Lloydspharmacy.com Health - Methods for quitting

Reviewed by Gay Sutherland, honorary consultant clinical psychologist

You've made the decision to quit and the big day is getting closer. You're determined to stop smoking - but how? For many the choice boils down to going cold turkey or using smoking cessation products, such as nicotine patches or Zyban.

There is no 'right' way to stop smoking. One thing that's true of all programmes and products to help you quit is that you'll still need willpower and be prepared to work at staying stopped. Aids can provide support, but only you can be responsible for making sure you succeed.

To help you make a decision, we've included success rates from clinical trials for each of the methods below.

Going it alone

Many smokers try to go 'cold turkey', relying solely on their willpower to quit. It's likely the first few weeks will be tougher, but it does mean you won't have to adjust to life without treatment further down the line. And unlike other methods, it's free of charge.

Unfortunately, statistics show it's one of the less effective ways of quitting. For every 100 smokers who quit without aids or counselling, only 10 will remain non-smokers for 12 months.

Professional help

Smoking cessation is now a priority area for the NHS, so you may want to make use of the information and counselling on offer.

This can be as simple as your GP giving you some advice, booklets and helpline numbers during an appointment, or you may be able to take part in group sessions with a counsellor as part of a programme run by a clinic.

There's nothing to stop you combining this advice with other techniques and treatments. Ask your GP about smoking cessation services in your area.

For every 100 smokers who quit with advice from a counsellor, 13 will stop smoking for at least six months.

Advice about how to quit (eg tips to boost willpower) from leaflets, websites, tapes, videos etc helps an extra one smoker in 100 to quit. This may not seem a lot, but that's 10,000 smokers in a million.

Medicines

Clinical studies have shown that you're more likely to succeed in stopping smoking with the help of a nicotine substitute (nicotine replacement therapy - NRT) or the prescription-only medicines Zyban (bupropion) and Champix (varenicline).

These medicines can reduce the severity of withdrawal symptoms and cravings that many smokers experience on quitting. Though they work in different ways, they all affect the regions in the brain that are implicated in addiction.

You can buy NRT over-the-counter, but it can work out cheaper to get it via your GP.

Studies have shown that smokers who quit using one of these methods are about twice as likely to be smoke-free after a year than those who use no aids - that's 17 out of 100 smokers for NRT, 20 out of 100 for buproprion, and 23 out of 100 for varenicline.

Hypnosis and acupuncture

Not everyone wants to take medicines to help them quit smoking, and there are plenty of alternatives for you to try.

Techniques such as hypnosis and acupuncture may help some smokers to quit and have few, if any, side-effects. But there is no conclusive evidence that either technique is more effective than quitting cold turkey.

As with any treatment, beware claims of high success rates - according to the smoking charity ASH, even the most effective smoking-cessation programmes rarely achieve a success rate of more than 30 per cent.

Why are success rates so low?

In all cases the success rates quoted are for 12 months - so why do so many ex-smokers fail to make it this far? If you've tried and failed before, you'll know the physical withdrawal symptoms - cravings, headaches etc - are often not the hardest part of quitting.

For most people, they usually peak after two to three days without cigarettes, then gradually disappear after a few weeks.

The difficult part is to stay quit in the long run, because there are two strands to addiction: physical and psychological dependency.

Physical dependency: nicotine is a stimulant and one of the most dependency-inducing drugs. Even the good feelings you attribute to smoking, ie improved concentration, are really due to relief of the withdrawal effects that come on between cigarettes. Tetchiness, headaches, poor concentration and cravings are your body's way of asking for more nicotine. While not easy to cope with, physical withdrawal symptoms are the most well-known and well-tackled difficulties in giving up smoking. Medicines can offer extra help in the early days.
Psychological dependency: no matter how little you smoked in the beginning, your smoking takes on a daily pattern, where certain situations trigger the urge for a cigarette. As well as these daily habits, you probably associate certain psychological benefits to smoking, eg as a way to overcome nerves, anxiety or shyness. Breaking this emotional attachment to cigarettes can be the hardest thing to master. Understanding why you smoke can make a difference to your success at quitting.

Which method is best?

The method you decide on is up to you, and you may want to discuss these options with your doctor. Whatever method you use, the support of family and friends can be crucial.

Tests such as the Fagerstrom test can help determine the severity of your addiction to nicotine, which may affect the method you choose. Bear the following in mind though.

It's too simplistic to connect physical addiction to quit method or likelihood of success. If you're 'heavily' addicted, it doesn't mean you won't be able to quit or you'll need extra help - whether you succeed depends on lots of other factors such as your personality, willpower levels and motivation for quitting in the first place.
Smoking cessation medicines address physical addiction, and give you the opportunity to focus on breaking your psychological dependency, but they still need willpower. Eventually, you will have to come off these products, too.
You can succeed at quitting without using smoking cessation products, even if you are a heavy smoker.
There is no easy way to quit. This doesn't mean it's impossible or you'll suffer terribly - boredom or lack of motivation are as likely reasons for smoking again as giving in to cravings.

References
Silagy C, Lancaster T, Stead L, et al. Nicotine replacement therapy for smoking cessation. 2002. Oxford, England: Update Software.

Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation (Cochrane Review). The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley & Sons, Ltd.

White AR, Rampes H, Ernst E. Acupuncture for smoking cessation (Cochrane Review). The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley & Sons, Ltd.

Abbot NC, Stead LF, White AR, Barnes J. Hypnotherapy for smoking cessation (Cochrane Review). The Cochrane Library, Issue 4, 2004. Chichester, UK: John Wiley & Sons, Ltd.

Lancaster T, Stead LF. Individual behavioural counselling for smoking cessation. The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd.

Based on a text by Marianne Møller, NetDoctor pharmacist

Last updated 16.05.2005