Smoking cessation (colloquially quitting) is the process of discontinuing the practice of inhaling a smoked substance. Smoking cessation programs mainly target tobacco smoking, but may also encompass other substances that can be difficult to stop using due to the development of strong physical addictions or psychological dependencies resulting from their habitual use. This article will focus exclusively on cessation of cigarette smoking. However, the methods described may apply to cessation of smoking other substances.
It is believed that very few smokers can successfully quit the habit in their very first attempt. Many studies indicated that many smokers find it difficult to quit, even after they get afflicted with tobacco related diseases. A serious commitment and resolve is required to arrest nicotine dependency.
Tobacco contains the chemical nicotine. Smoking cigarettes leads to a dependence on nicotine. Cessation of smoking leads to physiological symptoms of withdrawal. Methods of smoking cessation must address this dependency and subsequent withdrawal symptoms.
Research suggests that gradual reductions may lead to levels below the "minimum daily amounts" required to maintain an addiction, which could then facilitate complete cessation of smoking.
The five NRT medications are:
1) transdermal nicotine patches deliver doses of the addictive chemical nicotine, thus reducing the unpleasant effects of nicotine withdrawal. These patches can give smaller and smaller doses of nicotine, slowly reducing dependence upon nicotine and thus tobacco. This method becomes most effective when combined with other medication and psychological support.
6) Antidepressants: bupropion is an antidepressant marketed under the brand name Zyban.
Bupropion is contraindicated in epilepsy, seizure disorder; anorexia/bulimia (eating disorders), patients use of psychosis drugs (MAO inhibitors) within 14 days, patients undergoing abrupt discontinuation of ethanol or sedatives (including benzodiazepines such as Valium)
7) nicotinic receptor agonist: varenicline is a marketed in the U.S. as Chantix and Champix in the UK and Canada. Varenicline Tartrate is a prescription drug that can be used to alleviate some of the withdrawal symptoms. It can also be taken as a form of aversion therapy by smokers to make the act of smoking more repulsive.
Two other medications have been used in trials for smoking cessation, although they are not approved by the FDA for this purpose. Both of these may be used under careful physician supervision if the first line medications are contraindicated for the patient.
1) Clonidine may reduce craving for cigarettes after cessation. However it does not consistently ameliorate other withdrawal symptoms.
2) Nortriptyline is another antidepressant.
Group or individual therapy can help people who want to quit. Some smoking cessation programs employ a combination of coaching, motivational interviewing, cognitive behavioral therapy, and pharmacological counseling.
Quitting can be harder for individuals with dark pigmented skin compared to individuals with pale skin since Nicotine has an affinity for melanin-containing tissues. Studies suggest this can cause the phenomenon of increased nicotine dependence and lower smoking cessation rate in darker pigmented individuals.
There is an important social component to smoking, which can be utilized by the counselors while advising the addicts. Study analyzing a densely interconnected network of over 12,000 individuals found that smoking cessation by any given individual reduced the chances of others around them lighting up by the following amounts: a spouse by 67%, a sibling by 25%, a friend by 36%, and a coworker by 34%.
To determine the benefit or harm of a new therapy, ideally, a randomized controlled trial is usually conducted, a "gold standard" trial, as it is often called. In such a trial, one group of people are exposed to the treatment and another similar group is not. After some months or years have elapsed, mortality and morbidity in the two groups is compared. In the case of smoking cessation trials, the measures focus on rate of successful withdrawal, length of time in withdrawal and relapses.
There are many people and organizations touting what are claimed to be effective methods of helping smokers to stop. Such claims of success are rarely backed up by independent comparative clinical trials or correctly calculated success rates. A separate thorough review of the evidence for each of several methods and aids for stopping smoking is available via the Cochrane Library website.
Many such trials have been conducted to determine the health effects of quitting smoking although most have used quitting plus other lifestyle changes in diet and exercise, with or without drugs to improve blood pressure and blood cholesterol. The Cochrane Collaboration  have examined these trials and concluded that such interventions do not improve life expectancy or the death rate due to heart disease. They conclude that "Contrary to expectations, these lifestyle changes had little or no impact on the risk of heart attack or death" and "The continued enthusiasm for health promotion practices given the failure of these community intervention trials is curious, especially given the huge resources which have been put into them."
