What’s the best way to quit smoking?

Wynne Armand, MD
Wynne Armand, MD, Contributing Editor

Smoking cigarettes contributes to almost 1 in 5 deaths. The top three smoking-related causes of death are cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease (COPD). In addition to these “top three,” smoking is also linked to a number of other cancers, an increased likelihood of getting more colds and infections, diabetes, osteoporosis and hip fractures, problems in pregnancy, difficulty with erections, stomach ulcers, gum disease, and the list goes on.

Quitting smoking can add years to your life. Though the earlier the better, it’s never too late to quit. The benefits of quitting are real, even at the age of 80!

So what’s the best way to quit?

Set a quit date

Pick a date in the next few weeks, share it with your friends and your family, and mark it on your calendar. Plan to completely stop smoking on that quit date. Think about what might make it challenging to stop. Be prepared for how you will handle any withdrawal symptoms. Identify what triggers your craving for a cigarette, and have a strategy to avoid or deal with these triggers. Start exercising before your quit date to minimize weight gain when you stop smoking. Find healthy distractions to keep your mind and hands busy. Have nicotine replacement products like nicotine gum and patches ready on hand if you plan to use them.

Going “cold turkey” might be better

You can choose to cut down on your cigarettes gradually before your quit date, or smoke as you normally do up until your quit date. Either is fine, but it seems that quitting abruptly, going “cold turkey,” might be better.

A recent study randomly assigned about 700 participants to either gradually cut back on smoking over two weeks or quit abruptly on a set quit date. Both groups were offered counseling support as well as nicotine patches and other forms of short-acting nicotine replacement. The group assigned to cold turkey was significantly more successful at quitting smoking, both at the 4-week follow-up (49% vs. 39%) and the 6-month follow-up (22% vs. 15%).

Many people need extra support

Though some people are successful on their own, many have a hard time—and it often takes multiple tries to quit for good. Ask for help. There are many ways to get support, from one-on-one in person, to telephone call support, to mobile phone aps. Many counseling programs are free, and will even provide nicotine patches without charge.

In addition to your doctor, here are some places to start:

Treatments available

Treatment with medications (nicotine replacement, varenicline, or bupropion) increases quit-rates, especially when combined with counseling. These medications may help with cravings, withdrawal symptoms, and other side effects of quitting smoking. All of these agents can be used even if a person has not completely stopped smoking. Varenicline and bupropion take some time to work, so they should be started a week to several weeks before the quit date, depending on the medication. Talk to your doctor about which treatment is suitable for you, especially if you have depression.

If these various treatments don’t work, they may also be tried in combination. In addition, there are other alternative treatments, like acupuncture and hypnosis, but success has been less clear with these.

  1. Nicotine replacement. Using nicotine replacement doubles the quit-rate. It helps with withdrawal symptoms and cravings, and can be tapered off easily as withdrawal symptoms improve. There are many forms available over-the-counter or with prescription: patches, gum, lozenges, nasal spray, and inhaler. The highest dose patch (21mg) should be used if the smoker smokes more than 10 cigarettes a day. The patch delivers nicotine through the skin over 24 hours, but can also be removed at bedtime. The other short-acting forms of nicotine replacement can be used alone, or used with patches as needed for cravings or on a regular schedule at first (e.g. hourly while awake).
  2. Varenicline (Chantix). Varenicline works by binding to nicotine receptors in the body, partly turning them on to reduce withdrawal symptoms, but also blocking them from the nicotine in cigarettes and thus making smoking less pleasurable. So far, varenicline has shown the highest quit-rate in studies.
  3. Bupropion (Zyban, Wellbutrin SR). Bupropion is felt to work by working on the brain’s hormones. It has the added benefit of minimizing the initial weight gain with stopping smoking. Treatment for longer duration may help prevent relapse in those who have quit. It cannot be used in those who have a history of seizure disorders.

Most smokers who stop will feel better, and stopping will lower their risk of getting (and dying from) smoking-related illnesses. But quitting smoking can be very difficult. If you are a smoker and you want to stop, talk to your doctor about what the best options are for you to help you succeed.

