How to Stop Smoking for Real this Time

Some people swear by gradual smoking cessation methods. A new study finds that quitting abruptly, with the right support, is the better strategy for long-term success.

Dr. Nicola Lindson-Hawley, a post-doctoral researcher at the University of Oxford in the U.K., led a study published in the Annals of Internal Medicine that put 700 adult smokers into two groups: a gradual reduction group and an abrupt quitting group. About half of the 700 people wanted to cut down gradually, a third wanted to try quitting abruptly, and the rest did not have a preference on how or when they quit. Their preferences, however, had no bearing on which group they were assigned.

“What we found was that more people managed to quit when they stopped smoking all in one go, than when they gradually reduced before quitting,” Lindson-Hawley told Reuters Health.

Those in the gradual group were told to cut back by 75 percent over two weeks and were given nicotine patches, along with their choice of gums, tablets, and other short-acting nicotine replacements. In the abrupt quitting group, participants were also put on nicotine patches — there is some evidence that patches can help with quitting. This group was told to smoke as usual until their “abrupt quit” date. Both groups were given counseling afterward.

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After four weeks, 49 percent of the abrupt quitters and 40 percent of the gradual group were not smoking. By six months, 22 percent of abrupt quitters and 15 percent of gradual quitters were still smoke-free. (Participants were given a chemical breath analysis to confirm.)

What Works Better?
Dr. Michael Steinberg, a tobacco specialist at Rutgers Robert Wood Johnson Medical School, said the study calls into question the notion of gradually cutting back as a cessation strategy. He wrote an accompanying editorial on the study.

“For smokers who were ready to make a quit attempt, even among those who prefer to quit gradually, those who were assigned to quit abruptly did better,” he told LifeZette.

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That doesn’t mean gradually cutting back can’t still work. Although gradual reduction was not as effective as abrupt cessation in the study, Steinberg said that approach may still be useful for other smokers who want to quit smoking.

“Gradual reduction can still play a role, as it could encourage smokers who are not ready to quit to take steps toward eventually making a quit attempt,” Steinberg added.

Dr. Michael Fiore, who chaired the Health and Human Services Subcommittee on Tobacco Cessation and helped craft a national 25-year plan to assist 33 million smokers to quit, said it’s important to note that quitting abruptly doesn’t mean stopping cold turkey without support.

“People think cold turkey means you just quit, on your own, with no help — you just gut it out,” Fiore told LifeZette. “Unfortunately, that [assumption] kind of supports the notion that you don’t get any help, which just doesn’t make sense for a powerful addiction and chronic disease like smoking.”

Fiore said the study highlights issues that can help smokers quit.

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“This study gives additional evidence that picking a quit date and [taking] not a single puff from that day forward, that using the medicine and getting some counseling is the most effective way.”

The most recent data shows adult smoking is down to just under 17 percent of all adults. Compared to the early 1960s, when 44 percent of adults smoked, Fiore said the impact is really remarkable.

“It’s only about a third of what it was then. So that’s incredible progress. Here’s the downside. Where back in the 60s everybody smoked — men, women, rich, poor, etc. — today, smoking is almost exclusively concentrated, or highly concentrated, among the poor, among the least educated, and among people who have a mental health or substance abuse diagnosis. People paradoxically with the least resources are the ones who smoke at the highest rates. So in essence, we’ve left behind the most vulnerable people in our society who are smoking now at the highest rates.”

He added that more needs to be done to find a way to reach these populations and to do so more effectively. “It’s a giant challenge,” he said.