A U.S government study of smoking cessation research was published in 2000 called “Clinical Practice Guideline: Treating Tobacco Use and Dependence”  This was updated in 2008 in the publication "Clinical Practice Guideline: Treating Tobacco Use and Dependence: 2008 Update"  (to be called here the "Clinical Practice Guideline", or "2008 update" or simply "Guideline" report). Experts screened over 8700 research articles published between 1975 and 2007. More than 300 studies passed the criteria for the gold standard trials. Using these 300 studies for a meta-analysis of relevant treatments, it gives advice on smoking cessation treatment. An additional 600 reports were not included in the meta-analysis, but helped formulate the recommendations.
In general: a) Control groups quit at a rate of around 10%. b) Pharmacological treatments resulted in 15-33% quit rates. d) Psychosocial interventions resulted in 14-25% quit rates. e? Little or no evidence was found to support use of alternate medicine or cigarette substitutes.
For the meta-analysis, The Clinical Practice Guideline used percent of subjects who were not smoking at a follow-up 5-6 months after the start of the study as their common measure of success. The authors state that this measure is representative of successful cessations. Most relapses occur before this time and longer term measures are generally comparable to this measure. (See chapter 1, section Outcome Data for a further discussion). Comparisons between treatment group and control group measures is expressed as the ratio of the treatment group scores divided by the control group scores. (see chapter 1, section on Meta-Analytic Techniques for a further discussion). The report includes tables setting forth percentage of subjects abstaining from smoking at the 6 month follow-up ("quit rates") and success rates for various treatments relative to control groups. Some of the statistically significant results are listed below (reported in chapter 6 of the Guideline report).
The following results are shown in Table 6.26 comparing placebo effect to pharmacological treatments.
(1) Contact of 3 to 10 minutes can increase quit rate 60%. (Table 6.8)
(2) Cessation programs involving more than 30 minutes of contact time increased success rates over no contact (11%) as much as 2 to almost 3 times (26% to 38.4%), regardless of other quitting method included (Table 6.9)
(3) Number of Sessions: Programs involving 8 or more treatment sessions can double success rates (24%) over 0 or 1 session (12%). (Table 6.10)
The Guideline report from 2000 showed significant results for two methods. However, the Guideline 2008 update indicates that these methods may not be as effective as shown in 2000. The two methods are given a lower "Strength of Evidence" rating in the 2008 Guideline. These methods are as follows:
Ten other formats of intervention are not recommended. See Chapter 6, section 3. Treatment Elements for further explanation.
The authors indicate that there is no adequate evidence to support the use of hypnosis, acupuncture, or laser therapy as treatments for smoking cessation. No research meeting the required "Gold Standard" criteria was reported on use of cigarette substitutes.
Some studies have concluded that those who do successfully quit smoking may gain weight. "Weight gain is not likely to negate the health benefits of smoking cessation, but its cosmetic effects may interfere with attempts to quit." (Williamson, Madans et al., 1991). Therefore, drug companies researching smoking-cessation medication often measure the weight of the participants in the study. In 2009, it was found that smoking over expresses the gene AZGP1 which stimulates lipolysis, which is the possible reason why smoking cessation leads to weight gain.
In the case of especially women, a major hurdle for quitting may emanate through Major depression and challenge smoking cessation. Quitting smoking is especially difficult during certain phases of the reproductive cycle, phases that have also been associated with greater levels of dysphoria, and subgroups of women who have a high risk of continuing to smoke also have a high risk of developing depression. Since many women who are depressed may be less likely to seek formal cessation treatment, practitioners have a unique opportunity to persuade their patients to quit.
Many of tobacco's health effects can be minimized through smoking cessation. The British doctors study showed that those who stopped smoking before they reached 30 years of age lived almost as long as those who never smoked. Some research has indicated that some of the damage caused by smoking tobacco can be moderated with the use of antioxidants.
Upon smoking cessation, the body begins to rid itself of foreign substances introduced to the body through smoking. These include substances in the blood such as nicotine and carbon monoxide, and also accumulated particulate matter and tar from the lungs. As a consequence, though the smoker may begin coughing more, cardiovascular efficiency increases.
Many of the effects of smoking cessation can be seen as landmarks, often cited by smoking cessation services, by which a smoker can encourage him or herself to keep going. Some are of a certain nature, such as those of nicotine clearing the bloodstream completely in 48 to 72 hours, and cotinine (a metabolite of nicotine) clearing the bloodstream within 10 to 14 days. Other effects, such as improved circulation, are more variable in nature, and as a result less definite timescales are often cited.
