Varuna Srinivasan, MBBS, MPH, Kousha Mohseni, MS, Shahmir Ali, BA, National Center for Health Research
In the United States, over 480,000 people die every year from smoking and tobacco-related illnesses.1 A health professional can help develop an effective plan for quitting and can provide important support for those efforts. However, not everyone is getting the help they need even among those who have access to health care; in a survey of over 25 million smokers who reported smoking or trying to quit in the last year, those who were younger, living in rural areas, or living in Southern and Western states were less likely to get assistance from a health professional to quit smoking.2
Trying to quit smoking can be very difficult because nicotine is addictive and because of the behaviors that are associated with the habit of smoking. For example, some people tend to smoke cigarettes with their coffee so they crave a cigarette whenever they smell coffee.
A few examples of triggers include3
- Feeling stressed, anxious, restless, or bored
- Feeling happy or excited
- Being in a social situation
- Drinking at a bar
- Feeling satisfied after a meal
- After sex
- Drinking coffee or any other beverage
- During office breaks
- Driving in your car
Quitting smoking involves quitting the cigarette itself and also changing the behavior that is associated with smoking.
These are Popular Strategies to Quit Smoking, But Do They Work?
Nicotine products include cigarettes as well as e-cigarettes, Juul, snus, and tobacco chewing products. E-cigarette companies claim that their products help people quit cigarette smoking. There is no evidence to support that and it is important to understand that all these products contain nicotine and other harmful substances (for more information on e-cigarettes, click here).4 Research also shows that adolescents who start vaping are more likely to start smoking cigarettes in the future.
Smoking cessation drugs such as Chantix and Zyban can help you quit but can also cause uncontrollable anger, hostility, suicidal thoughts, and depressed mood (for more information, read this).
Nicotine is very addictive and changes the chemistry in the brain. The goal of nicotine replacement therapy is to gradually reduce the desire to smoke, help reduce withdrawal symptoms from quitting, and undermine the triggers that make it difficult to quit. Nicotine replacement products include nicotine gum, tablets, lozenges, sprays, or a nicotine patch. This can help break the habit of smoking and eventually help reduce dependence on nicotine.5
If I Don’t Want to Take Drugs to Quit, What Else is There?
Here are several alternatives to those drugs:
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people think differently about their emotional problems or addiction. CBT is effective for the treatment of depression, anxiety, PTSD and eating disorders as well as smoking cessation. It can be used in combination with nicotine replacement therapy or as a stand-alone therapy. Using techniques such as education, relaxation exercises, coping skills training, and stress management, CBT helps the person to be more aware of what is preventing them from quitting smoking.6
Group therapy can offer CBT in addition to the support of other patients who want to quit smoking. This helps individuals understand the reasons they smoke and why quitting is difficult and at the same time providing support and encouragement from others going through the same experience.7 It is not known whether group therapy is as effective as individual counseling, but it is likely less expensive because there is one therapist for several smokers.
Acupuncture for smoking cessation consists of stimulation on the ears using either needles or laser therapy.8 Some studies have shown that acupuncture might be more effective than medication to help people stop smoking, but more research is needed to know why acupuncture might work or how well it works.
Hypnosis is used to create an altered state of mind that could help people change their smoking habits. While this form of therapy is mainly used to treat anxiety and depression, it can be very useful by making the participant more receptive to stop smoking.8 Under hypnosis, the therapist will talk about how harmful cigarettes are, associate smoking with terrible sensations, and give patients coping mechanisms to help with withdrawal symptoms.8 More research is needed to determine how effective hypnosis is.
While quitting smoking can take a long time, the health benefits are substantial. Many smokers who quit see positive changes in their bodies. Start with small tasks such as setting a quit date, making a quitting plan, and informing your friends and family of your plans.
- Centers for Disease Control and Prevention. Fast Facts – Smoking & Tobacco Use. CDC.gov. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm. Updated February 20, 2018. Accessed October 3, 2018.
- Maki KG, Volk RJ. Disparities in Receipt of Smoking Cessation Assistance Within the US. JAMA Netw Open. 2022;5(6):e2215681. doi:10.1001/jamanetworkopen.2022.15681
- Know Your Triggers. Smokefree.gov. https://smokefree.gov/challenges-when-quitting/cravings-triggers/know-your-triggers. Accessed October 3, 2018.
- Weaver SR, Huang J, Pechacek TF, et al. Are electronic nicotine delivery systems helping cigarette smokers quit? Evidence from a prospective cohort study of U.S. adult smokers, 2015–2016. Public Library of Science ONE. 13(7): e0198047. https://doi.org/10.1371/journal.pone.0198047. Accessed October 3, 2018.
- Hartmann‐Boyce J, Chepkin SC, Ye W, et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews. 2018; Issue 5. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000146.pub5/full. Accessed October 3, 2018.
- Perkins K, Conklin C, Levine M. Cognitive-Behavioral Therapy for Smoking Cessation. New York City, New York: Routledge; 2008.
- Stead LF, Carroll AJ, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database of Systematic Reviews. 2017; Issue 3. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001007.pub3/full. Accessed October 3, 2018.
- Tahiri M, Mottillo S, Joseph L, et al. Alternative smoking cessation aids: A meta-analysis of randomized controlled trials. The American Journal of Medicine. 2012; 125(6): 576-584. https://www.amjmed.com/article/S0002-9343(12)00003-4/fulltext. Accessed October 3, 2018.