Smoking Cessation

Also indexed as: Giving up Smoking

Support is readily available to help you stop smoking and stay smoke-free for life. According to research or other evidence, the following self-care steps may be helpful:

Focus on physical fitness
Increase your physical activity after giving up tobacco to prevent weight gain

Participate in a programme
Find a smoking-cessation programme that holds regular meetings to discuss important topics such as strategies for stopping; factors that increase relapse risk; and problem-solving, stress-reduction, and coping skills

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full {concern name, sentence case} article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About Smoking Cessation

While cigarette smoking is declining in many Western countries, more than 20% of US adults continue to smoke.¹ However, studies show that 70% of them would like to quit.² ³ In many countries, major public health efforts are in place to encourage smokers to quit.⁴ ⁵ Since many attempts to give up smoking are not permanent, it may be important to take advantage of a variety of strategies to increase the chances of success.⁶ ⁷

Product ratings for Smoking Cessation

Science Ratings

Nutritional Supplements

Herbs

Tryptophan

Lobelia

Oat straw

Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars

Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star

For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Smoking cessation can result in improved health, including reduced risk of heart and lung diseases, many cancers, pregnancy complications, and other health problems. Soon after giving up, most smokers notice that coughing declines and that ordinary activities no longer result in shortness of breath. Also, smokers find that their teeth stain less easily, their breath is fresher, and food tastes better as their senses of taste and smell return to normal. However, smoking cessation can lead to short-term symptoms such as irritability, depression, difficulty sleeping or concentrating, headaches, and fatigue, due to the physical effects of nicotine withdrawal and the psychological effects of giving up a habit. Giving up smoking often leads to weight gain as well.

Medical options

The oral prescription drug bupropion (Zyban, Wellbutrin) may reduce nicotine cravings in some individuals. A nicotine inhaler (Nicotrol Inhaler) and nasal spray (Nicotrol NS) might help some people wean off cigarettes. Some healthcare providers might prescribe buspirone (Buspar), lorazepam (Ativan), or alprazolam (Xanax) to help with withdrawal anxiety.

Over-the-counter nicotine gum (Nicorette), lozenges (Commit), and patches (Nicoderm CQ, Nicotrol) are available to help people wean off cigarettes.

Individuals who want to give up smoking cigarettes will have better success if they decide on a quit date and change their routines around typical smoking cues, such as coffee breaks, meals, boredom, and sexual activity. Absolute stopping, known as giving up “cold turkey,” is generally considered a better method than weaning off.

Dietary changes that may be helpful

A high-carbohydrate diet, combined with a tryptophan supplement (50 mg per 2.2 pounds of body weight per day) lessened withdrawal symptoms and helped participants smoke fewer cigarettes in one controlled study,⁸ but no research has investigated the effect of dietary changes alone on smoking cessation.

Lifestyle changes that may be helpful

Smoking cessation often leads to weight gain, which can dissuade smokers from trying to quit or cause them to resume smoking.⁹ ¹⁰ Increasing physical activity after giving up smoking can minimise weight gain, and a controlled trial found that adding exercise to a smoking cessation behaviouralcounsellingprogramme improved abstinence rates.¹¹ ¹² However, other, smaller studies have not shown that exercise either alone or added to a comprehensive programme helps to maintain abstinence.¹³ ¹⁴ Adding weight control through dieting to smoking-cessation programmes has resulted in either an increase in smoking relapses or no effect.¹⁵ ¹⁶ Changing the diet at the same time as giving up smoking may require more discipline than most people can achieve.

Vitamins that may be helpful

Nicotine addiction is thought to be caused by increased stimulation of nerve receptors for various brain chemicals, including serotonin.¹⁷ Withdrawal symptoms that accompany smoking cessation could be related to the sudden drop in nerve receptor stimulation. However, a double-blind study found that depleting blood levels of tryptophan, the precursor to serotonin, had no effect on withdrawal symptoms after five hours of smoking abstinence.¹⁸ In a controlled study, a daily tryptophan supplement (50 mg per 2.2 pounds of body weight) along with a high-carbohydrate diet (which increases brain uptake of tryptophan) was added to a smoking-cessation programme. While rates of complete abstinence were not significantly affected, tryptophan plus a high-carbohydrate diet lessened withdrawal symptoms and helped participants smoke fewer cigarettes.¹⁹ More research is needed to clarify whether supplementing with tryptophan or other serotonin precursors might help support smoking cessation.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Lobelia (Lobelia inflata), also known as Indian tobacco, contains a substance (lobeline) that has some effects on the nervous system that are similar to the effects of nicotine, and preliminary reports suggested that pure lobeline or lobelia herb could be used to support smoking cessation.²⁰ ²¹ ²² However, results in preliminary human trials with lobeline have been mixed and generally negative, and no long-term controlled studies of lobeline or lobelia for smoking cessation have been done.²³ ²⁴