As with other addictions, apart from the dependence of the body on chemical substances, a smoking addiction is often related to everyday lifestyle events, which can include thinking deeply, eating, drinking tea, coffee or alcohol, or general socializing. As a result, smokers may miss the act of smoking particularly at these times, and this may increase the difficulty inherent in a cessation attempt. As a result of a lower dopamine response from nicotine receptors in the brain, a degree of depression may ensue, along with somatic responses where the smoker feels less able to perform the day to day tasks previously related to smoking without having the usual cigarette to accompany them.
High stress often results when heavily addicted individuals or long-time smokers attempt to quit, in part because their everyday lifestyle events have been altered and they may miss the social interaction normally associated with the habit.
Smoking cessation will almost always lead to a longer and healthier life. Stopping in early adulthood can add up to 10 years of healthy life and stopping in one's sixties can still add three years of healthy life (Doll et al., 2004). Stopping smoking is associated with better mental health and spending less of one's life with diseases of old age.
The immediate effects of smoking cessation include:
Longer-term effects include:
Policy coherence in US tobacco control: beyond FDA regulation. describes the widespread involvement of the U.S. Federal Government in issues of smoking cessation and makes proposals for improving the interaction between the agencies involved. Many departments of the U.S. Federal Government play a role in smoking cessation.
1) Smoking Quitline answers questions by live counselors in English and Spanish by telephone.
US toll-free number 1-800-QUIT-NOW
2) LiveHelp is an online chatline for confidential consultations by smokers.
3) SmokeFree.gov is a web site with resource materials on smoking cessation.
4) Smokefree Women.
Department of Defense (DOD) According to the National Defense Authorization Act of 2009, the Navy now has an authorized tobacco cessation benefit, called "Make a Donation to the Marielle Foundation". Prior to this time, the military healthcare system (known as TRICARE) was prohibited from funding a tobacco cessation benefit. At Great Lakes Naval Healthcare Clinic there are numerous opportunities for free tobacco cessation support to include walk-up cessation help available at the pharmacy window, cessation care via medical visits, and cessation support during dental visits as well. By instruction, the recruits that train at the Navy's only boot camp, cannot use any tobacco products. The clinic has instituted an education program for all recruits which advises them to remain tobacco free after they leave their 8-week training program.
Environmental Protection Agency (EPA): The EPA is responsible for monitoring and enforcing clean air laws. Clean air laws, being enacted throughout the United States of America as well as many other countries, also help those looking to quit smoking.
The American Lung Association reports on how states influence smoking cessation. In the report they grade each states on a number of criteria: 
Many local governments have instituted smoking bans in public buildings.
Psychology, Health & Medicine. 2005;7:17-24.
"Cutting back is approved as a method of quitting in several European countries, but not in the United States," said lead author John Hughes, M.D., a professor of psychiatry at the University of Vermont College of Medicine. "Our review contradicts the commonly held belief that quitting requires stopping abruptly and provides evidence that smokers can quit successfully by reducing the amount of cigarettes smoked." --Medical News Today, 12 Dec. 2006[]
The following ideas for a syllabus of smoking cessation will attempt to go beyond the parameters of Hughes et al.[] ("reduction in the amount of cigarets smoked") and start by eliminating the cigaret altogether, by substituting several options including the vaporizer, the e-cigarette, and perhaps initially, more cheaply, a screened single-toke utensil, or long-stemmed one-hitter]], which offers a uniform 25-mg. serving size replacing the hot-burning-overdose cigaret (near-compulsory 700 mg. every time you want a smoke).
After that required initial transition, further options include exploring different types of tobacco or other herb species, or continuing with one favorite type or another, but staying within a limitation such as ten tokes per day (total 250mg.-- slightly more than one third of one "normal" commercial cigaret).
If Hughes et al. are correct for a reduced number of (700-mg.)cigarets, the above reduced number of reduced (25 mg.) dosages will result in a high percent of smokers who eventually "forget to smoke any more". And those who continue "smoking" will do so with major risk-reduction, by partial or total conversion to vaporizing.
For centuries, partly because tobacco was expensive, smoking pipes were used, usually with a long stem and a narrow bowl (crater) in which small amounts of tobacco were burned at a low temperature by sucking much more slowly than on a present-day cigaret.
