Unassisted It often takes several attempts, and potentially utilizing different approaches each time, before achieving long-term abstinence. Over 74.7% of smokers attempt to quit without any assistance, otherwise known as "
cold turkey", or with home remedies. Previous smokers make between an estimated 6 to 30 attempts before successfully quitting. Identifying which approach or technique is eventually most successful is difficult. It has been estimated, for example, that only about 4% to 7% of people are able to quit smoking on any given attempt without medicines or other help. The majority of quit attempts are still unassisted, though the trend seems to be shifting. The most frequent unassisted methods were "cold turkey",
Cold turkey "
Cold turkey" is a colloquial term indicating abrupt withdrawal from an addictive drug. In this context, it indicates sudden and complete cessation of all nicotine use. In three studies, it was the quitting method cited by 76%, 85%, or 88% of long-term successful quitters. In a large British study of ex-smokers in the 1980s, before the advent of pharmacotherapy, 53% of the ex-smokers said that it was "not at all difficult" to stop, 27% said it was "fairly difficult", and the remaining 20% found it very difficult. Studies have found that two-thirds of recent quitters reported using the cold turkey method and found it helpful.
Cutting down to quit Gradual reduction involves slowly reducing one's daily intake of nicotine. This method can theoretically be accomplished through repeated changes to cigarettes with lower nicotine levels, by gradually reducing the number of cigarettes smoked daily, or by smoking only a fraction of a cigarette on each occasion. A 2009 systematic review by researchers at the
University of Birmingham found that gradual
nicotine replacement therapy could be effective in smoking cessation.
Medications applied to the left arm The
American Cancer Society notes that "Studies in medical journals have reported that about 25% of smokers who use medicines can stay smoke-free for over 6 months." Single medications include: •
Nicotine replacement therapy (NRT): Five medications have been approved by the U.S.
Food and Drug Administration (FDA) to deliver nicotine in a form that does not involve the risks of smoking: transdermal
nicotine patches,
nicotine gum,
nicotine lozenges, nicotine
inhalers, nicotine oral sprays, and nicotine nasal sprays. Some reported side effects are local slight irritation (inhalers and sprays) and non-ischemic chest pain (rare). A study found that 93% of over-the-counter NRT users relapse and return to smoking within six months. There is weak evidence that adding
mecamylamine to nicotine is more effective than nicotine alone. •
Antidepressants: The antidepressant
bupropion is considered a first-line medication for smoking cessation and has been shown in many studies to increase long-term success rates. Although bupropion increases the risk of getting adverse events, there is no clear evidence that the drug has more or less adverse effects when compared to a placebo.
Nortriptyline produces significant rates of abstinence versus placebo. Other antidepressants such as
selective serotonin reuptake inhibitors (SSRIs) and
St. John's wort have not been consistently shown to be effective for smoking cessation. The number of people stopping smoking with varenicline is higher than with bupropion or NRT. Varenicline more than doubled the chances of quitting compared to placebo, and was also as effective as combining two types of NRT. 2 mg/day of varenicline has been found to lead to the highest abstinence rate (33.2%) of any single therapy, while 1 mg/day leads to an abstinence rate of 25.4%. A 2016 systematic review and meta-analysis of randomized controlled trials concluded there is no evidence supporting a connection between varenicline and increased cardiovascular events. Concerns arose that varenicline may cause neuropsychiatric side effects, including suicidal thoughts and behavior. No link between depressed moods, agitation or suicidal thinking in smokers taking varenicline to decrease the urge to smoke has been identified. • There is no good evidence
anxiolytics are helpful. • Previously,
rimonabant, which is a
cannabinoid receptor type 1 antagonist, was used to help in quitting and moderate the expected weight gain. But it is important to know that the manufacturers of rimonabant and
taranabant stopped production in 2008 due to serious CNS side effects. Specific methods used in the community to encourage smoking cessation among adults include: • Policies making workplaces In 2008, the New York State of Alcoholism and Substance Abuse Services banned smoking by patients, staff, and volunteers at 1,300 addiction treatment centers. • Voluntary rules making homes smoke-free, which are thought to promote smoking cessation. • Initiatives to educate the public regarding the health effects of
second-hand smoke, including the significant dangers of secondhand smoke infiltration for residents of multi-unit housing. • Increasing the price of tobacco products, for example by
taxation. The US Task Force on Community Preventive Services found "strong scientific evidence" that this is effective in increasing tobacco use cessation • Weak evidence suggests that imposing institutional level smoking bans in hospitals and prisons may reduce smoking rates and second hand smoke exposure. • Researchers explored whether an opportunistic stop smoking intervention (advice, a vape starter pack and a referral to stop smoking services) was effective for people attending the emergency department. At 6 months, more people who received the intervention had quit smoking compared with people who received advice only.
