I quit smokin' for almost 20 months and countin', once in a bluemoon, i get cravin' despite 3ds: what advice do you give to your patients?

Multiple options: The lastest option is the electronic cigarette. Other options include chewing gum (nicotine or otherwise). Some people will exercise for 15-20 minutes until the craving disappears.

Expect cravings and: Wait them out - they go away. If they are severe, and you are at risk of relapsing to tobacco, i recommend the use of short-acting nicotine replacement therapy, such as the gum or (better) lozenges - 1 or 2 mg - when needed. If they become more severe or chronic, there are other treatments - nicotine patches, bupropion and varenicline (chantix). Psychological treatments also may help-hypnosis etc.

Fight cravings.: The average cigarette craving lasts 90 seconds and then passes. Surely you can fight that craving for 90 seconds, right. And the more cravings you fight, the more your brain will realize that it's just not going to get the nicotine it craves anymore, and the cravings will lessen in intensity and frequency.