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How to quit smoking: the methods with the best evidence

Updated Six Habits Editorial Team
A father putting out a cigarette in a bin as his small daughter waves to him from a window
The short answerNicotine replacement therapy (patches, gum, lozenges) raises the chances of quitting by about 50% to 60%. According to Cochrane reviews, the most effective options are varenicline and combining a patch with a short-acting nicotine product. Combining medication with counseling gives the best results.

Key points

Why quitting is hard

Nicotine is highly addictive. Most people who smoke want to quit, and many try several times before succeeding. That is normal; each attempt increases your chances.

What the science says

Nicotine replacement therapy. A Cochrane review of 133 trials found that all forms of NRT (patch, gum, lozenge, inhaler, nasal spray) increased the chances of quitting by about 50% to 60% (Hartmann-Boyce et al., 2018).

Comparing medications. A Cochrane network meta-analysis found that varenicline and combination NRT (a patch plus a fast-acting form) were more effective than single forms of NRT or bupropion (Cahill et al., 2013).

Safety. The EAGLES trial of more than 8,000 people, including people with psychiatric disorders, found no significant increase in serious neuropsychiatric events with varenicline or bupropion compared with nicotine patch or placebo (Anthenelli et al., 2016). The FDA removed the boxed warning for varenicline in 2016.

Benefits start quickly and add up

Within weeks, circulation and lung function improve. After a year, the excess risk of heart disease is about half that of someone who still smokes. Quitting before 40 gains about 10 years of life (Jha et al., 2013).

A 5-step plan

  1. Set a quit date within the next two weeks.
  2. Talk to your doctor or pharmacist about medication.
  3. Get support: call 1-800-QUIT-NOW, text QUIT to 47848 or use the free quitSTART app.
  4. Prepare: remove cigarettes, lighters and ashtrays; identify triggers.
  5. Plan for cravings and slips; a slip is not a failure.

When a craving hits

Frequently asked questions

How long do cravings last?

Each craving usually passes within 5 to 10 minutes. Physical withdrawal peaks in the first few days and eases over 2 to 4 weeks.

Is it better to quit cold turkey or cut down first?

Both can work. Setting a quit date and using medication and support gives the best odds.

Sources

  1. Hartmann-Boyce et al. (2018). Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews 2019(1). doi:10.1002/14651858.CD000146.pub5
  2. Cahill et al. (2013). Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database of Systematic Reviews 2015(7). doi:10.1002/14651858.CD009329.pub2
  3. Anthenelli et al. (2016). Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. The Lancet 387(10037):2507-2520. doi:10.1016/S0140-6736(16)30272-0
  4. Jha et al. (2013). 21st-Century Hazards of Smoking and Benefits of Cessation in the United States. New England Journal of Medicine 368(4):341-350. doi:10.1056/NEJMsa1211128
  5. National Cancer Institute. Smokefree.gov. smokefree.gov

Prepared according to our evidence methodology and the principles of lifestyle medicine. For education only; it does not replace advice from your doctor.

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