Pharmacist Interventions Pharmacist-led interventions have proven to be effective in helping smoking cessation attempts. Many
systematic reviews have looked at the importance of pharmacist involvement. In
Malaysia, their study looked at how pharmacist intervention in patients' overall healthcare showed improvements in
screening early stages of disease. This allowed for earlier treatment starts in smoking-caused
COPD. In addition, pharmacists in Malaysia could prescribe
NRT products, and when they led a smoking cessation service, it was more successful than other smoking cessation trials in Malaysia. They found that structured care, and regular visits, easy accessibility to pharmacists helped more people trying to quit than without. However, the study concluded that more research should be done in the area as they found an unknown risk of bias in the studies included They found that evidence suggests that the longer the duration of pharmacist-led intervention, the more influential the attempt at quitting was Computerised and interactive tailored interventions may be promising, • A
mobile phone-based intervention where automated, supportive text messages are sent alongside other forms of support helps more people quit smoking: "The current evidence supports a beneficial impact of mobile phone-based cessation interventions on six-month cessation outcomes." A 2011 randomized trial of mobile phone-based smoking cessation support in the UK found that a Txt2Stop cessation program significantly improved cessation rates at six months. A 2013 meta-analysis also noted "modest benefits" of mobile health interventions. • Interactive web-based programs combined with a Mobile phone: Two RCTs documented long-term treatment effects (abstinence rate: 20-22%) of such interventions.
Psychosocial approaches • The
Great American Smokeout is an annual event that invites smokers to quit for one day, hoping they will be able to extend this forever. • The World Health Organization's
World No Tobacco Day is held on May 31 each year. • Smoking-cessation support is often offered over the telephone
quitlines (e.g., the US toll-free number 1-800-QUIT-NOW), or in person. Three meta-analyses have concluded that telephone cessation support is effective when compared with minimal or no counselling or self-help and that telephone cessation support with medication is more effective than medication alone, A slight tendency towards better results for more intensive counselling was also observed in another meta-analysis. This analysis distinguished between reactive (smokers calling quitlines) and proactive (smokers receiving calls) interventions. For people who called the quitline themselves, additional calls helped to quit smoking for six months or longer. When proactively initiating contact with a smoker, telephone counselling increased the chances of smoking cessation by 2–4% compared with people who received no calls. There is about 10% to 25% increase in the chance of smoking cessation success with more behavioral support provided in person or via telephone when used as an adjunct to pharmacotherapy. • Online social cessation networks attempt to emulate offline group cessation models using purpose built web applications. They are designed to promote
online social support and encouragement for smokers when (usually automatically calculated) milestones are reached. Early studies have shown social cessation to be especially effective with smokers aged 19–29. • Group or individual psychological support can help people who want to quit. Recently, group therapy has been more helpful than self-help and some other individual intervention. The psychological support form of counselling can be effective alone; combining it with medication is more effective, and the number of support sessions with medication correlates with effectiveness.
cognitive behavioral therapy and
acceptance and commitment therapy, methods based on cognitive behavioral therapy. • The Freedom From Smoking group clinic includes eight sessions and features a step-by-step plan for quitting smoking. Each session is designed to help smokers gain control over their behavior. The clinic format encourages participants to work on the process and problems of quitting both individually and as part of a group. • Multiple formats of psychosocial interventions increase quit rates: 10.8% for no intervention, 15.1% for one format, 18.5% for 2 formats, and 23.2% for three or four formats. however, there is some evidence to suggest that "stage-based self-help interventions (expert systems and/or tailored materials) and individual counselling are neither more nor less effective than their non-stage-based equivalents."
