What will (and won't) help you quit smoking for good

Everyone knows it’s a challenge to quit smoking. Nicotine, one of the main chemical components in tobacco, is highly addictive. The key to saying farewell to your cigarettes for good is to break that dependence.

Luckily there is no reason to quit cold turkey when there are several different smoking cessation aids available. Here is everything you need to know to choose the right quit aid for you.

A cigarette craving comes from our brain chemistry. Each puff of smoke sends nicotine to the brain, where it starts a series of biochemical reactions that cause the release of dopamine, a chemical that gives a feeling of pleasure and calm. Between cigarettes, dopamine levels decrease, causing smokers to get crabby and jumpy. The brain craves nicotine to release more dopamine to bring it back to a “feel good” level. The next cigarette starts the process again, rewarding someone to continue to smoke.

While nicotine itself doesn’t cause any of the diseases and conditions associated with smoking, its addictiveness exposes users to the other harmful chemicals found in tobacco. Plus it’s the nicotine dependency that makes quitting very difficult.

Common withdrawal symptoms when decreasing tobacco use include:

• Anxiety and stress
• Cravings
• Headaches
• Irritability
• Bloating and/or cramps
• Insomnia
• Dizziness
• Poor concentration
• Depression
• Flu-like symptoms

The first week without cigarettes can be difficult, but these symptoms don’t last forever. For most people, they start to lessen several days after quitting, lasting a few weeks at the most.

According to Smoking Cessation: A Report of the Surgeon General, released in 2020, less than one in three US adults use any type of FDA-approved cessation medication or counseling when attempting to quit. These cessation aids are often free, low-cost or covered by insurance. Plus, certain medications and therapies have been found to double the odds of successfully quitting tobacco by helping to decrease nicotine addiction and alleviate withdrawal symptoms.

Currently, there are seven medications approved by the Food and Drug Administration (FDA) to help smokers quit. They fall into two categories: nicotine replacement therapy (NRT) and non-nicotine medications.

NRT products are supplemented with nicotine to lessen withdrawal symptoms and cravings. These products slow the uptake and breakdown of nicotine in gradually decreasing doses. FDA approved NRT products include:

• Patches
• Gum
• Lozenges
• Inhaler (prescription only)
• Nasal spray (prescription only)

Two non-nicotine prescription drugs, bupropion and varenicline, are currently approved to help curb smoking. Both quit aids interfere with the chemical interactions of nicotine in the brain.

Quit-meds should be used for as long as necessary, following the manufacturer’s recommendations and in consultation with your physician.

If you decide to try nicotine replacement therapy, consider your lifestyle and how much you smoke before choosing a product.

A gum or lozenge may be a good option if you smoke more during certain times of the day, want a controlled nicotine dose, or simply like the oral gratification of smoking. Smokers with extensive dental work or dentures may want to stay away from chewing gum, opting for lozenges instead.

Patches are only changed once per day, offering added convenience and ease. They are also more discrete. However, if you have an allergy to adhesive, it is best to avoid using one.

Nasal spray and nicotine inhalers are available through prescription only. Both are more expensive than over-the-counter options, but they relieve withdrawal symptoms very quickly by delivering nicotine directly into the bloodstream.

Over-the-counter quit aids come in varying dosages. This allows smokers to start using the right amount based on their level of nicotine addiction, with the goal of gradually decreasing in order to wean off the products. Start your nicotine replacement and quit tobacco completely on Quit Day. If you have a slip and smoke a cigarette, don’t stop your NRT unless you relapse back to regular smoking. Instead, try to prepare yourself to work through the next craving.

To figure out your correct dosage of gum or lozenge, think about when you have your first cigarette of the day. If it’s within 30 minutes of waking up, start with 4 mg. If you are awake longer than 30 minutes before your first cigarette, begin with 2 mg. Use gum or a lozenge every 1 to 2 hours or when you anticipate cravings. Do not chew more than 24 pieces of nicotine gum or use more than 20 lozenges in a 24 hour period. Cut back slowly over a period of 12 weeks, with the goal of decreasing doses to every four to six hours before stopping.

Nicotine patch therapy is a three-step program. Start with the highest level and gradually step down your dose.

• Step 1—21 mg
• Step 2—14 mg
• Step 3—7 mg

If you smoke less than ten cigarettes per day, you can start at step two.

Prescription NRT aids work almost immediately to relieve cravings but require many doses per day. The recommended dosage of nasal spray is 1 to 2 sprays per hour, up to 40 sprays per day.

Inhalers have a nicotine cartridge inside that delivers vapor directly to the bloodstream. These cartridges are inhaled all at once over a 20-minute period. It’s recommended that smokers use anywhere between 4 and 16 cartridges per day.

Before starting any NRT, it’s best to talk to your doctor. They can help you create a schedule, learn the proper use of each therapy and make you aware of any side effects. Some may recommend combining a patch with another type of NRT to increase their effectiveness.

There are currently two prescription medications approved to help with smoking cessation. They are bupropion, also called Zyban, Wellbutrin, or Aplenzin, and varenicline, which is known by the brand name Chantix.

Bupropion is an antidepressant that is also used to treat depression and seasonal affective disorder. It decreases the desire for nicotine while diminishing some or most withdrawal symptoms.

In contrast, varenicline blocks nicotine’s connection to receptors in the brain—making smoking unsatisfying—and mimics the effects of nicotine in the body, reducing or eliminating cravings. Some studies have shown it to be more effective than bupropion and NRT. Other research is exploring whether these drugs are more effective when taken together or along with an NRT.

If you think you would benefit more from a prescription medication, schedule an appointment with your doctor a few weeks before you plan to quit. Both bupropion and varenicline work best if they are started before your actual quit day.

Be sure to ask your doctor about how any quit aid could affect other medications you may be taking. 

E-cigarettes are not FDA-approved as smoking cessation aids. Plus, there is limited evidence that they are effective for quitting. Many smokers who try e-cigarettes to quit smoking end up using both products. These people, known as “dual users” end up doing more harm to their health.

Many e-cigarette products also contain THC and emit numerous potentially toxic substances, including heavy metals and chemicals. Vitamin E acetate, a chemical additive found in some e-cigarettes, has been linked to severe vaping-related lung disease.

Scientists are still uncertain about the long-term effects of these products. The bottom line: If you don’t currently vape, don’t start.