Smoking cessation: definition and strategies

Smoking cessation refers to the act of discontinuing smoking tobacco products, like cigarettes.

The smoking cessation strategies include pharmacotherapy, behavioral therapy, and combination therapy. Pharmacotherapy comprises nicotine replacement products like lozenges, gums, skin patches, inhalers, and sprays, as well as prescription medications like bupropion and varenicline.

What is smoking cessation?

Smoking cessation is the act of stopping smoking tobacco products like cigarettes. It is an abrupt act, colloquially known as going “cold turkey,” or a gradual process where an individual reduces the number of cigarettes they smoke per day before quitting altogether.

Smoking cessation is undertaken by individuals who want to overcome nicotine addiction and prevent the onset or halt the progression of tobacco-induced diseases. Overcoming tobacco addiction is possible via pharmaceutical and behavioral therapies, delivered alone or in combination. Smoking cessation programs have been consistently found to be clinically beneficial and significantly cost-effective compared to treatment programs for other disorders.

What are the smoking cessation strategies?

The smoking cessation strategies are listed below.

• Pharmaceutical therapy: Pharmacotherapy is a critical smoking cessation strategy that has been shown to reduce cravings, ease nicotine withdrawal symptoms, and promote and sustain abstinence from smoking, according to a 2024 article by Onwuzo et al., published in the journal Cureus, titled “A Review of Smoking Cessation Interventions: Efficacy, Strategies for Implementation, and Future Directions.” Nicotine replacement therapy (NRT), bupropion, and varenicline are the principal pharmaceutical interventions for smoking cessation. NRT products are available in different forms, such as lozenges, patches, gums, inhalers, and nasal sprays. The US Food and Drug Administration (FDA) has approved the use of these NRT products to deliver pharmacotherapy for nicotine dependence. It has been observed that combination therapy produces significantly more positive outcomes than monotherapy. These therapies include combining multiple NRT interventions or administering varenicline with NRT.
• Behavioral interventions: Non-pharmacological interventions like behavioral therapies have been shown to be effective as smoking cessation strategies. Behavioral therapy includes methods like cognitive behavioral therapy (CBT), motivational interviewing, contingency management or incentive-based interventions, and acceptance and commitment therapy, as noted in the chapter “Interventions for Smoking Cessation and Treatments for Nicotine Dependence” in the 2020 publication by the US Department of Health and Human Services, titled “Smoking Cessation: A Report of the Surgeon General [Internet].” These interventions are grounded in the tenets of behavioral and cognitive psychology. They aim to modify distorted and/or biased thoughts, perceptions, and beliefs that contribute to smoking habits and promote smoking cessation by teaching individuals techniques like setting and achieving goals, identifying triggers, and resisting urges to smoke to prevent a relapse. Behavioral interventions are delivered individually or in group formats by a mental healthcare practitioner, over the telephone, or as a computer-based module. They are brief or intensive, depending on specific patient needs and treatment goals.
• Integrated therapy: It has been proven that an integrated treatment plan that combines educational and behavioral therapy with pharmacotherapy is the most effective smoking cessation strategy, according to a 2023 article by Adler et al., published in the journal Tobacco Induced Diseases, titled “Smoking cessation – better together: A retrospective cohort study.” An integrated therapy is the most commonly employed method to quit smoking and has the potential to enhance the efficacy of smoking cessation interventions, increase treatment retention, and improve clinical outcomes.

What happens on smoking cessation?

Smoking cessation produces immediate benefits as well as withdrawal symptoms. The immediate benefits of smoking cessation include improved taste and sense of smell, according to the American Cancer Society in its web publication titled “Health Benefits of Quitting Smoking Over Time” last revised on 23 May 2025. Individuals notice that their breath, hair, and clothes smell better, and their fingernails and teeth stop yellowing. They are able to perform daily activities like doing light housework and climbing stairs without getting breathless. Smoking cessation produces withdrawal symptoms that manifest within 4-24 hours of having the last cigarette and peak on the second or third day of being tobacco-free. These symptoms subside within a few days to 3-4 weeks after stopping smoking.

At a physiological level, the benefits of smoking cessation are immediate. Heart rate and blood pressure levels reduce within 20 minutes of stopping smoking, and carbon monoxide levels in the blood fall to normal levels within 12 hours of smoking cessation, according to a February 2020 publication by the World Health Organization, titled “Tobacco: Health benefits of smoking cessation.”

