For long-time smokers, particularly those who puff 20 or more cigarettes a day, quitting isn't easy. Studies have demonstrated that it may take several tries before many smokers are able to finally quit. Stress, habit and cigarette cravings are common reasons for people to resume smoking.

Even though many smokers quit cold turkey without the help of programs or prescriptions, the success rate is only about 5 percent per attempt, which is lower than for assisted quitting methods. If you are a heavy smoker — smoking more than one pack per day or needing to light a cigarette within 30 minutes of waking up in the morning — you may have a more difficult time quitting and should consider trying the more effective methods. Research shows that these methods increase the rate of success in smoking cessation:

• Nicotine replacement with counseling. Nicotine replacement allows your first weeks or months without cigarettes to be a time with fewer symptoms from nicotine withdrawal than you would otherwise have. The success rate for most counseling plus nicotine replacement programs is about 20 percent but can range up to 40 percent at some of the best university-based smoking-cessation programs. Nicotine replacement can be as simple as wearing the patch or chewing nicotine-containing gum, both of which are available over the counter. There is also a nicotine nasal spray or an inhaler that give heavy smokers a faster and higher dose of nicotine, which could more closely simulate smoking. Some smokers may find these newer methods more effective.
  
  
• Smoking-cessation programs. If you're looking for counseling, try local hospitals, health plans, your employer, the American Cancer Society or other health associations. To increase your odds of success, many experts recommend that you select a program that is at least four to eight weeks in length. The programs that work best provide plenty of encouragement and weekly one-on-one meetings with a counselor. The programs should also teach ways to cope with stress and other situations that might lead to a relapse. Free counseling is available in many states in the form of a telephone hotline for quitters. Your doctor can help you to identify a tobacco "quit line" if one is available.
  
  
• Nicotine replacement alone. In the absence of counseling, nicotine replacement doubles the normal cold turkey success rate to about 10 percent. Though this is not as good as the 20- to 40-percent success rates that can be obtained with behavioral and nicotine-replacement therapy, it's better than the estimated 5-percent success rate of attempting to quit cold turkey.
  
  
• Prescription medications.
  
  
• Antidepressants. The prescription drug Zyban (bupropion), which aids in the control of cravings for nicotine, is another effective therapy to help smokers quit. Studies have shown that smokers who took Zyban as well as nicotine replacement therapy had double the success rate in quitting — 20 percent or more — when compared with those who received only the nicotine-replacement therapy. In addition, people who take Zyban gain less weight than those who quit with other methods. Although this drug originally was developed as an antidepressant, it works well even in smokers who are not depressed. Another antidepressant medicine, nortriptyline (Aventyl, Pamelor, or generic nortriptyline) has been shown to have similar beneficial effects.



• Varenicline (Chantix). Varenicline is the first new anti-smoking drug approved by the US Food and Drug Administration in the past ten years. This prescription drug acts on nicotine receptors in the brain to both decrease the craving for nicotine and also to diminish the intensity of nicotine withdrawal symptoms. The standard dose is one milligram two times per day for 12 weeks. People often start at one-half the usual dose and increase the dose after a few days. The quit rate at one year is three times up to three times higher compared to a placebo.