How to set a quit date Most smoking cessation resources such as the
Centers for Disease Control and Prevention (CDC) and
The Mayo Clinic encourage smokers to create a quit plan, including setting a quit date, which helps them anticipate and plan for smoking challenges. A quit plan can improve a smoker's chance of a successful quit as can setting Monday, as the quit date, given that research has shown that Monday more than any other day is when smokers are seeking information online to quit smoking and calling state quitlines. In Nepal,
smokers are not selfish, a
health campaign of two weeks is started on the occasion of
Valentine's Day and
Vasant Panchami to motivate individuals to quit smoking as a sacrifice for their loved ones and making it a meaningful decision of life. This campaign is taking public attention.
Self-help Self-help materials may produce a small increase in quit rates specially when there is no other supporting intervention form. "The effect of self-help was weak", and the number of types of self-help did not produce higher abstinence rates. or web-based cessation resources such as Smokefree.gov, which offers various types of assistance including self-help materials. • WebMD: a resource providing health information, tools for managing health, and support. •
Self-help books such as
Allen Carr's
Easy Way to Stop Smoking. •
Spirituality: In one survey of adult smokers, 88% reported a history of spiritual practice or belief, and of those more than three-quarters were of the opinion that using spiritual resources may help them quit smoking. • A review of
mindfulness training as a treatment for addiction showed reduction in craving and smoking following training. • Physical activities help in the maintenance of smoking cessation even if there is no conclusive evidence of the most appropriate exercise intensity.
Biochemical feedback Various methods allow a smoker to see the impact of their tobacco use and the immediate effects of quitting. Using biochemical feedback methods can allow tobacco users to be identified and assessed, and monitoring throughout an effort to quit can increase motivation to quit. Evidence-wise, little is known about the effects of using biomechanical tests to determine a person's risk related to smoking cessation. • Breath carbon monoxide (CO) monitoring:
carbon monoxide is a significant component of cigarette smoke, and a
breath carbon monoxide monitor can be used to detect current cigarette use. Carbon monoxide concentration in breath is directly correlated with the CO concentration in blood, known as percent
carboxyhemoglobin. The value of demonstrating blood CO concentration to a smoker through a non-invasive breath sample is that it links the smoking habit with the physiological harm associated with smoking. CO concentrations show a noticeable decrease within hours of quitting, which can encourage someone to work on quitting. Breath CO monitoring has been utilized in smoking cessation as a tool to provide patients with biomarker feedback, similar to how other diagnostic tools such as the stethoscope, the blood pressure cuff, and the cholesterol test have been used by treatment professionals in medicine. Cotinine levels can be tested through urine, saliva, blood, or hair samples. One of the main concerns of cotinine testing is the invasiveness of typical sampling methods. While both measures offer high sensitivity and specificity, they differ in usage method and cost. For example, breath CO monitoring is non-invasive, while cotinine testing relies on bodily fluid. For instance, these two methods can be used alone or together when abstinence verification needs additional confirmation.
Competitions and incentives Financial or material incentives to entice people to quit smoking improve smoking cessation while the motivation is in place. Competitions that require participants to deposit their own money, "betting" that they will succeed in quitting smoking, appear to be an effective incentive. Evidence also shows that incentive programs are effective for pregnant mothers who smoke both during pregnancy and post-partum.
Workplace incentives A 2008
Cochrane review of smoking cessation activities in work-places concluded that "interventions directed towards individual smokers increase the likelihood of quitting smoking". A 2010 systematic review determined that worksite incentives and competitions needed to be combined with additional interventions to produce significant increases in smoking cessation rates.
