The 5 R’s: For Those Not Ready to Quit

Some patients may not be ready to kick the habit – but they may respond to a motivational intervention. They can be motivated to consider a quit attempt with the
"5 R's": Relevance, Risks, Rewards, Roadblocks, and Repetition.

Ask the patient to identify why quitting might be personally relevant, such as children in her home, money saved by quitting, a history of smoking related illness, etc.

Example: “Your child's asthma flare-up is certainly related to your smoking habit.”

Ask the patient to identify her own negative consequences from smoking.

Additional risks that can be mentioned to the patient:

  • Acute risks - shortness of breath, exacerbation of asthma, impotence, infertility.
  • Long term risks - heart attacks, strokes, lung and other cancers, Chronic Obstructive Pulmonary Disease (COPD).
  • Environmental risks - increased risk of lung cancer in spouse and children; higher rates of smoking by children; increased risk for Sudden Infant Death Syndrome (SIDS), asthma, middle ear disease and respiratory infection in children.


Ask the patient to identify:

  • Positive benefits they currently derive from smoking. Discuss alternative methods for filling the potential void after cessation.
  • The potential rewards of smoking cessation including improved health, improved sense of smell and taste, money saved, healthier children, freedom from addiction, more physically fit, and reduced wrinkling and aging of skin.

Example: “You’ll set a good example for your children and their friends.”     “Your clothes and house will smell better.”


Ask the patient to identify barriers to quitting smoking. As the patient self-identifies barriers, you are given the opportunity to address them and to reassure the patient that assistance and encouragement are available. She needs to know that roadblocks can be overcome.

Examples of roadblocks: Social situations where they want to smoke, partner/co-worker who smokes, fears about quitting smoking, etc.


Repeat the above strategies every time an unmotivated patient has a visit.



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