Comments:

  1. Dr. Ashraf Chaudhry

    In my opinion, cold turkey with strong will power is the best way to stop smoking in 90% cases. However, smokers with weak will power (in 10% cases) can also get the help of medicines. For Muslims, month of Ramadan is the best month to quit smoking when they enjoy strong will power to correct their weaknesses.

  2. Kapil

    Wonderful article.
    In my opinion, cold turkey is best.

  3. Immigration Consultant

    Nice Blog

  4. william

    the only way to stop smoking is to STOP , thats it !! , one has to break the habit , so intead of getting up from your sleep and having a coffee or tea and a cigarette or breakfast , after arising clean your teeth and shower straight away, and then start your day ,,YES!! of course you will need willpower ,unfortunately you cant buy this the strength of this lies within yourself in just how much you REALLY want to stop smoking , ten days should be enough to break the habit your, daily ritual from awakening ,this is the most important time and also the time when your willpower is at its lowest ,dont replace your habit with E -cigs’ or nicotine patches ,your just shifting one addiction to another , cold turkey is really the best way ,yes you may put weight on ? , but not always the case , to be fat and a non-smoker is far better than being slim and a smoker ,, good luck ,this is my 19th year of being a seriously heavy NON-smoker

  5. Anaya Sekhawat

    I have been trying to leave smoking for years now but without a luck. I have already done most of what is written in this place except Varenicline (Chantix) which is unavailable in the place i m currently at.

    • william

      dont stop trying ,you will eventually do it
      !! , willpower and the need to REALLY want to stop , is all you need there truly is no substitute to cling on to , its not easy ,breaking the habit ,its a must !!, change your routine especially in the mornings ,dont sit with a ciggy and tea for breakfast , get showered and get out ,if only to get a paper or to get into work a little earlier , 7/10 days and the habit is broken ,the rest is all willpower and determination ,the benefits of not smoking is truly in abundance ,and especially now where the banning of smoking in many public places are on the increase ,good luck ,never give up trying to stop

    • Wynne Armand

      Anaya,
      I encourage you to not give up. For some people, it can take many attempts to quit before they are successful. The Center of Disease Control estimates on average 8-11 attempts before quitting. A 2016 study in BMJ Open (BMJ Open. 2016; 6(6): e011045) estimates on average 30 or more attempts to quit before successfully quitting for 1 year or more.

  6. Judy Yocum Ruffino

    How I quit smoking after 15 years with no cravings and no helps, in one day.
    I read “You Can Stop”. Instead of making a list of all the helps you can have ( because of course you will suffer and need all the help you can get), the book makes a long list of what happens to you when you quit. I focused on those, ie., my clothes and I no longer smell bad, my curtain will no longer be yellow, same for teeth and bad breath. (Speaks to vanity first.) Secondly, I will feel better, I will have more energy and be able to do a lot of interesting and new things. People will like me better, and more respect for me.

    All the details on how I will become short of breath and probably succumb to various and sundry illnesses and disorders down the road didn’t work for me. I didn’t like thinking about those things. Instead, I wanted to think about the nice things that could happen to me tomorrow.

    And that is precisely what happened to me. What was the catalyst?

    KISS. Keep it simple stupid. Don’t overthink this.

    I was in a doctor’s office at Kaiser Permanente, Hayward, CA.
    I told him I was having headaches and didn’t want to rely on medication. I would tell myself, ” I don’t have a headache”. He educated me by saying, “That won’t work. The brain is like a computer in that it can’t accept a negative.” (I didn’t even have a computer so how would I know.)

    On the way home I stopped for a cup of coffee and my usual cigarette. As I looked at the pack of Marlboro’s, I decided to try a positive statement. (Just for fun.) I settled on, “I feel good without this cigarette.” So then what happened…….

    Something happened and I don’t know what it was. I finished my coffee and drove home without the cigarette. I didn’t keep repeating that statement. I just let it be. No additive words, just the simple “I feel good without that cigarette.” There were no cravings but whenever I would even think about a cigarette, I would KISS, and repeat the statement. No elaborations. For whatever reason, I would just go do something, forgetting cigarettes.

    There was one other thing I remembered from the book and that was, “One will hurt”. KISS. As long I didn’t have “one”, I was officially a non- smoker. In one day! That was 38 years ago.

    So then what happened…… Something happened and I don’t know what it was.