How to quit smoking

Quitting smoking has major and immediate health benefits for men and women of all ages. Quitting smoking dramatically reduces the risk of lung and other cancers, coronary heart disease, stroke, and chronic lung disease. For example, 10 years after a person quits smoking, his or her risk of lung cancer is decreased to about one-third to one-half of that of a person who continues to smoke; with continued abstinence from smoking, the risk of lung cancer decreases even further.

Although quitting smoking is beneficial at any age, the earlier in life a person quits, the more likely it is that he or she will avoid the devastating health effects of continued tobacco use. Few smokers can quit successfully on their first attempt; most people will require several attempts before they are able to permanently quit. This emphasizes the need for smokers to begin trying to quit as early in life as possible.

There’s no one right way to quit, but there are some requirements for quitting with success.

If you want to stop smoking, several different treatments are available from shops, pharmacies and on prescription to help you beat your addiction and reduce withdrawal symptoms.

The best treatment for you will depend on your personal preference, your age, whether you’re pregnant or breastfeeding and any medical conditions you have. Speak to your doctor for stop smoking advice.

Key steps for quitting are covered here. Research has shown that all these methods can be effective.

Make the decision to quit smoking

The decision to quit smoking is one that only you can make. Others may want you to quit, but the real commitment must come from you.

Think about why you want to quit.

• Are you worried that you could get a smoking-related disease?
• Do you really believe that the benefits of quitting outweigh the benefits of continuing to smoke?
• Do you know someone who has had health problems because of smoking?
• Are you ready to make a serious try at quitting?

Write down your reasons so you can look at them every time you want to smoke.

If you’re ready to quit, setting a date and deciding on a plan will help move you to the next step.

Set a date and make a quit smoking plan

What’s important about picking a Quit Day?

Once you’ve decided to quit, you’re ready to pick a quit date. This is a key step. Pick a day within the next month as your Quit Day. Picking a date too far away gives you time to change your mind. Still, you need to give yourself enough time to prepare. You might choose a date with a special meaning like a birthday or anniversary, or the date of the Great American Smokeout (the third Thursday in November each year). Or you might want to just pick a random date. Circle the date on your calendar. Make a strong, personal commitment to quit on that day.

• Creating Your Quit Plan ¹
• https://smokefree.gov/

How do you plan to quit?

There are many ways to quit, and some work better than others. Nicotine replacement therapy, prescription drugs, and other methods are available. Learn more about ways to quit so you can find the method that best suites you. It’s also a good idea to talk to your doctor and get their advice and support.

Support is another key part of your plan. Stop-smoking programs, telephone quit lines, Nicotine Anonymous meetings, self-help materials such as books and pamphlets, and smoking counselors can be a great help. Also tell your family, friends, and co-workers that you’re quitting. They can give you help and encouragement, which increases your chances of quitting for good.

For the best chance at success, your plan should include at least 2 of these options.

Do quit smoking programs really work?

As you make your quit plan, you may wonder about success rates of the many different methods available. Success rates are hard to figure out for many reasons. First, not all programs define success in the same way. Does success mean that a person isn’t smoking at the end of the program? After 3 months? 6 months? 1 year? Does smoking fewer cigarettes (rather than stopping completely) count as success? If a method you’re considering claims a certain success rate, ask for more details on how success is defined and what kind of follow-up is done to confirm the rate.

It’s important to remember that quitting is hard. Quit smoking programs in general seem to have fairly low success rates, but they can still be worthwhile. Only about 4% to 7% of people are able to quit smoking on any given attempt without medicines or other help. Finding a program that fits your needs can make a difference.

What can I do to increase my chances of quitting?

Counseling and other types of emotional support can boost success rates higher than medicines alone. There’s also early evidence that combining certain medicines may work better than using a single drug.

Behavioral and supportive therapies may increase success rates even further. They also help the person stay smoke-free. Check the package insert of any product you are using to see if the manufacturer provides free telephone-based counseling.

