Smoking is a notoriously difficult habit to give up.

According to Action on Smoking and Health (ASH), two thirds of smokers want to quit. But a significantly lower number (30-40%) will actually attempt to do so over the course of a year.

The good news for public health is that the number of smokers in general is in decline. The same report from ASH notes that since 1974, when around half of adults smoked, rates in the UK have halved. Only 19 percent of adults in Britain smoke.

There are perhaps a number of reasons behind this drop.

Firstly, the health risks of smoking (heart disease, several forms of cancer and COPD to name just a handful) are much more widely known today than they were 40 years ago, and awareness campaigns in the interim have done much to educate people of these risks.

Secondly, several market restraints have been placed on the cigarette trade to try and reduce tobacco consumption. Taxes on cigarettes have risen, so they have become exponentially more expensive. Advertising and sponsorship restrictions have also been put in place, so it is now very difficult in the UK for cigarette companies to market their products to consumers.

And thirdly, the introduction of cessation methods, including nicotine replacement products, medication, and even motivational support programmes, means that there are more options available to those looking to quit than ever before.

The goal of every smoker should be to give up. Doing so will help to reduce the chances of associated illnesses, and those who succeed in stopping will inevitably notice that their overall health improves.

Of course every smoker is different. Just because a particular method of quitting works for one person doesn’t mean it will work for everyone.

Luckily, there are several different methods available for smokers to try; so if one particular technique doesn’t work, others options can be explored.

These include:

  1. Prescription smoking cessation medicine (Zyban and Champix)
  2. Nicotine replacement therapy
  3. Electronic cigarettes
  4. Cold turkey

Prescription smoking cessation

There are two prescription medications available which have been designated specifically for smoking cessation.

When someone takes these medicines, they will stop smoking shortly after starting the course. The treatments function by reducing the extent of nicotine withdrawal.

Zyban is manufactured by GlaxoSmithKline and was approved in 1997. It contains an ingredient called bupropion and is typically given as a nine-week course. It helps the user to quit smoking by preventing the reuptake of certain chemical neurotransmitters in the brain, which are usually stimulated by nicotine inhalation.

This means that the person taking the medicine doesn’t feel the effects of withdrawal as much as they normally would from quitting.

Champix is a tablet medicine made by Pfizer and was approved for use as a smoking cessation aid in 2006.

It is taken in a similar fashion to Zyban. Users will begin on a low dose then typically up their dose to coincide with their quit date. The course usually lasts for up to 12 weeks and a doctor will decide at this point whether to reduce or discontinue the treatment.

The functioning agent in Champix is varenicline, which acts on nicotinic receptors in the brain to prevent nicotine withdrawal. It also has the added benefit of diminishing the effect of inhaled nicotine on these receptors, so that even if someone taking the medicine does smoke, they won’t feel the benefits of doing so.

These medicines aren’t suited to everyone. A doctor will have to assess a patient’s medical profile before issuing a prescription for either, as they both carry a risk of causing side effects. It’s also important to note that these medicines are intended to be used as part of a comprehensive cessation programme. This might include support in the form of counselling and regular monitoring with a healthcare professional.

Both medicines have shown to increase quit rates in clinical trials when compared to placebo.

Nicotine replacement therapy

For many years, nicotine replacement therapy was considered the go-to option for those needing help giving up. It is available in a range of forms, including transdermal patches, gum, lozenges and inhalers.

These items deliver nicotine into the body, replacing that lost through the cessation of smoking. This then reduces cravings to smoke.

Because of their varying delivery methods, the nicotinic load given by these items may differ.

For instance, nicotine patches tend to issue a dose gradually over the course of 16-24 hours, depending on whether or not the patch is removed at night.

The patch is replaced once per day, and is available in different dosage levels. Typically, someone will begin on a higher dose upon quitting smoking, then aim to reduce the dose over the course of several weeks.

Other nicotine replacement routes, such as gum, inhalers and lozenges, may deliver a shorter and less-sustained nicotine ‘hit’, and are more so aimed at reducing cravings on-demand.

Nicotine from oral NRT products such as gum and lozenges is taken up through tissues in the mouth into the bloodstream. They are chewed by the user in a specific way in stages, in order to ensure that the nicotine load is delivered efficiently. The beginning of the course will coincide with the quit date. Some brands advise that a course should last for 12 weeks, and again the aim is to slowly wean the user off nicotine by gradually reducing the dose.

Inhalation devices also deliver a nicotine load through the tissues in the mouth, and are preferred by some as the way they are used replicates the physical action of smoking.

There are several different brands of each item available. In some cases, a doctor may advise the use of more than one type of NRT to give a smoker the best chance at quitting. The dose and duration of the treatment used may depend on someone’s smoking habit; specifically how long they have smoked, and the number of cigarettes they typically smoked in a day.

A review of trials found that the use of NRT increases a person’s chances of quitting smoking from 50 percent to 70 percent. Other reviews have suggested that single NRT programmes effectively double the user’s chances of giving up.

You can find out more about nicotine replacement therapy by visiting the NHS Smokefree site.

Electronic cigarettes

Vapour emitting devices more commonly referred to as e-cigs have become widely used in recent years.

E-cigs arguably provide the closest replicatory action to smoking itself, as the devices are shaped like cigarettes and provides a similar ‘hit’.

The devices carry a liquid which contains nicotine. When this is heated, a vapour is produced which releases nicotine and is inhaled by the user. As it does not involve the burning of tobacco and containing chemicals, it enables the user to take up a dose of nicotine without inhaling the majority of toxins contained in cigarettes; Carbon monoxide and tar are not consumed through the use of e-cigs, but other harmful chemicals are, albeit it at significantly reduced levels when compared to regular cigarettes.

E-cigs have been stated by several studies to be significantly useful in helping smokers to give up cigarettes.

Their effectiveness has been found to be 60 percent more than NRT bought over the counter: ‘broadly similar’ to prescription medication with ‘limited behavioural support’; but less effective than the same with ‘specialised behavioural support’, according to the Smoking Toolkit Study.

The use of e-cigarettes has been the subject of extensive debate in recent years; because they are a new commodity, little is known about the long-term effects of them, and whether or not they may pose a health risk.

The NHS consider them a viable option particularly for those who have tried other methods of giving up and not succeeded, but still advise those who want to quit while using them to get advice from their stop smoking service.

Cold turkey

This is when someone stops smoking without using any form of smoking cessation aid. It relies solely on willpower and sometimes mental techniques and, in some studies compared to NRT, prescription medicine and the use of e-cigarettes, has been found to yield the least successful results. Quitting smoking cold turkey is widely seen as the most difficult route.

However, it is an approach which can work, and one which the majority of smokers looking to give up should be encouraged to try first.

The rate at which someone smokes and the duration for which they have smoked can make a huge difference when it comes to giving up cold turkey. Light smokers may be less conditioned to receiving nicotine regularly, and be better equipped to deal with the withdrawal caused by stopping. Heavy smokers however may have a harder task.

A portion of people who attempt to give up using this method do succeed, even if it is rarely an approach which provides the desired result the first time someone tries it. For instance, someone making several quit attempts using cold turkey may turn a corner and succeed on their second, third or fourth try.

So while on paper and in clinical trials it might not seem like the most effective way to give up, there’s no harm in trying it.

Those who are determined to give up smoking without using NRT or smoking cessation medication may still be able to find help from the NHS stop smoking service in the form of motivational support.

Page last reviewed:  02/01/2018