Medically reviewed by C. Fookes, BPharm Last updated on May 23, 2019.
So, you have decided you want to stop smoking? Congratulations! One of the most significant factors in stopping smoking is making the decision to quit.
We acknowledge that quitting smoking can be difficult. One study in BMJ Open concluded that it may take 30 or more quit attempts for many smokers before being successful. Which is why you shouldn’t beat yourself up about it if you don’t succeed on your first or even tenth or twentieth quit attempt. If you want to quit, don’t give up on quitting.
Quitting success rates are vastly improved in people who have good, professional, support to quit smoking and in those who use smoking cessation medications. Quitline Services (1-800-QUIT-NOW or 1-800-784-8669) is a free telephone support service that offers free support, advice, and counseling from experienced Quitline coaches and free or discounted medications depending on eligibility and state or residence.
There are also many resources online, such as the CDC’s quit smoking resources and several excellent Apps (such as Cessation Nation, Easy Quit, My Quit Coach, and Smoke-Free) that will help you quit your habit, one day at a time.
- Why is it hard to stop smoking?
- What are the health benefits of stopping smoking?
- Symptoms to expect when quitting smoking (nicotine withdrawal symptoms)
- What are the differences between smoking cessation treatments?
- Tips to help you quit smoking
- How to avoid gaining weight when you quit smoking
- Smoking cessation help in the US
- Images of smoking cessation drugs
- Additional Resources
Nicotine is one of the most addictive substances we know. Within 7 seconds of smoking, vaping, or chewing nicotine, several "feel-good" substances - such as dopamine - are released in the brain. This sudden reward pathway is thought to be the reason cravings for nicotine can be so intense.
As with many drugs, dopamine prompts or “teaches” the brain to repeat the same behavior (such as smoking, inhaling, or chewing tobacco) over and over. This is also called reinforcement. Every time a person takes a puff from a cigarette or inhales the vapor from an E-cigarette, the brain gets a dopamine “hit”. For a person taking 10 or more puffs per cigarette, who smokes 25 cigarettes a day, this amounts to 250 hits, which is a lot of “teaching” of the brain to keep using nicotine. Repeated daily use of nicotine increases the risk of addiction.
Most people completely underestimate how powerful the reinforcing effects of nicotine are. Which is why teens who start vaping often switch to regular cigarettes - to increase the amount of nicotine the brain now craves.
Nicotine isn’t the only ingredient in conventional cigarettes, cigars, and tobacco. Flavorings and other chemicals are also added, and when all these ingredients burn, they create a haze of over 7000 chemicals including 70 carcinogens (cancer-causing agents). This means you also end up inhaling other toxic chemicals, such as cyanide, benzene, formaldehyde, acetylene and ammonia, and poisonous gases, such as carbon monoxide and nitrogen oxide. Inhalation of tar is also an inevitable part of smoking. Tar is sticky and ends up coating the cilia (fine projections) in your lungs that exchange oxygen and carbon dioxide, seriously affecting your breathing.
More than 480,000 Americans die every year from smoking-related conditions. Smoking is the main cause of small cell and non-small cell lung cancer; men who smoke are 23 times more likely to develop lung cancer compared to never-smokers, women are 13 times more likely. The risk of cancers of the mouth, bladder, cervix, stomach, pancreas, and liver are also increased. People who smoke are also more likely to develop chronic obstructive pulmonary disease (COPD), osteoporosis, gum disease, and many other conditions, from psoriasis to hyperthyroidism. Women who smoke during pregnancy have an increased risk of premature delivery and small babies, and their infants are at increased risk of sudden infant death syndrome (SIDS or cot death).
Continued smoking increases your risk of a heart attack, stroke, or circulatory problems. Smoking can worsen asthma, hinder recovery from a cold or flu, age your skin faster, and cause impotence or a decrease in fertility.
