Tips to Stop Smoking
You might associate cigarette smoking with lung disease or lung cancer. But smoking can harm nearly every organ of the body, from the heart to the reproductive system.
Cigarette smoking rates have fallen from 20.9% in 2005 to 11.5% in 2021, according to the Centers for Disease Control and Prevention (CDC). This change is due to a greater understanding of the harms smoking causes and public awareness campaigns. However, smoking remains a huge public health concern in the United States. The CDC reports cigarette smoking kills more than 480,000 Americans each year.
“Cigarette smoking is the leading preventable cause of death in the U.S, and people who smoke compared to those who don’t lose up to 10 years of life expectancy,” says Nancy Rigotti, MD, a Mass General Brigham primary care doctor. Dr. Rigotti founded and directs the Tobacco Research and Treatment Center at Massachusetts General Hospital.
Fortunately, there are many options to help people stop smoking. Dr. Rigotti shares tips for how to quit smoking for once and for all.
“It’s never too early to quit,” says Dr. Rigotti. “The sooner the better. But it’s also never too late.”
How is cigarette smoking addictive?
Dr. Rigotti explains that smoking is addictive in two ways:
Addiction to nicotine: Nicotine is the addictive substance in tobacco products, and it causes chemical changes in the brain that result in a feeling of euphoria. Over time, the body adapts and requires more nicotine to get the same effect, causing addiction.
Association with habits: Smoking cigarettes becomes a part of someone’s lifestyle, associated with certain types of situations or cues (like finishing a meal or taking a break from work). These cues can trigger cigarette cravings.
What are the symptoms of nicotine withdrawal?
Nicotine withdrawal typically starts within a few hours of the last cigarette, and peaks 2 to 3 days later. “It gradually gets better over a couple of weeks, and is mostly gone by a month later,” says Dr. Rigotti.
Symptoms of nicotine withdrawal can include:
The urge or craving to smoke
Feeling irritable, impatient, restless, and angry
Having trouble sleeping
Difficulty concentrating
Feeling hungry or gaining weight
“People often don’t recognize that they are in withdrawal, because the symptoms of nicotine withdrawal can be subtle. If they have a cigarette, it makes those symptoms go away. People then believe that smoking relieves stress and discomfort—but really, they’re just treating their nicotine withdrawal,” Dr. Rigotti says.
If you get stimulated by a cue that reminds you of smoking, you can still get intense cravings for cigarettes, even long after the physical symptoms of withdrawal leave the body.
Most successful ways to quit smoking
Seven in 10 current smokers want to quit and wish they didn’t smoke.
“We know that more than half of people who are smokers say they tried to quit last year, and they went at least 24 hours without smoking. There are a lot of quitting attempts being made, but many of them are not successful for the long term,” Dr. Rigotti says.
Fortunately, there are many solutions that can help people stop smoking. People are more successful if they use multiple approaches.
“Only 7% of people who quit ‘cold turkey’ will succeed in quitting for a year. You’re going to be more successful if you use a medication, if you use behavioral support, and you prepare in advance,” Dr. Rigotti recommends.
Medication therapy to stop smoking
There are 3 types of medicines that are FDA-approved for stopping smoking.
Nicotine replacement: Nicotine replacement medications include patches, gum, lozenges, a nasal spray, and an inhaler. They’re available over the counter or by prescription (sometimes covered by health insurance). Each one is effective by itself, but combining the patch and the gum or lozenge helps more people to quit than using only one of these products.
Buproprion: An antidepressant that also helps people quit smoking.
Varenicline: A medication that works on nicotine receptors in the brain to reduce withdrawal symptoms and the rewarding feeling that a cigarette provides.
“They’re all more effective than a placebo. And we now know that these therapies can be used together. It’s better to combine two types of nicotine replacement therapies to reduce cravings and give a steady level of nicotine than to use just one of these products. Combining varenicline and nicotine replacement therapies can also be very helpful,” says Dr. Rigotti.
Dr. Rigotti recommends working with your primary care provider (PCP) to find the best approach for you. They can help you develop a plan to stop smoking and help you manage your symptoms.
Behavioral therapy and social support to stop smoking
Behavioral therapy and social support can help break the habits that make it so hard to leave smoking behind. “They help people break the connection between having a craving and picking up a cigarette,” Dr. Rigotti says. “It’s being equipped with simple habit change strategies that can really work.”
Make lifestyle changes can also help change your habits:
Remove temptation and get rid of cigarettes and ashtrays from your home.
Avoid being around people who are smoking, or other triggers that may induce a craving.
Get support and encouragement from family members, friends, or ex-smokers.
Distract yourself by staying active, exercising, and establishing new routines.
Other support systems include:
1-800-QUIT-NOW is a national helpline that connects people to evidence-based support, like referrals to local programs, addiction coaching or counselling, and sometimes free medication.
Free online resources like gov/quit or smokefree.gov
Free texting programs or mobile apps to stop smoking, like Smokefree TXT or QuitGuide
“For the many people who say they've tried everything, they haven't really gotten the behavioral support that they really need because quitting smoking is more than just treating nicotine addiction. It’s breaking a longstanding habit, and people have to find other ways to handle things like finishing a meal or handling stress,” explains Dr. Rigotti.
Benefits of stopping smoking
Stopping smoking can help you:
Increase life expectancy
Lower the risk of 12 types of cancer, including lung, cervix, colon, and mouth and throat
Lower the risk of heart conditions like coronary artery disease, AFib, heart failure, and heart attack
Reduce the risk of stroke
Reduce the risk of developing COPD, and slow the progression of existing COPD
Have a healthier pregnancy and baby, reducing the risk of miscarriage, premature birth, and birth defects
Some people who have smoked for a long time may believe that it’s not worth quitting. That assumption is false, says Dr. Rigotti.
“Everybody who smokes, even if they’ve smoked for many years and already have a tobacco-related disease, can benefit from quitting. We know that stopping smoking reduces your cardiovascular risk very rapidly. Even if you’ve smoked for many years, quitting makes a huge difference very quickly,” she says.
