What's the best way to quit smoking?

Smoking is on the decline. But if you are one of the 28 million Americans still smoking, you probably know how hard it is to quit. 

Close to 70% of smokers report that they want to stop smoking. Of those, 55% said they tried to quit in the previous year. Only around 7% succeeded. 

There are plenty of reasons to try to reduce your nicotine addiction: Tobacco use – and smoking, in particular – accounts for about one-third of all cancers, and up to 90% of lung cancer cases. It also contributes to heart disease, stroke and lung disease. 

So, what's the best way to quit smoking? 

“The best way to quit smoking is with a combination of medication and counseling,” says Maher Karam-Hage, M.D., medical director of the Tobacco Research and Treatment Program at MD Anderson. “They both help. But you double your chances by using both compared with one of them.” 

What products can help you quit smoking?

There are several products that can help reduce your nicotine cravings.

Prescription medication

Smoking cessation options that require a doctor’s prescription include:

Varenicline (formerly sold as Chantix) works in two ways. First, it provides a mild version of nicotine’s effects. This helps reduce withdrawal symptoms and cravings. Second, it stops your brain from feeling the pleasurable effects of nicotine when you smoke. This makes smoking less appealing. Varenicline is the most effective single medication, Karam-Hage says. But it's also the most expensive.

Bupropion (also sold as Zyban or Wellbutrin) blocks the effects of nicotine in your brain. This makes smoking feel less pleasurable, but it does not replace the effect of nicotine.

Nicotine nasal spray is a nicotine replacement therapy that is sprayed into the nostril and absorbed into the nasal lining and bloodstream. This product provides nicotine without the other harmful effects of cigarettes.

Over-the-counter options

Over-the-counter nicotine replacement therapies partially satisfy nicotine cravings by giving the body small amounts of nicotine. This can help with cravings and make it easier to stop smoking. 

The over-the-counter nicotine replacement therapies available in the United States are:

Nicotine patches are 3- or 4-inch-wide patches that release a steady dose of nicotine. They are applied to the upper body and changed daily. They come in 7 mg, 14 mg and 21 mg doses.

Lozenges release nicotine as they dissolve in the mouth. They are available in mini and regular sizes and 2 mg and 4 mg doses.

Nicotine gum users follow the ‘chew and park’ method. The gum is chewed for 5 to 10 seconds then parked between the teeth and cheek for another 5 to 10 seconds. This process is then repeated in different parts of the mouth. It comes in 2mg and 4 mg doses.

Why is counseling important?

Working with a counselor can help you better understand your medication. A counselor can also give you the tools to cope with setbacks, stress and cravings by building skills in several areas. These include:

Problem solving

We all run into problems in life, like personal conflicts, that can make us feel helpless. Working with a counselor to tackle them one at a time can help you build knowledge and skills that can be used in other areas.

Coping strategies

Anything from a traffic jam to a death in the family can set off a strong urge to smoke. Learning strategies like deep breathing exercises, meditation and mindfulness can help a smoker get to the other side of a crisis without smoking.

Behavior change

Smokers who quit may miss the “hand-to-mouth” act of smoking. Counseling can help them find substitutions like using a straw, cinnamon stick or gum.

Identifying triggers

Counseling can help you identify what triggers you to smoke, like that morning cup of coffee or spending time with friends who smoke. Once you identify your triggers, you can learn to deal with them or avoid them.

Once smokers start counseling, they appreciate the tools and support it provides in their effort to quit smoking, Karam-Hage says.

“Finally, somebody understands the struggle they're going through,” he says. “Someone is acknowledging that it's not a simple thing to quit. That is very helpful.”

What option should you try first?

Not sure where to start? For many, over-the-counter nicotine replacement therapies are quicker and easier to get than medication because they don’t require prescriptions and can be purchased at most pharmacies.

However, remember that nicotine replacement therapies must be used consistently to be effective. If you find it hard to regularly use options like the patch, lozenges or gum, or if they don’t help you quit, Karam-Hage says you might consider medication.

Your doctor can prescribe medication to help you quit. They can also advise you on how to combine nicotine replacement therapies. This might look like using the patch along with either nicotine gum, lozenges or nicotine nasal spray. 

Additionally, a professional counselor can help you monitor what is and isn’t working and work with a prescriber on your care team to adjust the medication you take to set you up for success.

Want to quit but don't have access to a comprehensive program that includes both counseling and medication? You have options.

You can get phone and text support through the National Institutes of Health Quitline by calling 1-800-784-8669, texting QUIT to 47848, or visiting SmokeFree.gov. If you live in Texas, you can use the Texas Tobacco Quitline by calling 1-877-YES-QUIT or visiting YESQUIT.org.

Should you quit smoking cold turkey?

Knowing the health risks and addictive properties of nicotine, you might be wondering whether you should simply quit smoking cold turkey.

Karam-Hage says it’s wonderful if a smoker can quit cold turkey, but notes it is not necessarily better than using medication and counseling. This is because while it works for some, it does not work for everyone. 

Most people who attempt to quit smoking on their own fail to do so, he says. Because of this, he notes people may benefit from using both medication and counseling in future attempts to quit smoking. He says the unfortunate reality is that only about 30% of people attempting to quit get either medication or counseling, and only 5% of people get both medication and counseling.

If you’ve tried and failed to quit smoking long-term, Karam-Hage recommends a combination of counseling and medication. Enrolling in a comprehensive tobacco treatment program like MD Anderson’s Tobacco Research and Treatment Program, which is open to MD Anderson patients and caregivers, can be helpful for those seeking additional support. A 2019 study showed that 45% of people enrolled in MD Anderson’s program managed to quit smoking.

What happens to your body when you quit smoking?

Let’s start with the organ that is perhaps most associated with smoking: the lungs. 

Those who quit smoking might note that they can breathe a little easier – and not just metaphorically! Karam-Hage says this is because the toxins from cigarette smoke are gone.

As for whether the lungs can regenerate after you quit smoking, the answer depends on just how damaged the lung tissue is. For lung tissue that is damaged but still alive, Karam-Hage says it is possible for it to recover. However, totally damaged cells can’t be reversed.

“Whatever cells have died are gone and no regeneration is possible,” he says, noting this is why conditions like chronic obstructive pulmonary disease (COPD) are permanent.

While smoking’s effects don’t entirely go away when you quit, Karam-Hage says there are many positive health impacts that happen when you quit smoking.

These benefits include:

• Reduced heart rate and blood pressure
• Reduced level of carbon monoxide in blood
• Improved circulation and lung function
• Improved sense of taste and smell
• Reduced risk of heart disease
• Reduced risk of stroke
• Reduced risk of mouth, throat, larynx, esophageal, bladder, cervical, lung, kidney, liver, colorectal, leukemia and pancreatic cancer

“There are many benefits, and they continue to get better as time passes,” he says.

Request an appointment at MD Anderson online or call 1-877-632-6789.