Within 2-12 weeks of quitting, blood circulation and lung functionality improve, and symptoms like shortness of breath and coughing decrease within 1-9 months of stopping smoking tobacco. After a year of not smoking, the risk of developing coronary heart disease falls to half compared to that of a smoker. After 5-15 years of not smoking, the risk of stroke decreases to the level of a non-smoker. About 10 years of not smoking reduces the risk of developing lung cancer by about half compared to that of an individual who smokes. After 15 years of not smoking cigarettes, the risk of developing coronary heart disease falls to the level of a non-smoker.

What are the side effects of smoking cessation?

The side effects of smoking cessation are listed below.

• Cravings: It is possible for individuals who quit tobacco to experience cravings just 30 minutes after the last cigarette. These cravings are short-lived, but they come and go in waves. They range from mild ones to powerful urges.
• Physical effects: The physical effects of quitting smoking manifest as headaches, fatigue, sore throat, coughing, and chest tightness. Collectively, these symptoms are known as smokers’ flu because they mimic the typical flu-like symptoms. Tobacco smoke impairs the respiratory system and prevents it from clearing mucus and toxins, such as dust particles, from the lungs. Quitting smoking allows the respiratory system to clear mucus and cigarette tar and grow new tissue. These effects trigger coughing bouts and a sore throat. Withdrawal symptoms like sore throat worsen immediately after quitting tobacco, tend to peak on the second or third day, and typically resolve within a month. Other physical symptoms of smoking cessation include constipation, dizziness, dry mouth, nausea, and tingling in the hands and feet.
• Restlessness and impaired sleep: The U.S. Centers for Disease Control and Prevention, in its web publication titled “7 Common Withdrawal Symptoms-And What You Can Do About Them,” last reviewed on 27 September 2024, notes that feeling restless or jumpy is common during the first days or weeks after quitting smoking. Having trouble concentrating and/or sleeping are common side effects of smoking cessation that manifest during the first few days of having the last cigarette. Brain fog and issues like trouble focusing begin to resolve after 2-4 weeks of quitting smoking.
• Mood changes: Anxiety, depression, irritability, and anger are common psychological side effects of smoking cessation. Smoking tobacco alleviates stress, so anxiety manifests when nicotine starts to leave the body. Anxiety typically starts from the third day of quitting smoking and lasts a few weeks. Depression manifests on the first day after smoking cessation and tends to resolve within a month. However, individuals with a history of anxiety and depression are known to experience prolonged side effects after quitting tobacco that necessitate medical intervention.
• Increased appetite: Individuals who quit smoking experience an increase in their appetite within about a day of having the last cigarette. Smoking cigarettes triggers a release of dopamine and serotonin in the brain. These neurotransmitters curb hunger. So, when an individual quits smoking and nicotine is gradually cleared from the body, their appetite increases. A percentage of individuals experience cravings for carbs and sweets. A majority of individuals gain weight during the first 2 weeks of quitting smoking. However, this weight gain is counteracted by increasing physical activity, using nicotine replacement products like gums and lozenges, and taking bupropion prescribed by a physician.

What are the benefits of smoking cessation?

The benefits of smoking cessation are listed below.