Even though electronic cigarettes do not contain the same number of chemicals that tobacco products or conventional cigarettes do, they are not without their risks. Research indicates they still emit toxic vapors and contain chemicals linked to lung disease. Nicotine reduces blood flow, and plastic surgeons recommend patients avoid smoking e-cigarettes for at least four weeks before their procedure. Nicotine in E-cigarettes is just as addictive as nicotine in conventional cigarettes.
It is never too late to stop smoking although the earlier you stop the better. A person in their thirties who stops smoking gains on average an extra 10 years of life. Even a person in their sixties who stops smoking gains on average another three more years.
Stopping smoking also saves money and importantly, improves your health as well as that of everybody around you who is exposed to your second-hand smoke. It boosts your physical fitness as well as your sense of smell. Even if you are still smoking when you develop a medical condition, such as a heart attack or lung cancer, stopping smoking improves your chance of survival.
If you stop using nicotine abruptly, it takes some time for your body to adjust. As levels of nicotine slowly decrease in your body, you may experience both physical and psychological withdrawal symptoms. Psychological symptoms include:
- A low mood or mood swings
- Anger or agitation
- Craving cigarettes or tobacco
- Difficulty concentrating or thinking
- Irritability or frustration.
Physical symptoms of nicotine withdrawal include:
- Abdominal cramps or digestive issues, such as constipation
- Difficulty sleeping or waking at night
- Hunger or an increased appetite
Withdrawal symptoms usually peak after 1–3 days then slowly improve over the next 3 to 4 weeks. After this time, most of the nicotine in your body has gone, and the withdrawal effects are mainly psychological.
Research has shown that smoking cessation is much more likely if pharmacological treatments are combined with active support or behavioral therapy. There are three types of treatments that have been approved by the FDA and been found to be effective:
- Nicotine replacement products (available over-the-counter as nicotine patches, gum or lozenge, or on prescription as nicotine patches, inhaler, or nasal spray)
- bupropion SR (Zyban) (available on prescription)
- varenicline tartrate (Chantix) (available on prescription).
Other prescription medicines, such as nortriptyline and clonidine have also been used. There is not enough evidence to recommend smoking cessation agents for adolescents, and treatment has not been found to be effective in light smokers and in those who use smokeless tobacco.
Before choosing a smoking cessation treatment, your doctor will consider a number of different factors, such as:
- A person’s prior experience with a medication (previous length of abstinence, tolerability, ease of use)
- Current smoking status (low/heavy/sporadic/constant)
- Social and cultural factors and support network
- Health insurance coverage and out-of-pocket costs
- Likelihood of adherence
- Dentures when considering the gum
- Dermatitis when considering the patch.
Combination therapy may be helpful for highly dependent smokers or those with a history of severe withdrawal. The most common combinations include:
- The nicotine patch with nicotine gum/nasal spray/ or inhaler
- The nicotine patch with Zyban.
The combination of varenicline with NRT has been associated with higher rates of side effects (eg, nausea, headaches), and is not recommended.
Some people may continue with smoking cessation treatment long term or still use treatments every now and then even once they have successfully quit smoking. Zyban, Chantix and some NRT treatments have been approved by the FDA for 6-month use. Long-term use does not present a health risk and developing a dependence on these medications is uncommon.
Chantix (varenicline) stimulates nicotine receptors which reduces cravings and prevents nicotine from binding. Serious neuropsychiatric symptoms have been reported in patients being treated with this drug and therefore it should not be given to people with a history of neuropsychiatric disorders and people taking this drugs should be monitored for agitation, depressed mood, and changes in behavior that are not typical for the patient.
Zyban (bupropion sustained release [SR]) is thought to increase dopamine levels in the nerve synapse by inhibiting the reuptake of dopamine. Levels of norepinephrine, another neurotransmitter, may also be affected. Zyban also carries an FDA warning for neuropsychiatric adverse events and should not be used in people with a history of eating disorders, seizure disorders, or taking other medications that lower the seizure threshold. Patients taking Zyban should be monitored for depression or suicidal ideation.
