While often very challenging, quitting smoking is one of the most important things smokers can do for their health.
Quitting smoking brings immediate health benefits that increase over time.
People who stop smoking may become irritable, anxious, sad, and restless; these symptoms decline over time.
Quitting smoking also provides health benefits for people around them.
Most smokers want to quit and have tried doing so without success.
Counseling and support in changing behavior, nicotine replacement products, and certain drugs double the chances of quitting smoking for good.
(See also Smoking Smoking Smoking tobacco is harmful to almost every organ in the body. Smoking increases the risk of heart attack, lung cancer, chronic obstructive pulmonary disease (COPD), and other disorders. Nicotine... read more and Vaping Vaping Vaping refers to inhaling vapor (volatilized liquid) produced by battery-powered devices. The vapor can contain nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, and other substances... read more .)
Smoking is harmful to almost every organ in the body, and quitting smoking brings immediate health benefits that increase over time. Within 30 minutes from the last cigarette, blood pressure and pulse decline and return to normal. Within 8 hours, carbon monoxide levels return to normal. After 24 hours, the chance of heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or a heart attack (myocardial infarction), depending on the location and amount... read more 
declines, and within 3 years the risk of heart attack is similar to that of people who have never smoked. Over time, cancer Lung Cancer Lung cancer is the leading cause of cancer death in both men and women. About 85% of cases are related to cigarette smoking. One common symptom is a persistent cough or a change in the character... read more 
risk decreases as well.
Most smokers who quit do so for health or economic reasons. About 70% of U.S. smokers say they want to quit and have already tried to quit at least once. Withdrawal symptoms are a major barrier to quitting (smoking cessation).
Quitting smoking improves the health and finances of those who quit and brings immediate benefits to those who are exposed to exhaled smoke and smoke emitted from the end of a lit cigarette. The Surgeon General concluded in 2006 that there is no safe level of secondhand smoke exposure. Someone who successfully quits smoking can become a role model and support to other smokers who want to quit. Quitting smoking can be challenging, but it is possible and evidence-based treatments are available.
Nicotine Withdrawal
Quitting smoking causes strong cravings for cigarettes and also symptoms such as anxiety, depression (mostly mild, but sometimes severe), inability to concentrate, irritability, restlessness, hunger, tremor, sweating, dizziness, headaches, abdominal pains, nausea, and disrupted sleep. Nicotine withdrawal symptoms tend to be most intense in the first 2 to 3 days of going smoke-free and then subside within 2 to 4 weeks. Drugs are available to reduce the symptoms of nicotine withdrawal.
Because nicotine suppresses appetite and slightly increases the rate at which calories are burned, people who quit smoking may gain weight. Food also starts to taste and smell better, because smoking dulls the sense of smell and harms taste buds. Exercise helps prevent weight gain and may reduce the craving for nicotine. Drinking water is recommended along with other strategies for coping with oral cravings (for example, using a toothpick or chewing on a straw or carrot sticks). Use of nicotine gum may help delay weight gain. A temporary cough may develop as the lungs start to heal themselves.
Below are examples of common nicotine withdrawal symptoms, their estimated time of duration, and behavioral strategies for relieving them.
Symptoms of Withdrawal*
Withdrawal Symptom | Duration | Behavioral Strategies |
|---|---|---|
Chest tightness | A few days | Deep breathing |
Constipation | 1–2 weeks | Drink fluids Eat fiber-rich foods |
Cough | A few days | Drink fluids |
Cigarette cravings | 2–3 days frequently, then decreases | Distract yourself Exercise |
Depressed mood | 1–2 weeks | Increase pleasurable activities Ask family and friends for support |
Difficulty concentrating | A few weeks | Plan workload in advance |
Dizziness | 1–2 days | Change positions slowly and use caution |
Fatigue | 2–4 days | Take naps Do not push yourself |
Hunger | Up to several weeks | Drink water Eat low-calorie snacks |
Insomnia | 1 week | Limit caffeine (do not drink it after noon) Practice relaxation techniques |
Irritability | 2–4 weeks | Take walks Take hot baths Practice relaxation techniques |
*Reproduced with permission from Rx for Change: Clinician-Assisted Tobacco Cessation program. The Regents of the University of California. Copyright © 1999-2018. RxforChange. | ||
Prognosis
About 20 million smokers in the United States (almost half of all smokers) make a 24-hour quit attempt each year. Most do not use any supportive counseling or other proven aids to quitting. Only about 5% of such people are successful long term. In contrast, the 1-year success rate for people using proven methods to achieve long-term success in quitting is 20 to 30%.
