A young adult man met his primary care physician for the first time, during which his prior military history came to light. The young man recalled the anxiety he experienced when he received his military orders for deployment to Iraq. Prior to the notice of deployment, he smoked cigarettes only occasionally, maybe 1 or 2 cigarettes a day. As the time for deployment approached, he started smoking more cigarettes and by the time he arrived in Iraq was up to a full pack a day. Throughout the 12-month deployment, he steadily increased his smoking with peak consumption of nearly 40 cigarettes a day. The soldier suffered several significant combat-related traumas resulting in mild physical injuries.
Upon return to the United States, the soldier completed his military obligation and left the service. Although still experiencing some lingering physical and emotional pain from his tour of duty, the former soldier was improving except in one area. His use of tobacco products stubbornly persisted, despite efforts to quit. The 2 packs of cigarettes a day was not only expensive, it was no longer enjoyable. When closely questioned he admitted that only the first cigarette of the day was truly enjoyable. His wife was complaining that the expensive habit was creating an unnecessary financial strain on their meagre resources.
Despite his apparent willingness to consider quitting the use of tobacco, the former soldier also readily admitted he was frightened by the prospect. He recognized that his unresolved, but currently under treatment, emotional issues from the war offered a reason not to tackle another problem at this time. The doctor appreciated this frank disclosure but took issue with the patient’s conclusion. The patient appeared motivated, probably contemplating change, but needed an additional boost to consider a smoking cessation program.
At this point, the doctor decided to discuss co-occurring disorders by explaining the common