to present severe health challenges.As we try to motivate others to quit these two addictive products, we should be aware that the mega corporations that make billions in profits from their sales are spending commensurate sums to motivate the same people to INCREASE their usage.Especially with cigarettes, as the developed countries became aware of the severe negative effect of cigarette on the human system and their governments began to take countermeasures, such as warning labels, the producers shifted focus to developing countries such as the West Indies. We are at even greater risk than before.And just to recap the 5 R’s: in trying to motivate a patient to make a change in their behaviour, it’s important to explain to them how the change is relevant to them personally, to talk about the risks of their current behaviour, to educate the patient about the potential rewards of change, and to address possible roadblocks they might encounter while trying to change. And the final R is repetition- doctors should try to respectfully repeat the 5 R’s each visit to try to motivate their patients to make the changes to live a healthier life.In terms of relevancy to the person, there should be a discussion about how quitting smoking would directly impact their life – it could save them money, improve their quality of life, and decrease the chances of heart attack, cancer or stroke. Quitting smoking would also improve the quality of life of the persons they live with – secondhand smoke can be as dangerous as if you were smoking the cigarettes yourself.Each person is different, and there will be different issues that are relevant to them and it is important for their doctor to discuss those issues with them in a respectful, non-confrontational manner.In terms of risks, there are long-term and short-term risks of smoking. In the short-term, risks include a reduction in taste and smell, a continuous cough and a weakened immune system.In the long-term, heart disease, lung disease, lung cancer, throat cancer, stomach cancer, bladder cancer and a host of other cancers.The discussion of risks isn’t meant to be a scare-tactic, it’s supposed to be a frank discussion where the abuser is made aware of the risks and where their perception of those risks is explored.In terms of rewards, there are all of the health rewards – add on more than a couple of years to your lifespan, regain your sense of smell and taste. And of course, there’s all of that money that you can save. And for each patient, there are specific areas where their smoking is causing a problem, so there should be a discussion about how those problems might be ameliorated by cutting down the drinking.And of course, change is never easy – if it was, they probably wouldn’t have had to come up with 5 R’s to motivate people. But that brings us to the 4th R: roadblocks. There should be a discussion with the person about possible hurdles they’ll have to face on the road to change and the smoker and doctor should come up with strategies on how to handle those problems when they arise. They may suffer withdrawal symptoms, or they may live in an environment that encourages their smoking.The final R is repetition. As I mentioned before, doctors should try to respectfully repeat the 5 R’s each visit to try to motivate the smoker to quit. Concerned friends and family should also do the same.And doctors should also break the stereotypes of being high abusers of alcohol and cigarettes.