Treatment
Counseling and support in changing behavior
Using nicotine replacement products
Using certain drugs
Quitting is most likely to be successful by combining counseling and support with drug therapy (except for unusual cases). Seven drugs are effective for smoking cessation.
Health care practitioners can recommend ways to change behavior, provide education on cessation drugs, write prescriptions, and offer helpful referrals for additional support. All U.S. states have telephone quit lines that can provide additional support for smokers trying to quit. People can call the national 1-800-QUIT-NOW (1-800-784-8669) number to connect with counseling services for their state. Quit lines seem to be at least as effective as in-person counseling. The National Cancer Institute's web site (Smokefree.gov) is a comprehensive resource for quitting smoking with information, treatment planning, and personalized behavioral counseling via text and live chat.
Hypnosis, lasers, herbal treatments, and acupuncture have not proved to be effective for smoking cessation. For smokeless tobacco users, counseling and support in changing behavior appear to be effective, while the evidence for nicotine replacement and other drugs is weaker.
Changing behavior
Behavioral strategies are recommended for quitting smoking. Behavioral strategies are focused on
Making the surroundings smoke-free (for example, throwing out all cigarettes, ashtrays, and lighters and avoiding places where people typically buy cigarettes and/or smoke)
Recognizing cues to smoking that occur during normal daily activities (such as phone conversations, coffee breaks, meals, sexual activity, boredom, traffic problems, and other frustrations as well as awakening)
After recognizing a cue to smoke, changing the behavior triggering the cue (for example, taking a walk instead of a coffee break) or substituting another behavior for smoking (for example, sucking on candy, chewing on a toothpick, holding ice, doodling, chewing gum, or doing puzzles such as crosswords)
Engaging in pleasant activities and rewarding efforts to stay smoke-free (for example, listening to music, talking with friends, putting saved money into a money jar)
Other recommended strategies include engaging in physical activities, deep breathing, and relaxation techniques as well as drinking water and eating low-calorie snacks and fiber-rich foods. People may want to avoid drinking alcohol or using marijuana because both substances can temporarily lower a person's resolve to quit smoking.
Selection of a quit date is very helpful. The quit date may be selected arbitrarily or set on a special occasion (such as a holiday or anniversary). A stressful time, such as when a deadline (for example, a tax deadline) needs to be met, is not a good time to try to quit. If others in the home also smoke, it is important to make the home smoke-free.
Quitting cigarettes completely (cold turkey) is better than gradually decreasing the number of cigarettes smoked. People who smoke fewer cigarettes may unconsciously inhale more deeply or smoke down to the filter, and thus get as much nicotine as they did before.
Drug-supported therapies
Nicotine replacement therapy (NRT), bupropion, and varenicline are all drug-based therapies that help minimize the discomfort of nicotine withdrawal, thus allowing people to focus on the behavioral aspects of quitting smoking.
Nicotine replacement therapy is available in a variety of formulations, including patch, gum, lozenge, inhaler, and nasal spray. All provide nicotine to the brain but without the quick hit of a cigarette. The speed at which a drug reaches the brain increases its addiction potential. Hence, very few people become dependent on the nicotine replacement products. The patch, gum, and lozenges are available for purchase over-the-counter; the nasal spray and inhaler are available in the United States by prescription only. Combination nicotine replacement, which typically combines the long-acting nicotine patch with a shorter-acting formulation (gum, lozenge, inhaler, or nasal spray) is a particularly effective strategy, which more than doubles the chances of quitting smoking over the long term.
Nicotine replacement products have a few cautions:
People with jaw (temporomandibular) disorders should not use the gum.
People with severe skin sensitivity should not use the patch.
These products may have harmful effects in pregnant women.
People who have had heart attacks recently or certain blood vessel disorders should talk to their doctor before using one of these products.
