Smoking: Harm reduction versus abstinence

Is there a time when it would be more harmful to encourage a patient to quit smoking? I had a patient who was a 60-year-old man with an extensive cardiovascular disease history, which included four stents, who most recently presented with an S-T elevation myocardial infarction (STEMI) to the psychiatric emergency room complaining of a panic attack. The patient was taken for percutaneous intervention (PCI) and was discharged from coronary care unit (CCU) to the inpatient psychiatric unit on the usual post myocardial infarction (MI) regimen, which he had been taking prior to the new cardiac event, of a beta blocker, ACE-inhibitor, statin, aspirin, and clopidogrel (Plavix®). The patient happens to have a history of smoking 5–10 cigarettes per day for the last 20 years. Other comorbidities include major depressive disorder, cervical spine stenosis, and alcoholism.