Healthcare systems Interventions delivered via healthcare providers and healthcare systems have been shown to improve smoking cessation among people who visit those services. • A clinic screening system (e.g., computer prompts) to identify whether or not a person smokes doubled abstinence rates, from 3.1% to 6.4%. • A 2008 Guideline meta-analysis estimated that physician advice to quit smoking led to a quit rate of 10.2%, as opposed to a quit rate of 7.9% among patients who did not receive physician advice to quit smoking. and there is evidence that the physicians' probability of giving smoking cessation advice declines with the person who smokes age. There is evidence that only 81% of smokers age 50 or greater received advice on quitting from their physicians in the preceding year. • For one-to-one or person-to-person counselling sessions, the duration of each session, the total contact time, and the number of sessions all correlated with the effectiveness of smoking cessation. For example, "Higher intensity" interventions (>10 minutes) produced a quit rate of 22.1% as opposed to 10.9% for "no contact" over 300 minutes of contact time made a quit rate of 25.5% as opposed to 11.0% for "no minutes" and more than 8 sessions produced a quit rate of 24.7% as opposed to 12.4% for 0–1 sessions. Another review found some positive effects when trained community pharmacists support patients in their smoking cessation trials. • Dental professionals also provide a key component in increasing tobacco abstinence rates in the community through counseling patients on the effects of tobacco on oral health in conjunction with an oral exam. • According to the 2008 Guideline, based on two studies the training of clinicians in smoking cessation methods may increase abstinence rates; • Reducing or eliminating the costs of cessation therapies for smokers increased quit rates in three meta-analyses. • In one systematic review and meta-analysis, multi-component interventions increased quit rates in
primary care settings. "Multi-component" interventions were defined as those that combined two or more of the following strategies known as the "5 A's": •
Electronic cigarettes (ECs): There is high‐certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate‐certainty evidence that they increase quit rates compared to ECs without nicotine. Little is known regarding the long-term harms related to vaping. A 2016 UK
Royal College of Physicians report supports using e-cigarettes as a smoking cessation tool. A 2015
Public Health England report stated that "Smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes (EC) to stop smoking and stop smoking services should support smokers using EC to quit by offering them behavioural support." However, since little is known about long term effects, other regulated options such as nicotine replacement therapy, varenicline or bupropion should be discussed primarily.
Alternative approaches vending machine. Pez was invented in 1927 as a smoking cessation aid, serving as an alternative to tobacco. It is important to note that most of the alternative approaches below have minimal evidence to support their use, and their efficacy and safety should be discussed with a healthcare professional before starting. •
Acupuncture: Acupuncture has been explored as an adjunct treatment method for smoking cessation. A 2014 Cochrane review was unable to make conclusions regarding acupuncture as the evidence is poor. A 2008 guideline found no difference between acupuncture and placebo, found no scientific studies supporting laser therapy based on acupuncture principles but without the needles. Clinical trials studying hypnosis and
hypnotherapy as a method for smoking cessation have been inconclusive. A Cochrane review was unable to find evidence of benefit of hypnosis in smoking cessation, and suggested if there is a beneficial effect, it is small at best. However, a randomized trial published in 2008 found that hypnosis and nicotine patches "compares favorably" with standard behavioral counseling and nicotine patches in 12-month quit rates. •
Herbal medicine: Many herbs have been studied as a method for smoking cessation, including
lobelia and
St John's wort. The results are inconclusive, but St. Johns Wort shows few adverse events, but is a contraindication to many medications. Lobelia has been used to treat respiratory diseases like
asthma and bronchitis, and has been used for smoking cessation because of chemical similarities to tobacco; lobelia is now listed in the
FDA's Poisonous Plant Database. Lobelia can still be found in many products sold for smoking cessation and should be used with caution. Herbal products should be discussed with healthcare professionals before use to confirm safety with other medications. •
Smokeless tobacco: There is little smoking in Sweden, which is reflected in the very low cancer rates for Swedish men. Use of
snus (a form of steam-pasteurized, rather than heat-pasteurized, air-cured smokeless tobacco) is an observed cessation method for Swedish men and even recommended by some Swedish doctors. However, the report by the
Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) concludes "STP (smokeless tobacco products) are addictive and their use is hazardous to health. Evidence on the effectiveness of STP as a smoking cessation aid is insufficient." A recent national study on the use of alternative tobacco products, including snus, did not show that these products promote cessation. •
Aversion therapy is a method of treatment which works by pairing the pleasurable stimulus of smoking with other unpleasant stimuli, for example in the form of a wearable wristband which administers an electric stimulus. A Cochrane review reported that there is insufficient evidence of its efficacy. •
Nicotine vaccines: Nicotine vaccines (e.g.,
NicVAX and
TA-NIC) work by reducing the amount of nicotine reaching the brain; however, this method of therapy needs more investigations to establish its role and determine its side effects. • Technology and machine learning: Research studies using machine learning or
artificial intelligence tools to provide feedback and communication with those who are trying to quit smoking are increasing, yet the findings are so far inconclusive. A 2025 study examining the efficacy of real-time intervention using a smartband found it helpful for reducing smoking. •
Psilocybin has been being investigated as a potential smoking cessation aid for several years. In 2021,
Johns Hopkins Medicine was awarded a grant from the National Institutes of Health to explore the potential impacts of psilocybin and talk therapy on tobacco addiction. == Special populations ==