Nicotine replacement therapy (NRT) (gum/lozenge, patch, inhaler) reduces craving and withdrawal symptoms by partially replacing lost nicotine intake. Patches should be applied to a clean, dry, hairless area of skin on the upper chest, back, upper arm, or hip as directed by the package directions. The dosage of the patch depends upon how many cigarettes you had been smoking a day and the intensity of your cravings upon quitting. Talk to your doctor or pharmacist about what strength is best for you.
Behavioral therapies can help smokers identify environmental triggers of craving so they put into place strategies to prevent or circumvent these symptoms and urges. For some people, the way a cigarette looks, feels and smells and the ritual involved with obtaining, handling, lighting, and smoking a cigarette are all associated with the pleasurable effects of smoking.
Higher intensity counseling (longer sessions and/or multiple sessions) are better than lower intensity.
Learn More: Smoking Cessation
Table of smoking cessation drugs
|Treatment||How used (summary)||How effective||Common side effects|
Nicotine replacement therapy (NRT)
Zyban (bupropion SR)
- Avoid situations that make you want to smoke. Work out the times you normally smoke and how you will avoid picking up a cigarette. Don't go out drinking with friends who smoke until you feel confident you have got your cravings under control.
- Try to avoid being near cigarettes. Don't keep any for just in case. If your partner smokes, try to quit together. Ask others not to smoke around you or leave their cigarettes lying around. Leave the room when others are smoking.
- Have a plan in place for if you get cravings, such as nicotine gum/inhaler or drink water, take some deep breaths or do something else. Always carry a drink bottle full of water.
- Make your home and car smoke-free and get rid of ashtrays. Wash all your 'smoky' clothes and wipe down all furnishings
- Cut down on alcohol
- Use a fresh minty toothpaste to brush your teeth with and book into your dentist to have your teeth cleaned
- Try to reduce some of the stresses in your life
- Reward yourself every now and then and do things you enjoy
- Enlist the help of friends and family members and ask for their support
- Make a list of reasons why you quit and put it up somewhere you can see it
- Practice saying "I don't smoke", "I am a non-smoker", or "I'm not smoking anymore"
- Share your story with other people who have also stopped smoking.
Although weight gain is common when stopping smoking, there are several ways you can minimize gaining weight, such as:
- Have healthy snacks easily available, e.g. carrot or celery sticks in the fridge and plenty of fruit
- Keep fat and sugar intake low
- Buy a new healthy cookbook to get inspired on cooking healthy meals
- Think of other things to do when you crave a cigarette that doesn't involve eating, e.g. have a drink of water, telephone a friend, read a magazine
- Drinking alcohol is often associated with smoking. Avoid or minimize alcohol to help avoid cravings for cigarettes and reduce weight gain
- Consider starting an exercise program at the same time as you stop smoking. Check with your doctor first. Find an exercise you like to do and a buddy to do it with and it will be much easier. Think about a goal to get fit for, e.g. a 10km walk
- Reward yourself for keeping off the cigarettes with non-food rewards – e.g. a facial or a new book after the first week
- Use the stairs instead of a lift*
- Get off the bus or train a stop early and walk the rest of the way*
- Do usual activities with more energy – e.g. cleaning the house, walking up the stairs*
*Check with your doctor before changing your exercise
Exercise helps to reduce cravings for cigarettes. Craving reduces both during the exercise and for up to 50 minutes afterward. Exercise also improves poor concentration – a problem when quitting smoking.
Zyban may reduce weight gain from stopping smoking while it is being taken, although weight gain can occur when Zyban is discontinued.
There are a number of places for smoking cessation help.
- Free Quit Line. 1-800-QUIT-NOW (1-800-784-8669)
- American Cancer Society: Tobacco and cancer
- American Heart Association: Quit smoking
- American Lung Association: Stop smoking
- Centers for Disease Control and Prevention (CDC): Smoking and Tobacco Use
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