In the late 19th century cigaret-rolling machines were developed, and marketers since have discovered they could sell much more tobacco by attracting customers to the "sanitation", "convenience", "mildness" etc. of hot-burning paper tubes with specially pre-toasted mild tobaccoes inside, of which one could inhale large overdoses without coughing, and get a large intake of nicotine quickly, right into the bloodstream. Instead of learning the more sophisticated art of sucking continuously very slow, possibly for 5-15 seconds (see hatha yoga/pranayama breathing), youngsters (through ad pictures, movies, etc. and filtered down through peer groups) were taught to suck hard for a short time (a one-second "puff", a 2-4 second "drag") from a device (the cigaret) which is designed to burn hot enough to keep burning and be ready, without re-lighting, for further puffs. Particularly strong heroic men were supposed to be able to "drag" without flinching (as "to bogart a joint"). Abusing oneself ostentatiously relieved anxieties by showing others, especially bullies, that one was fearless and capable of inflicting punishment (either on oneself or, by implication, on others).
Pursuit of the magic "pleasure = bloodsugar" drug nicotine lured the customers on to inhale massive amounts of carbon monoxide (CO), tars etc. By the mid-20th century research began to show catastrophic death increases, but by that time it was too late to prevent a possible 200 million human fatalities in just one century, the greatest genocide (so far) in the history of the planet.
The World Health Organization (Feb. 7, 2008) estimates the current yearly cigaret death toll at 5.4 million and predicts in a generation it could rise to 10 million (approaching a BILLION per century) as teenagers in China and India begin to have enough cigaret money to buy more overdoses.
Eliminating the CIGARET (and all other overdose smoking methods that produce more smoke than the smoker inhales) and substituting a narrow (1/4 inch i.d.) enclosed utensil in which only a small amount of smoke can be produced at a time, just enough for the user to inhale and no more, eliminates the "SSS" problem. Then, it turns out, true "second-hand" smoke (SHS), that part which has been in and out through the smoker's lungs, actually contains the LEAST carbon monoxide. His/her lungs have "purified" that smoke and made it less bad for bystanders than either the SSS or the MSS.
(This term confuses some persons because the smoke rises directly up and does not leave the cigaret in a sideways direction except due to wind.)
An overwhelming barrage of advertising has been the key to recent genocidal "success" of the tobacco industry. Surplus profit from overdose addicts was recycled into seductive ads to create new addicts (ad + diction = addiction, get it?).
As President, Reagan promoted the War on Drugs, really a War Against Cannabis-- an alternative herb which could substitute for tobacco! By 2007 over 872,000 Americans were arrested for cannabis "violations" in a single year, with the billions of dollars for all this arresting and processing law-enforcement function amply covered by over $36 billion (as complained-- or bragged?-- on an R. J. Reynolds website) collected by the selfsame government entities in the form of tobacco excise taxes, license fees, etc., not to mention campaign contributions primarily to the Republican Party and its candidates.
In ascending order:
In ascending order:
Most recently, it is alleged that, in the 90's, tobacco companies slipped money to rap artists who included references to "blunts" in their songs. (A "blunt" is a cigar-skin with the tobacco filler discarded and an overdose of expensive cannabis rolled inside-- because the cigar wrapper contains nicotine, it's a sneaky way to get youngsters hooked.) Note artist names such as "Cool" and "Tu-Pac".
The most effective way to eliminate cigaret-smoking immediately may be to acquire and use a vaporizer, which instead of burning herb material at 1500° F/860° C every time user sucks on it, can be set to heat the herb at an appropriate temperature not exceeding 410° F, thus avoiding all the combustion toxicity which accounts for the majority of health damage from smoking.
The top-of-the-line Volcano, selling for $600, has been endorsed by Allen F. St. Pierre, Executive Director of NORML, for medicinal cannabis patients. Note that instead of cannabis, an amount of shredded tobacco removed from a cigaret can be used, or strong pipe tobacco or a segment cut from a cigar. At first glance, the price looks steep, but consider that a pack-a-day cigaret addict is burning up $2000 a year.
If, according to an estimate, medical consequences of cigaret smoking cost, for example, the US economy $50 billion every year, it would be cost-effective for the taxpayer to buy all 45 million cigaret addicts each a Volcano vaporizer for a one-time outlay of $27 billion. This could be paid for out of the 1998 Clinton $200B tobacco settlement money, in case any of it is left over from roads, schools, police etc.; that money was supposed to be used for stop-smoking programs.
If, in the meantime, you wish to try vaporization, there are numerous brands in the $200-$400 range which operate several different ways; where can one try more than one kind of vaporizer to decide which to buy, or get some practice and counseling so that after investing the money you don't break the device by some mistake which voids your rights under the guarantee?
