Dr. Gerry Yukevich, a partner in Dr. Michael Jacob’s Walk-In Clinic on State Road in Vineyard Haven, is often called upon to help patients quit smoking.

He said in a recent interview, “Our job is easier these days because smoking is so frowned upon publicly, peer pressure eliminates it for most people.”

Now the medical community is targeting the hard-core smokers who still refuse to budge from the habit.

“Smoking dropped by 21 per cent in the 1990s,” Dr. Yukevich said. “We thought the numbers would continue to decline, but instead they’ve stayed stable. How can we get this percentage lower? The fact is, nicotine is a vicious, addictive drug.”

While stories abound of smokers stopping cold turkey, many aspiring nonsmokers prefer to use pharmaceutical aids (NRTs, Nicotine Reduction Therapy). Dr. Yukevich said studies have shown no known dangers associated with nicotine lozenges or gum.

Some ex-smokers have long ago given up the “cancer sticks” but continue to use the NRTs. Dr. Yukevich isn’t overly concerned about this.

“It’s the tar and carcinogens in smoking that cause disease, so you’ve eliminated these toxins with the lozenges and gum. If after a while you’d like to eliminate NRT altogether, I recommend cutting out one lozenge the first week, two the next, and so forth, until you’re down to none.”

An additional item in the NRT arsenal is the antidepressant, Wellbutrin. “People have discovered that when they take the medication their desire to smoke diminishes,” Dr. Yukevich said.

A newer medication that’s showing good results is Chantix.

“People take the drug and continue to smoke,” Dr. Yukevitch explained. “Then three or four weeks down the line, they wake up one morning, take a look at their pack of cigarettes, their lighter — their usual paraphernalia, in other words — and they no longer identify with any of it. It’s as if that center of the brain in which the nicotine resides no longer exists.”

Dr. Yukevitch is also interested in a more holistic approach. “Humans are creatures of habit and you have to eliminate a habit by forming another one, a good one. I recommend a daily athletic discipline and get them into that for a couple of months. Their reliance on cigarettes diminishes, sometimes almost immediately.”

The doctor also urges people to commit to quitting smoking only when nothing in their lives is giving them a particularly hard time. “Don’t even try if there’s too much going on at the moment.” He’s also noticed that people do best if they’re motivated by a scare, some kind of intimation of mortality like a loved one dying of a smoking-related cancer, for example.

Dr. Yukevich is chagrined when he recalls his residency at Deaconess Medical Center in Boston in the mid-70s. The hospital was devoted to the treatment of cancer, yet all the doctors smoked. Finally they realized the insanity of what they were doing. First they established a contained smoking area outdoors. Now even that is gone.

Dr. Gerry Yukevich put the issue in astounding context when he recently sent the following e-mail to me.

“On 9/11/01, 3,000 people were killed when the planes hit the buildings. Every year in this country over 400,000 people die from cigarette smoking, which is like a 9/11 disaster every couple of days. Think of the efforts we’ve made to avenge these deaths. I try to stress this to my patients — that those people couldn’t get out of the building or out of the airplane. All the patient has to do is put down the cigarette.”