Quitting Options

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Harvard Medical School
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Quitting Options

Tobacco Cessation
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Quitting Options
Quitting Options
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There are many tools available to smokers who want to quit. In fact, the more options you use, the better your chances of quitting.
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InteliHealth
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InteliHealth Medical Content
2014-09-07

Reviewed by the Faculty of Harvard Medical School

Quitting Options
There are many tools available to smokers who want to quit. Although you may want to try going cold turkey (stopping smoking abruptly, on quit day), most smokers find it useful to use a combination of options. In fact, the more options you use, the better your chances of quitting.
You may have tried one of these approaches in the past, only to start smoking again. If this happened to you, try a different approach. Just because one method didn't work for you doesn't mean that another one won't. Or try the same method again. You're at a different point in your life and may have more success this time around.
If money is an issue for you, first check into the costs of these approaches and whether your health plan covers them. Although different options vary in price, a higher costing one doesn't guarantee a better outcome. The approach that works for you may not work for another smoker. There is no option that guarantees universal success.
As you review your options, keep in mind how well each will fit into your lifestyle and which ones are suitable for you. And talk with you doctor about which method, if any, may be most appropriate for you. Your doctor can answer your questions and, if needed, write you a prescription. Including your doctor in the smoking cessation process will increase your odds of success.
Cold Turkey
More than three-fourths of all smokers have tried going cold turkey at some point. However, fewer than 5% of those who do it this way succeed. According to scientific studies, it is the least successful quit method.
"Going cold turkey" means you quit abruptly, without any changes in your smoking habits before your quit day. Although going cold turkey doesn't require any weaning or changes in your cigarette use, it does take some mental preparation, as self-motivation will be key.
And you may need to make some behavioral changes to alter the typical habits that you associate with smoking. (This is true for any smoking cessation option that you choose.) For example, if you usually smoke first thing in the morning, you may want to go for a walk or do something else as soon as you wake up. This will help take your mind off of that first cigarette.
Unfortunately, going cold turkey increases the severity of nicotine withdrawal symptoms. Decreasing the usual number of cigarettes that you smoke to zero overnight can lead to irritability, fatigue, headache and other problems associated with nicotine withdrawal. That fact makes this smoking cessation technique the most disruptive to daily living.
Cold turkey is more effective if used in combination with another approach. For example, you can increase your odds of success if you go cold turkey while participating in a support group. There are also many books and audiotapes available to assist you.
Advantages
  • Going cold turkey doesn't cost anything.
Disadvantages
  • Going cold turkey is often associated with severe nicotine withdrawal symptoms.
  • Because of the withdrawal symptoms, going cold turkey may disrupt your daily life.
  • Your chance of success is less than 5%.

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Nicotine Replacement
About 10% of the people who use nicotine replacement succeed (about twice the amount of those who go cold turkey). You can increase your odds to 20% to 40% if you use nicotine replacement in combination with another smoking cessation technique, such as a smoking cessation program or support group.
Nicotine replacement is available in four forms:
  • Patch
  • Gum
  • Nasal spray
  • Inhaler
Each of these forms delivers a constant, low dose of nicotine that reduces withdrawal symptoms and fights nicotine cravings. As your body adapts to a low dose of nicotine, you can reduce your nicotine-replacement dose until you are able to remain tobacco-free without any nicotine replacement.
Important: Nicotine replacement does not mean switching to "low-tar, low-nicotine" cigarettes. After switching to lower-potency tobacco, many people compensate by puffing cigarettes more often or smoking each cigarette more deeply or to a shorter butt length. If you compensate in this way, it means you're inhaling the usual amount of nicotine, which defeats your purpose.
Warning:

Consult your doctor when using nicotine replacement. You must abstain from all tobacco products. If you smoke while using nicotine replacement, you may develop nicotine overdose, which is a medical emergency. Use all nicotine-replacement products as directed.

Nicotine Patches

Nicotine patches are available under several names, including Nicoderm and Nicotrol. Most brands don't require a prescription, but your doctor can give you one and advise you about your starting patch strength and recommended length of use.
All patches deliver nicotine through the skin and into the bloodstream. This delivery method is slower than inhaling smoke, but it is still useful for the purpose of smoking cessation. You usually wear the patch on your shoulder or upper back for 24 hours. There are also 16-hour patches that don't need to be worn overnight.
Full-strength patches deliver about 15 to 22 milligrams of nicotine (about one-half to one-third of the dose delivered through cigarettes). After your body adjusts to this dose, you can switch to patches that deliver five to 14 milligrams of nicotine. Overall, patches are worn for about eight weeks.
Advantages
  • Nicotine patches are easy to use.
  • Nicotine patches have few side effects.
  • Nicotine patches deliver nicotine safely (without the other toxins, such as the tars and carbon monoxide, found in cigarettes).
Disadvantages
  • Nicotine patches may cause a skin rash. (Moving the patch to a different part of the body usually helps.)
  • Twenty-four-hour nicotine patches may disrupt sleep.

Nicotine Gum

Nicotine gum is available over the counter in either two- or four-milligram doses. It is not as effective as nicotine patches are, but you can increase your odds of success if you combine nicotine gum with a smoking cessation program or support group.
There are many brands of nicotine gum available, such as Nicorette, and they're available in different flavors. Nicotine gum works by delivering nicotine orally through the lining of the mouth and into the bloodstream. The dose you receive depends on the number of pieces that you chew and their strength.
For best results, you must chew nicotine gum slowly, for about 30 minutes. Most doctors advise that you give each piece of gum a few chews and then tuck the gum into your cheek, where it can slowly release its nicotine, instead of chewing the gum constantly. This way the release of nicotine is more continuous. You will likely need to chew one piece of nicotine gum every one or two hours for one to three months.
Advantages
  • Nicotine gum is easily available.
  • You can easily adjust the dose of nicotine gum.
  • Nicotine gum delivers nicotine safely (without the other toxins, such as the tars and carbon monoxide, found in cigarettes).
Disadvantages
  • Some people don't like the taste.
  • Nicotine gum may cause hiccups.
  • If chewed frequently, nicotine gum can lead to jaw ache.
  • Nicotine gum may cause stomachache.