• Improved respiratory health: Quitting smoking improves respiratory health by improving symptoms like coughing, wheezing, and excess sputum production, and reducing the risk of contracting infections and developing pneumonia and bronchitis. Stopping smoking reduces the risk of developing COPD (chronic obstructive pulmonary disease) or halts the progression of the disease and consequent loss of lung function in individuals already diagnosed with COPD. There is a reduction in the risk of blood clots forming in the legs that are likely to travel to the lungs.
• Decreased risk of developing cardiovascular diseases: The U.S. Centers for Disease Control and Prevention, in its release titled “Benefits of Quitting Smoking” and published on 15 May 2024, notes that quitting tobacco reduces the risk of developing cardiovascular ailments. Stopping tobacco consumption reduces inflammation and abnormal blood clotting; improves the levels of high-density lipoprotein cholesterol, or the “good cholesterol;” decreases the chances of developing subclinical atherosclerosis and/or stalling its progression; and reduces the risk of developing abdominal aortic aneurysm. It is possible that quitting tobacco decreases the risks of morbidity and mortality from stroke, atrial fibrillation, heart failure, venous thromboembolism, peripheral arterial disease, and sudden cardiac death.Individuals who stop using tobacco after having a heart attack decrease their risk of having another attack by 50%.
• Decreased risk of developing cancer: Stopping smoking cigarettes reduces the risk of developing 12 different cancers, including those of the bladder, lung, colon and rectum, kidney, liver, mouth and throat, voice box, pancreas, and stomach. Smoking cessation reduces the risk of developing acute myeloid leukemia. It is possible that cancer survivors who quit smoking improve disease prognosis and reduce the risk of premature mortality.
• Improved reproductive and newborn health : Smoking cessation decreases the risk of erectile dysfunction and infertility that is caused by damaged sperm. Quitting smoking reduces the risk of pregnancy complications like premature labor and miscarriage. Expectant mothers who quit smoking reduce the chances of their infants being born with a low birth weight and cleft lip.
• Improved health of infants and children who live with a smoker: The benefits of smoking cessation extend to the infants and children who live with an individual who smokes and thus are exposed to second-hand smoke. There are fewer visits to the emergency room and fewer episodes of colds, pneumonia, and ear infections. Their asthma, if any, is controlled better, and the risk of sudden infant death syndrome is reduced.
• Increased life expectancy: Compared to those who continue to smoke cigarettes, individuals who quit smoking gain about 10 years of life expectancy at the age of 30; 9 years at the age of 40; 6 years at the age of 50; and 3 years at the age of 60, according to a February 2020 publication by the World Health Organization, titled “Tobacco: Health benefits of smoking cessation.”
• Increased opportunities for socializing: Quitting smoking increases opportunities for socializing. A percentage of individuals who do not smoke tend to avoid being around those who smoke, and in their homes or cars. As a non-smoker, it is also easier to find hotel rooms and apartments.
• Increased monetary savings: Smoking cessation saves money. An individual who smoked one pack of cigarettes a day will save about $2000 a year when they quit.

What is the success rate of smoking cessation?

The success rate of smoking cessation varies depending on factors like the individual’s motivation level, whether they take medications to quit nicotine and/or receive counseling advice from a professional, the duration of quitting, and the number of earlier cessation attempts. The U.S. Centers for Disease Control and Prevention, in its publication titled “Smoking Cessation: Fast Facts,” which was posted on 17 September 2024, notes that less than 1 in 10 adults who smoke are successful in quitting tobacco in a given year.

In 2022, 8.8% of adults who smoked were successful in stopping smoking in the previous year. In 2021, 66.5% of all adults who ever smoked were able to quit smoking in the previous year. Smoking cessation without professional assistance is successful only in 3-5% of individuals, according to a 2016 article by Andritsou et al., published in the European Respiratory Journal, titled “Success rates are correlated mainly to completion of a smoking cessation program.”

Smoking cessation programs that integrate pharmacotherapy with counseling have been shown to increase success rates from 35% to 55% after 6 months, depending on the experience of the healthcare professional who delivers therapy. It has been observed that combining NRT strategies increases quit rates by 25% compared to NRT monotherapy, according to a 2022 article by Gaddey et al., published in the journal American Family Physician, titled “Smoking Cessation Interventions.”

Varenicline delivered over a 4-week period has been found to be more effective at producing abstinence than bupropion and placebo, according to a 2024 article by Onwuzo et al., published in the journal Cureus, titled “A Review of Smoking Cessation Interventions: Efficacy, Strategies for Implementation, and Future Directions.” The abstinence rate for patients on Varenicline was 44% while those for bupropion and placebo were 29.5% and 17.7%, respectively.

Former smokers who stay away from tobacco for 3 months or more are 90% likely to remain continuously abstinent till the next follow-up, according to a 1997 article by Gilpin et al., published in the Journal of the National Cancer Institute, titled “Duration of smoking abstinence and success in quitting.” This number increases to 95% for those who remain tobacco-free for a year or more.

According to authors Joly et al., in the 2017 article titled “Success rates in smoking cessation: Psychological preparation plays a critical role and interacts with other factors such as psychoactive substances” published in the journal PLoS One, the cessation success rate is positively affected by factors like starting to smoke at a late age; a short duration of smoking; stable body weight; living and/or working in a non-smoking environment; stable socio-professional status; and high socio-economic and educational levels. A positive belief in one’s ability to become a non-smoker in the following six months, not having a history of depression, and being in an emotionally supportive intimate relationship are the other predictors of successful smoking cessation.

How can one quit smoking?

One can quit smoking by using NRT products and/or prescription medications, undergoing behavioral therapy, avoiding triggers, learning to manage cravings, and cultivating a healthy lifestyle. It is equally important to find a powerful and deeply personal reason to quit smoking, which will motivate you to carry on in the face of cravings and the discomfort of withdrawal.