Bupropion is a prescription antidepressant that was found to help with smoking cessation in smokers with and without depression. Bupropion can be used in combination with a nicotine replacement product. Together, they have a higher success rate than either alone. The results of both drugs are best when used with a behavior modification program. People at risk for seizures should not use bupropion.
Nortriptyline, another antidepressant, also has been shown to help people quit smoking. People who are depressed and attempt to quit smoking should also receive counseling.
Varenicline, another prescription drug, helps lessen cravings and withdrawal symptoms, makes smoking less rewarding, and increases success with quitting over the long term. Varenicline works in two ways:
It partially blocks the receptors in the brain that are affected by nicotine, which eases withdrawal symptoms.
It stops nicotine from attaching to the receptors, so that a person who smokes a cigarette while taking varenicline finds the activity less rewarding.
Nicotine replacement products and varenicline are generally not used together.
Some people taking bupropion SR or varenicline have developed serious nervous system or behavioral side effects, such as hostility, agitation, depressed mood, other behavioral abnormalities, suicidal thoughts, and attempted or completed suicide. Anyone who experiences any of these should immediately stop taking the drug and notify their health care provider.
Cytisine, one of the oldest smoking cessation drugs, is used largely in Eastern Europe but is not available in the United States. Recent studies suggest that cytisine is as effective as nicotine replacement drugs. Because cytisine costs so little to produce, it is being considered for use as an affordable cessation treatment worldwide.
Nicotine replacement and other smoking cessation drugs (bupropion and varenicline) are typically taken for 8 to 12 weeks; some may be taken longer to help prevent relapse to smoking.
At this time, cessation drugs and nicotine replacement products are not recommended for the following:
Pregnant smokers, unless behavioral measures have been ineffective
Light smokers (< 10 cigarettes/day)
Adolescents (under age 18), except possibly regular heavy smokers
Users of smokeless tobacco (because its effectiveness is not proven)
Adolescents who are regular heavy smokers and pregnant women in whom behavioral measures have been ineffective should consult their physician to discuss cessation drugs and nicotine replacement product use. In general, all people should talk with their health care provider about the different drugs available to help them quit smoking, to determine which is best for them. People should also be sure to read the package inserts that come with all smoking cessation products.
E-cigarettes Vaping Vaping refers to inhaling vapor (volatilized liquid) produced by battery-powered devices. The vapor can contain nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, and other substances... read more may sometimes be considered for use in smoking cessation programs, although the evidence for their effectiveness is not strong. There is also concern that because nicotine inhaled from some e-cigarette devices is delivered to the brain as rapidly as nicotine from smoked cigarettes, people might remain similarly addicted.
Cessation in children and adolescents
Parents should maintain a smoke-free household and communicate the expectation to their children that the children will remain nonsmokers.
The counseling approach is similar to that for adults, but children and adolescents typically are not given smoking cessation drugs.
More Information about Smoking Cessation
The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.
American Cancer Society: Stay Away from Tobacco: Information about the risks of using tobacco products and resources on how to quit
American Lung Association: Stop Smoking: Tools, tips, and support for smokers or their loved ones to help end addiction to tobacco
Cancer.Net: Stopping Tobacco Use After a Cancer Diagnosis: Resources to help quit tobacco use after receiving a cancer diagnosis
Centers for Disease Control and Prevention: Tips from Former Smokers: Stories from people living with smoking-related disease and resources for tobacco users and public leaders to help people quit smoking
Centers for Disease Control and Prevention: Youth Tobacco Prevention: Fact sheets, infographics, and other resources for teachers, coaches, parents, and others involved in anti-smoking, youth education
Smokefree.gov: The National Cancer Institute (NCI) resource to help reduce smoking rates in the US, particularly among certain populations, by providing cessation information, a tailored quit plan, and text-based support
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
nicotine |
Commit, Habitrol, Nicoderm CQ, NICOrelief , Nicorette, Nicotrol, Nicotrol NS |
bupropion |
Aplenzin, Budeprion SR , Budeprion XL , Buproban, Forfivo XL, Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban |
varenicline |
Chantix, Tyrvaya |
nortriptyline |
Aventyl, Pamelor |