Nicotine Sprays And Nicotine Inhalers
Both nicotine sprays and nicotine inhalers require a prescription. Their short-term effectiveness is equal to that of nicotine patches and gum.
Nicotine spray is squirted directly into the nostrils. Because nicotine spray delivers nicotine directly through the respiratory system, the dose is delivered faster than it is by other nicotine-replacement methods. And the dose is potent, creating nicotine levels in the blood that are comparable to those achieved by smoking. This method effectively decreases nicotine cravings when used for about three months.
Nicotine inhalers use nicotine cartridges that deliver nicotine through a plastic device that looks similar to a cigarette. The nicotine is absorbed orally and then enters the bloodstream. Nicotine inhalers mimic smoking in that they offer a quick fix of nicotine as needed, unlike nicotine patches, which deliver nicotine in a steady stream. In addition, the use of nicotine inhalers simulates cigarette smoking because you hold the inhaler like a cigarette. (Many ex-smokers miss holding a cigarette in their hand.) The inhaler is used for six months.
Advantages
  • Nicotine sprays and nicotine inhalers are good options for heavy smokers who have not had success with a patch or gum.
Disadvantages
  • These methods are less convenient than patches or gum.
  • These methods need to be used frequently to be effective.
  • These methods may cause burning or irritation in the nose or throat, as well as coughing.
  • The effectiveness of these methods has not been studied as thoroughly as other nicotine replacement methods.

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Bupropion

Bupropion (Zyban, Wellbutrin) is a nicotine-free prescription drug available for smoking cessation. This drug is an antidepressant that also decreases nicotine cravings. Up to 30% of smokers who use bupropion are able to quit smoking. The success rate is even higher if bupropion is combined with another smoking cessation method, such as the nicotine patch.
Bupropion is believed to stimulate the same brain chemicals (dopamine and others) that nicotine stimulates. Keeping these brain chemicals at a constant level during smoking cessation reduces the severity of withdrawal symptoms.
Bupropion therapy usually lasts for about seven to 12 weeks, starting a week before you stop smoking.
Advantages
  • Bupropion is easy to use.
  • Compared with other smoking cessation methods, bupropion is associated with the least amount of weight gain.
  • Bupropion is nicotine-free.
Disadvantages
  • Bupropion may cause dry mouth.
  • Bupropion may cause tremulousness, anxiety, insomnia or vivid dreams.
  • You can't use this medicine if you have a seizure condition or if you have a history of a serious eating disorder such as anorexia.

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Varenicline

Varenicline (Chantix) is a nicotine-free prescription drug. This medicine reduces withdrawal symptoms and cravings. It also reduces the amount of pleasure that you may feel from smoking after a relapse. Based on the studies that have been done, it may be slightly more effective than other currently available treatments. Varenicline has some worrisome side effects including mood changes and depression. Also it may interfere with a person's ability to safely operate heavy machinery.
Varenicline is used for 12 weeks after you quit smoking. Some doctors recommend using the medicine for an additional 12 weeks, to help limit the likelihood of a relapse. Varenicline is not intended to be combined with the nicotine patch or other forms of nicotine replacement.
Advantages
  • Varenicline may be slightly more effective than other currently available treatments to help you quit smoking.
  • Varenicline is nicotine-free.
  • Varenicline may help minimize relapses, because it reduces the pleasure you get from smoking.
Disadvantages
  • There may be an increased risk of non-fatal heart attacks in people that already have cardiovascular disease.
  • Possible serious side effect of depression, sometimes with suicidal thinking.
  • Other possible side effects include nausea, headache, gas, insomnia and changes in dreaming patterns.
  • There are new concerns about how it may interfere with operating heavy machinery.
  • This is a relatively new drug, so there is little known about long-term safety.
  • The medicine must be taken twice a day.

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Nortriptyline

Nortriptyline (Aventyl, Pamelor) is a nicotine-free prescription drug used to treat nerve pain (neuropathy) or depression more often than it is used to help with smoking cessation. However, a fairly small study funded by the U.S. Veterans Administration found that this drug can help to reduce cravings when it is combined with the nicotine patch. The study demonstrated an equivalent improvement in quitter success at six months for nortriptyline and the patch, compared with bupropion and the patch. Nortriptyline is an old-fashioned and very inexpensive medicine.
To maximize your quit efforts, nortriptyline should be used for two to three months after you stop smoking.
Advantages
  • Nortriptyline is inexpensive.
  • Nortriptyline improves quit rates in combination with the nicotine patch.
  • Nortriptyline has been used as a drug for a long time, so long-term safety is well known.
Disadvantages
  • Side effects include drowsiness, dry mouth and constipation. These side effects typically diminish after you have taken the medicine at a steady dose for a week or longer, but they did cause one in every seven or eight people in the smoking study to stop taking the medicine within the first seven weeks of treatment.
  • You should not take this drug if you have significant heart disease, since high doses can trigger a heart rhythm change in people with previous cardiac illness.
  • Nortriptyline has not been studied as a stand-alone drug for smoking cessation, but only in combination with the nicotine patch.)

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Alternative Treatments

Acupuncture, hypnosis and biofeedback are alternative treatments that people try most frequently. There is no evidence, however, that any complementary and alternative medicine approach is effective for smoking cessation.

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Last updated June 06, 2014


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