Other herbs used to treat anxiety are sometimes recommended as part of a smoking cessation programme, including oat straw (Avena sativa), scullcap (Scutellaria lateriflora), valerian (Valeriana officinalis), lemon balm (Melissa officinalis), and vervain (Verbena officinalis). Of these herbs, only oat straw has been investigated in human research for smoking cessation. At least three trials have reported no effect of oat straw on smoking cessation, but one controlled study in India found that taking 1 ml of an alcohol extract of oat straw four times per day significantly reduced the number of cigarettes smoked per day.²⁵ ²⁶ ²⁷ ²⁸

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Integrated approaches that may be helpful

In the year 2000, the United States Public Health Service published updated smoking-cessation guidelines for doctors.²⁹ This report identified counselling and behavioural therapies as proven effective components of a smoking-cessation programme. Effective components include providing basic information about successful giving up, identifying factors that will increase the risk of relapse, and teaching problem-solving and coping skills. Also effective is social support provided either in a healthcare setting (for example, being able to talk about the giving up process with a doctor) or by strategies that teach the quitter to build a support network among friends, family, and the community. Guidelines issued in other countries have reached similar conclusions about the effectiveness of counselling and behavioural therapies.³⁰ Government-sponsored, free counselling resources in North America include Quitline [800-QUIT-NOW] and SmokeFree (www.smokefree.gov). Group or individual counselling is often a component of successful smoking cessation programmes offered in schools and the workplace.³¹ ³²

People tend to smoke more often under conditions of stress. Those who achieve long-term success in giving up smoking have been shown to have more social support and less stress than people who eventually relapse.³³ Stress-reduction techniques that have been shown in controlled trials to be effective for assisting smoking cessation include self-massage, guided relaxation imagery, and exercise.³⁴ ³⁵ ³⁶

Some research indicates that the effectiveness of acupuncture on abstinence from smoking is similar to that reported for nicotine chewing gum and behavioural therapy, and that these methods can complement each other.³⁷ One controlled trial showed that daily cigarette consumption decreased more significantly during acupuncture treatment to points associated with smoking cessation than in fake acupuncture treatment (i.e., acupuncture applied to points not associated with smoking cessation). Altogether, 31% of subjects in the treatment group had quit smoking completely at the end of the treatment, compared with none in the control group.³⁸ Electroacupuncture treatment to points on the ear has also been shown to aid in smoking cessation compared with fake ear acupuncture in a controlled trial.³⁹ However, most clinical trials have not achieved comparable results. An analysis of 22 studies found that while acupuncture is often as effective as other smoking cessation techniques, its effectiveness does not last very long. Moreover, in most studies the overall effect of real acupuncture was no better on average than fake acupuncture for smoking cessation.⁴⁰

A controlled clinical trial showed that people undergoing single hypnosis sessions smoked significantly fewer cigarettes and had a higher frequency of abstinence than a placebo control group.⁴¹ However, most clinical trials have not corroborated these results.⁴² A review of 59 studies of hypnosis and smoking cessation concluded that hypnosis “cannot be considered a specific and efficacious treatment for smoking cessation.”⁴³

References
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1. Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults—United States, 2003. MMWR 2005;54:509–13.

2. Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults—United States, 1995. MMWR 1997;46:1217–20.

3. Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults—United States, 2000. MMWR 2002;51:642–5.

4. The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. A clinical practice guideline for treating tobacco use and dependence: A US Public Health Service report. JAMA 2000;283:3244–54 [review].

5. Zwar N, Richmond R, Borland R, et al. Smoking cessation guidelines for Australian general practice. Aust Fam Physician 2005;34:461–6 [review].

6. Centers for Disease Control and Prevention (CDC). Smoking cessation during previous year among adults—United States, 1990 and 1991. MMWR 1993;42:504–7.

7. Hatziandreu EJ, Pierce JP, Lefkopoulou M, et al. Quitting smoking in the United States in 1986. J Natl Cancer Inst 1990;82:1402–6.

8. Bowen DJ, Spring B, Fox E. Tryptophan and high-carbohydrate diets as adjuncts to smoking cessation therapy. J Behav Med 1991;14:97–110.

9. Froom P, Melamed S, Benbassat J. Smoking cessation and weight gain. J Fam Pract 1998;46:460–4 [review].

10. Klesges RC, Meyers AW, Klesges LM, La Vasque ME. Smoking, body weight, and their effects on smoking behavior: a comprehensive review of the literature. Psychol Bull 1989;106:204–30 [review].

11. Kawachi I, Troisi RJ, Rotnitzky AG, et al. Can physical activity minimize weight gain in women after smoking cessation? Am J Public Health 1996;86:999–1004.

12. Marcus BH, Albrecht AE, King TK, et al. The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial. Arch Intern Med 1999;159:1229–34.

13. Russell PO, Epstein LH, Johnston JJ, et al. The effects of physical activity as maintenance for smoking cessation. Addict Behav 1988;13:215–8.