Start by setting a “quit date.” Ask your loved ones for practical and emotional support, and/or join a support group. Undergo behavioral therapy to identify and alter skewed beliefs around smoking tobacco. Consider NRT products to manage cravings. Speak to a healthcare practitioner to find one that works best for you.

Consult with a physician and use medicines to manage cravings and ease withdrawal symptoms. Identify smoking triggers and avoid them. These triggers include acquaintances who smoke, smoking environments, and activities that have come to be associated with lighting a cigarette, such as having coffee or drinking alcohol. Remove all items from your house that are likely to remind you of smoking. For instance, throw away all ashtrays and lighters and thoroughly vacuum the upholstery to remove all traces of tobacco smell from them.

Adopt habits and practices that will serve as distractions when cravings arise. When cravings arise, remind yourself that this is just an urge that will peak and fade even if you do not consume nicotine. If smoking tobacco is a means to relieve stress, find other ways to destress and relax.

Physical exercise is believed to keep away nicotine cravings and ease withdrawal symptoms. Motivate yourself to continue the abstinence journey by rewarding yourself occasionally. Finally, remember that it is common for individuals to make multiple quit attempts before achieving continuous abstinence. So, consider a relapse, if any, as an opportunity to determine which quit strategy works best for you.

What can replace the urge to smoke?

Using nicotine replacement products, keeping the mouth busy, distracting oneself, and doing physical and breathing exercises can replace the urge to smoke. Nicotine replacement products like lozenges, gums, and patches are able to curb cravings.Prescription medications like bupropion and varenicline help curb the urge to smoke.

Activities like chewing on apple slices, celery, carrots, pickles, sugar-free gum, or hard candy, and holding a straw or a stir stick in the mouth keep the mouth busy and suppress the urge to smoke. Knitting or solving a jigsaw puzzle, chopping vegetables, and holding a pen, rubber band, or stress ball keep the hands busy and serve as distractions.

Physical exercise, even for short durations, helps replace the urge to smoke. Going for a short walk, climbing stairs, doing squats, and jogging in place are as helpful in this regard as a 30-minute walk or an extended session at the gym. Individuals who smoke as a way to de-stress benefit from relaxation exercises like yoga, Tai Chi, meditation, visualization, listening to music, and reading or listening to a book. Additionally, these activities work as distractions and help individuals ride out urges.

How to help someone quit smoking?

To help someone quit smoking, support them emotionally and practically. Encourage them as they begin their abstinence journey and assure them of your consistent presence and support. Listen to them non-judgmentally as they relate their struggles to you. If you are a smoker, consider supporting your loved one by quitting smoking yourself and being a role model for them.

However, if you cannot, do not smoke or buy cigarettes when you are with them. Ensure that you are not smelling of tobacco when you are with your loved one. Change clothes, wash your hands thoroughly with soap, and use a mouthwash before you meet your loved one. Create a trigger-free environment by removing ashtrays, cigarettes, and lighters from sight. Find smoke-free activities to do together to distract your loved one from smoking. Find and visit smoke-free places together. Gift them “quit kits” containing items that will help them manage cravings. These items include chewing gum, candy, puzzles, and stress balls. Celebrate small milestones along the recovery journey. Express faith in your loved one’s ability to succeed in quitting.

Refrain from rebuking, teasing, nagging, and preaching them so that you do not hurt their feelings. If they “slip” or relapse, do not blame them or make them feel guilty. Instead, praise them for making the effort to quit and encourage them to try again. Remind them that it is common and normal for individuals to need multiple quit attempts before they are able to achieve complete and continuous abstinence. Remind your loved ones about their reason(s) for quitting tobacco and help them refine or recreate their quit plan so that they don’t slip or relapse.

Is it safe to stop smoking immediately?

Yes, it is safe to stop smoking immediately, according to a 2019 article by Tan et al., published in the journal Tobacco Induced Diseases, titled “A meta-analysis of the effectiveness of gradual versus abrupt smoking cessation.” The majority of treatment guidelines recommend abrupt cessation of smoking or going “cold turkey.”

However, it has been observed that quitting smoking progressively or cutting down before stopping smoking is more effective and acceptable for individuals who lack motivation or find it challenging to quit, according to a 2023 article by Li et al., published in the journal PLoS One, titled “Effect of quitting immediately vs progressively on smoking cessation for smokers at emergency department in Hong Kong: A posteriori analysis of a randomized controlled trial.”