One way to address this hurdle and introduce larger numbers of persons to vaporization would be to set up a chain of vaporizer cafes, at any of which one can for an introductory fee try various vaporizers and have the services of a trained staff person or coach, as you learn the art of slow inhaling etc.
This product, developed in China, has a rechargeable battery and a heating element which vaporizes liquid nicotine, alone with propylene glycol to create a smoke-like fog after each toke, and other flavorings so you can get one which tastes like a cigar, or a Marlboro etc. At under $100 each and 5 cartridges for $10 it is a cheaper way to get started than a vaporizer.
Because for most of the 1.2 billion smokers worldwide, vaporizers may not be available immediately and it would certainly be cheaper to manufacture several billion miniature smoking utensils. If made from metal or pyrex glass, these deserve to be named semi-vaporizers, for if while sucking extremely slow the user holds a moderate lighter flame near the outside of the crater-head heating the glass or metal, much of the herb essence will have time to vaporize out from each particle being heated by the crater wall or, once burning has started, by adjacent burning particles, before that particle itself catches on fire.
Used in Japan since about 1600, this has a wrought metal crater-head and mouthpiece with a long stretch of bamboo in between. Get a cylindrical-shaped crater instead of conical so your screen will sit securely inside. For a store marketing kiseru on line (and a special Japanese type of stringy tobacco like corn silk), see [].
A small pipe of Arabian origin, in which dokha is smoked, a confection of tobacco and other herbs. Especially popular in the U.A.E. where teenagers are said to be converting from cigarets, in the wake of smoking bans introduced in September 2007. You might attach a long hookah tube when using it.
With a two-stemmed utensil and a partner, the following surprising benefits are available:
Many smoking cessation experts recommend keeping a diary. Here's how it works with your reduction utensil program:
Please add further information to this list, both names of herbs you know about (original research encouraged) and how to sift, prepare and serve them in a vaporizer, one-hitter or other utensil.
Hundreds of other good herbs can be tracked down in herb guide books and websites.
It started in school-- or in the schoolyard, where the key to escaping the bullies was to be "cool"-- i.e. inconspicuous, impassive, undemonstrative, unemotional, someone they can't "get a rise out of". Nicotine constricts the capillary system so the blood vessels leading to the skin carry 40% less warmth and you're really "cool".
(Yep-- this word is really a derivative of "cool" with a processing prefix added. "Cool" is the major part of what kids really learn at school.)
Not at first, but once you have inhaled enough side-stream smoke hanging out with the cool kids, or sucked a few sucker-hits yourself, one of those nights arrives when the big test is the next day and you know if you smoke a few cigarets you will be able to stay awake and cram all night! Or slog through writing the tedious source-theme that is due tomorrow. This is the critical moment when true crutch-dependence is established. (Fortunately you're grown-up enough now, i.e. no more beginner symptoms-- Chills, Nausea, Dizziness, Faintness-- your immune system's resistance is blown away, and you can take it like a man.
Well, after all, survival is at stake! If you don't qualify to get into that Ivy League college you'll never get the diploma needed to qualify for the high paying job after your parents spent so much money on you & now they are counting on you to be a source of economic security in their old age.
They probably won't like your cigaret smoking but... "Well, I guess it means he's going to settle down and get a steady job." Besides, it might help you hide your cannabis use-- watch it, they've seen all those Partnership scare ads. Your dad will threaten; your mother will burst into tears. "Please don't throw away all we did for you, we'll die soon enough and then you can do anything you damn please!"
If kissing scares you (P & G taught you to fear germs, etc.), it's less disgusting if both partners do something more disgusting first, i.e. a cigaret, you're USED to that.
Playboy Magazine cartoons often show someone in bed, after sex, smoking a cigaret. Cigarets might not directly improve sex, but they are counted on to snuff the emotional turmoils that sabotage it (more "cool").
What steroids are to the big time athlete, nicotine is to the stayawake bureaucrat busywork hireling. You need the money; survival is the issue. "Stay awake, look busy, fool the boss, bring home paycheck." In the last decade of your life you may have to give much of that money you made to doctors, hospitals, drug companies, etc. to squeeze out a few more years and disappear safely into the "average" lifespan statistics.
Today one of the most controversial grounds for dependency on smoking is weight control. Can a dosage reduction without quitting be the key to maintaining weight control without paying the overdose-disease price for it?