14. Jonsdottir D, Jonsdottir H. Does physical exercise in addition to a multicomponent smoking cessation program increase abstinence rate and suppress weight gain? An intervention study. Scand J Caring Sci 2001;15:275–82.

15. Pirie PL, McBride CM, Hellerstedt W, et al. Smoking cessation in women concerned about weight. Am J Public Health 1992;82:1238–43.

16. Hall SM, Tunstall CD, Vila KL, Duffy J. Weight gain prevention and smoking cessation: Cautionary findings. Am J Public Health 1992;82:799–803.

17. Quattrocki E, Baird A, Yurgelun-Todd D. Biological aspects of the link between smoking and depression. Harv Rev Psychiatry 2000;8:99–110 [review].

18. Perugini M, Mahoney C, Ilivitsky V, et al. Effects of tryptophan depletion on acute smoking abstinence symptoms and the acute smoking response. Pharmacol Biochem Behav 2003;74:513–22.

19. Bowen DJ, Spring B, Fox E. Tryptophan and high-carbohydrate diets as adjuncts to smoking cessation therapy. J Behav Med 1991;14:97–110.

20. Dwoskin LP, Crooks PA. A novel mechanism of action and potential use for lobeline as a treatment for psychostimulant abuse. Biochem Pharmacol 2002;63:89–98 [review].

21. Wren RC, Ed. Potter’s Cyclopaedia of Botanical Drugs and Preparations. Saffron Walden, Essex, England: C.W. Daniel Company, 1988:175–6 [review].

22. Fagerstrom K. New perspectives in the treatment of tobacco dependence. Monaldi Arch Chest Dis 2003;60:179–83 [review].

23. Davison GC, Rosen RC. Lobeline and reduction of cigarette smoking. Psychol Rep 1972;31:443–56.

24. Stead LF, Hughes JR. Lobeline for smoking cessation. Cochrane Database Syst Rev 2000;CD000124 [review].

25. Bye C, Fowle AS, Letley E, Wilkinson S. Lack of effect of Avena sativa on cigarette smoking. Nature 1974;252:580–1.

26. Schmidt K, Geckeler K. Pharmacotherapy with avena sativa - a double blind study. Int J Clin Pharmacol Biopharm 1976;14:214–6.

27. Beglinger C, Frey C, Abelin T. [Modification of smoking behavior using long-distance methods]. Soz Praventivmed 1977;22:182–3 [in German].

28. Anand CL. Effect of avena sativa on cigarette smoking. Nature 1971;233:496.

29. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. A Clinical Practice Guideline. Rockville, Md: US Dept of Health and Human Services; 2000. AHRQ publication No. 00-0032.

30. Zwar N, Richmond R, Borland R, et al. Smoking cessation guidelines for Australian general practice. Aust Fam Physician 2005;34:461–6 [review].

31. Garrison MM, Christakis DA, Ebel BE, et al. Smoking cessation interventions for adolescents: a systematic review. Am J Prev Med 2003;25:363–7 [review].

32. Smedslund G, Fisher KJ, Boles SM, Lichtenstein E. The effectiveness of workplace smoking cessation programmes: a meta-analysis of recent studies. Tob Control 2004;13:197–204 [review].

33. Curry S, Thompson B, Sexton M, Omenn GS. Psychosocial predictors of outcome in a worksite smoking cessation program. Am J Prev Med 1989;5:2–7.

34. Hernandez-Reif M, Field T, Hart S. Smoking cravings are reduced by self-massage. Prev Med 1999;28:28–32.

35. Wynd CA. Guided health imagery for smoking cessation and long-term abstinence. J Nurs Scholarsh 2005;37:245–50.

36. Marcus BH, Albrecht AE, King TK, et al. The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial. Arch Intern Med 1999;159:1229–34.

37. Jiang A, Cui M. Analysis of therapeutic effects of acupuncture on abstinence from smoking. J Tradit Chin Med 1994;14:56–63 [review].

38. He D, Berg JE, Hostmark AT. Effects of acupuncture on smoking cessation or reduction for motivated smokers. Prev Med 1997;26:208–14.

39. Waite NR, Clough JB. A single-blind, placebo-controlled trial of a simple acupuncture treatment in the cessation of smoking. Br J Gen Pract 1998;48:1487–90.

40. White AR, Rampes H, Ernst E. Acupuncture for smoking cessation. Cochrane Database Syst Rev 2002;CD000009 [review].

41. Williams JM, Hall DW. Use of single session hypnosis for smoking cessation. Addict Behav 1988;13:205–8

42. Abbot NC, Stead LF, White AR,et al. Hypnotherapy for smoking cessation. Cochrane Database Syst Rev 2000;CD001008 [review].

43. Green JP, Lynn SJ. Hypnosis and suggestion-based approaches to smoking cessation: an examination of the evidence. Int J Clin Exp Hypn 2000;48:195–224 [review].

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.