What are the symptoms of smoking cessation withdrawal?

The symptoms of smoking cessation withdrawal include experiencing cravings, having trouble concentrating, having difficulty sleeping, and feeling restless, anxious, and/or irritable. Individuals are likely to experience an increase in appetite and tend to gain weight after stopping smoking. It is possible for a percentage of individuals to feel sadness or depression upon smoking cessation. The less common symptoms of smoking cessation withdrawal are headaches, nausea, dizziness, constipation, coughs and sore throat, dry mouth, and nightmares.

Are treatments available for smoking cessation?

Yes, there are treatments available for smoking cessation. These treatments include behavioral therapies and medications approved by the FDA. Behavioral therapy is delivered individually, in a group, or over the phone and consists of practical counseling to impart problem-solving and skills-development training, and provision of social support.

Other treatments for smoking cessation include brief advice from a healthcare practitioner, automated text messaging, self-help material, telephone support and quitlines, web-based therapeutic interventions, and support via social media, as noted by the National Institute on Drug Abuse in its January 2020 research report titled “Tobacco, Nicotine, and E-Cigarettes Research Report: What are treatments for tobacco dependence?”

The prescription medications approved by the FDA include varenicline tartrate and bupropion hydrochloride. Nicotine replacement therapy products like inhalers and sprays are available with a prescription, while skin patches, lozenges, and chewing gums are available over the counter.

How do smoking cessation programs work?

Smoking cessation programs work to help individuals quit smoking and prevent the development of or stem the progression of multiple tobacco-induced diseases by addressing both the physical aspect of nicotine dependence as well as the behavioral and emotional aspects of smoking. These programs typically integrate medications and behavioral therapies.

Pharmacotherapy, comprising medications and NRT, helps curb nicotine cravings and ease withdrawal symptoms. Behavioral therapies promote long-term abstinence by helping individuals identify and alter maladaptive thought patterns and behavioral responses that contribute to their addiction, and prevent relapses by developing healthy coping strategies.

Integrated programs where counseling is delivered alongside pharmacotherapy produce higher rates of quitting than those that deliver a single therapy, according to the National Institute on Drug Abuse in its January 2020 research report titled “Tobacco, Nicotine, and E-Cigarettes Research Report: What are treatments for tobacco dependence?”.

Intensive smoking cessation programs include counseling sessions that are longer than 10 minutes, with each program typically incorporating more than 4 such sessions and more than 30 minutes of interactions. However, there is no “one-size-fits-all” treatment model for tobacco cessation. The most effective programs are personalized to suit the needs of individual patients.

For instance, the American Lung Association’s Freedom From Smoking® initiative allows participants to choose from group programs, online programs, and self-help guides and create a personalized smoking cessation plan that suits their goals and convenience. The American Lung Association’s NOT For Me program, based on the principles of their Not On Tobacco initiative, is a tobacco cessation plan that is suited to the unique needs, circumstances, and media consumption preferences of teenagers. It is a self-directed, mobile-friendly program for young adults who vape, smoke, or use tobacco products in any other way.

The quitSTART app, a product of Smokefree.gov, and Empowered to Quit, an email-based program by the American Cancer Society, are two self-directed smoking cessation programs for motivated individuals.

What medications are used for smoking cessation?

The medications used for smoking cessation are nicotine replacement medicines and prescription pills. The nicotine replacement medicines approved by the FDA are the transdermal nicotine patch, inhaler, nasal spray, lozenge, and gum. The transdermal patch is a long-acting NRT. The inhaler, spray, lozenge, and gum are short-acting therapies.

The prescription pills for smoking cessation approved by the FDA are bupropion (Zyban) and varenicline (Chantix). Clonidine and nortriptyline are regarded as second-line medications for smoking cessation. They are prescribed when other treatments have failed to produce desirable results.

Why is pharmacotherapy important in smoking cessation?

Pharmacotherapy is important in smoking cessation because quit-smoking medications promote long-term abstinence by easing tobacco withdrawal symptoms and blocking nicotine’s positive reinforcing effects without producing significant adverse side effects, according to a 2023 article by Pajai et al., published in the journal Cureus, titled “Pharmacotherapy in Tobacco Cessation: A Narrative Review.”

Additionally, medications like varenicline disrupt the neurobiological pathways implicated in tobacco addiction and have been found to be effective even in patients who are unwilling to quit, according to a 2022 article by Gaddey et al., published in the journal American Family Physician, titled “Smoking Cessation Interventions.”