28 Oct Quit Smoking
Smoking cessation (also known as quitting smoking or simply quitting) is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. Nicotine withdrawal often makes the process of quitting difficult.
About 70% of smokers would like to quit smoking, and 50% report having made a quit attempt in the past year. Smoking is the leading preventable cause of death worldwide.
Tobacco cessation significantly reduces the risk of dying from tobacco-related diseases such as coronary heart disease, chronic obstructive pulmonary disease (COPD), and lung cancer. Due to its link to many chronic diseases, cigarette smoking has been restricted in many public areas.
Many different strategies can be used for smoking cessation, including abruptly quitting without assistance (“cold turkey“), cutting down then quitting, behavioral counseling, and medications such as bupropion, cytisine, nicotine replacement therapy, or varenicline. Most smokers who try to quit do so without assistance. However, only 3-6% of quit attempts without assistance are successful long-term. Behavioral counseling and medications each increase the rate of successfully quitting smoking, and a combination of behavioral counseling with a medication such as bupropion is more effective than either intervention alone. A meta-analysis from 2018, conducted on 61 randomized controlled trials, showed among people who quit smoking with a cessation medication (and some behavioral help), approximately 20% were still quit a year later, as compared to 12% who did not take medication.
In nicotine-dependent smokers, quitting smoking can lead to symptoms of nicotine withdrawal such as nicotine cravings, anxiety, irritability, depression, and weight gain. Professional smoking cessation support methods generally attempt to address nicotine withdrawal symptoms to help the person break free of nicotine addiction.
- Acupuncture: Acupuncture has been explored as an adjunct treatment method for smoking cessation. A 2014 Cochrane review was unable to make conclusions regarding acupuncture as the evidence is poor. A 2008 guideline found no difference between acupuncture and placebo, found no scientific studies supporting laser therapy based on acupuncture principles but without the needles.
- Chewing cinnamon sticks or gum has been recommended when trying to quit the use of tobacco.
- Hypnosis: Hypnosis often involves the hypnotherapist suggesting to the patient the unpleasant outcomes of smoking. Clinical trials studying hypnosis and hypnotherapy as a method for smoking cessation have been inconclusive. A Cochrane review was unable to find evidence of benefit of hypnosis in smoking cessation, and suggested if there is a beneficial effect, it is small at best. However, a randomized trial published in 2008 found that hypnosis and nicotine patches “compares favorably” with standard behavioral counseling and nicotine patches in 12-month quit rates.
- Herbs: Many herbs have been studied as a method for smoking cessation, including lobelia and St John’s wort. The results are inconclusive, but St. Johns Wort shows few adverse events. Lobelia has been used to treat respiratory diseases like asthma and bronchitis, and has been used for smoking cessation because of chemical similarities to tobacco; lobelia is now listed in the FDA’s Poisonous Plant Database. Lobelia can still be found in many products sold for smoking cessation and should be used with caution.
- Smokeless tobacco: There is little smoking in Sweden, which is reflected in the very low cancer rates for Swedish men. Use of snus (a form of steam-pasteurized, rather than heat-pasteurized, air-cured smokeless tobacco) is an observed cessation method for Swedish men and even recommended by some Swedish doctors. However, the report by the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) concludes “STP (smokeless tobacco products) are addictive and their use is hazardous to health. Evidence on the effectiveness of STP as a smoking cessation aid is insufficient,”. A recent national study on the use of alternative tobacco products, including snus, did not show that these products promote cessation.
- Aversion therapy: It is a method of treatment works by pairing the pleasurable stimulus of smoking with other unpleasant stimului. A Cochrane review reported that there is insufficient evidence of its efficacy.
- Nicotine vaccines: Nicotine vaccines (e.g., NicVAX and TA-NIC) work by reducing the amount of nicotine reaching the brain, however, this method of therapy needs more investigations to establish its role and determine its side effects.
- Technology and machine learning: Research studies using machine learning or artificial intelligence tools to provide feedback and communication with those who are trying to quit smoking are increasing, yet the findings are so far inconclusive.