Prepared by Amelia Lee

Smoking cessation is a complex process that extends beyond willpower. In Malaysia, a journal has reported that 79.9% of adult smokers attempted to quit in the past year, and 85.2% expressed the intention to quit within the next six months (Kamaludin et al. 2024). Despite these encouraging figures, successful cessation remains limited—reflecting the multifaceted nature of nicotine dependence.

The most frequently reported barriers to quitting include nicotine addiction (88%), habitual behavior (88%), and stress (62%) (Hughes 2009). These factors underscore the need for interventions that address not only physiological dependence, but also psychological and behavioral components.

While pharmacological treatments such as nicotine replacement therapy (NRT) are valuable, they are often insufficient on their own. Many individuals focus solely on the biological aspects of addiction, overlooking the critical roles of self-regulation, behavioral modification, and internal motivation. Sustainable cessation requires both medical support and psychological empowerment.

One of the most effective behavioral approaches in this context is Motivational Interviewing (MI)—a collaborative, person-centered counseling method designed to enhance motivation and commitment to change. MI does not impose decisions; rather, it supports patients in exploring and articulating their own reasons for change, leading to outcomes that are more personally meaningful and enduring.

MI is grounded in four core components:

1. The Spirit of MI
   This foundational mindset emphasizes:
   • Partnership: Working collaboratively with the patient
   • Acceptance: Respecting autonomy and individual values
   • Compassion: Demonstrating genuine care and concern
   • Evocation: Drawing out personal motivations rather than imposing external reasons
     
2. OARS Communication Skills
   These tools promote effective, empathetic dialogue:
   • Open-ended questions
   • Affirmations
   • Reflective listening
   • Summarizing
     
3. Change Talk (DARN-CAT)
   MI helps identify and strengthen key language related to:
   • Desire, Ability, Reason, and Need (DARN)
   • Commitment, Activation, and Taking steps (CAT)
     
4. Rolling with Resistance
   Instead of confronting resistance directly, MI encourages empathetic engagement and reframing to maintain rapport and openness.
   • Reflective Listening: Acknowledge the patient’s emotions or beliefs without judgment.
   • Shifting Focus: Redirect away from stuck points.
   • Emphasizing Autonomy: Reinforce the patient’s control over their decisions.
   • Reframing: Turn resistance into a strength.

These principles work synergistically to support lasting behavior change by enhancing the patient’s sense of agency, readiness, and commitment.