Prepare for your Quit Day

Here are some steps to help you get ready for your Quit Day:

• Pick the date and mark it on your calendar.
• Tell friends and family about your Quit Day.
• Get rid of all the cigarettes and ashtrays in your home, car, and at work.
• Stock up on oral substitutes – sugarless gum, carrot sticks, hard candy, cinnamon sticks, coffee stirrers, straws, and/or toothpicks.
• Decide on a plan. Will you use nicotine replacement therapy or other medicines? Will you attend a stop-smoking class? If so, sign up now.
• Practice saying, “No thank you, I don’t smoke.”
• Set up a support system. This could be a group program or a friend or family member who has successfully quit and is willing to help you.
• Ask family and friends who still smoke not to smoke around you, and not to leave cigarettes out where you can see them.
• If you are using bupropion or varenicline, take your dose each day leading up to your Quit Day.
• Think about your past attempts to quit. Try to figure out what worked and what didn’t.

Successful quitting is a matter of planning and commitment, not luck. Decide now on your own plan.

On your Quit Day

Over time, smoking becomes a strong habit. Daily events, like waking up in the morning, finishing a meal, drinking coffee, or taking a break at work, often trigger your urge to smoke. Breaking the link between the trigger and smoking will help you stop.

On your Quit Day go down this list:

• Do not smoke. This means not at all – not even one puff!
• Stay busy – try walking, short bursts of exercise, or other activities and hobbies.
• Drink lots of water and juices.
• Start using nicotine replacement if that’s your choice.
• Attend a stop-smoking class or follow your self-help plan.
• Avoid situations where the urge to smoke is strong.
• Avoid people who are smoking.
• Drink less alcohol or avoid it completely.
• Think about how you can change your routine. Use a different route to go to work. Drink tea instead of coffee. Eat breakfast in a different place or eat different foods.

Be prepared to feel the urge to smoke. It will pass whether you smoke or not. Use the 4 D’s to help fight the urge:

• Delay for 10 minutes. Repeat if needed.
• Deep breathe. Close your eyes, slowly breathe in through your nose and out through your mouth. Picture your lungs filling with fresh, clean air.
• Drink water slowly, sip by sip.
• Do something else. Some activities trigger cravings. Get up and move around.

Often this simple trick will allow you to move beyond the strong urge to smoke.

Nicotine replacement therapy

The main reason that people smoke is because they are addicted to nicotine. The nicotine in tobacco leads to actual physical dependence. This can cause unpleasant withdrawal symptoms when a person tries to quit. Nicotine replacement therapy (NRT) gives you nicotine – in the form of gum, patches, sprays, inhalers, or lozenges – but not the other harmful chemicals in tobacco. Nicotine replacement therapy can help relieve some of the physical withdrawal symptoms so that you can focus on the psychological (emotional) aspects of quitting. Many studies have shown using nicotine replacement therapy can nearly double the chances of quitting smoking. It hasn’t been studied as much for quitting smokeless tobacco, but the nicotine replacement therapy lozenges may help.

Nicotine replacement therapy is a medication that provides you with a low level of nicotine, without the tar, carbon monoxide and other poisonous chemicals present in tobacco smoke.

It can help reduce unpleasant withdrawal effects, such as bad moods and cravings, which may occur when you stop smoking — that most people say is their only reason for not giving up tobacco.

Many people can quit tobacco without using nicotine replacement therapy, but most of those who attempt quitting do not succeed on the first try. In fact, smokers usually need many tries – sometimes as many as 10 or more – before they’re able to quit for good. Most people who try to quit on their own go back to smoking within the first month of quitting – often because of the withdrawal symptoms.

Together with counseling or other support, nicotine replacement therapy has been shown to help increase the number of smokeless tobacco users who quit, too.

Where to get nicotine replacement therapy and how to use it

Nicotine replacement therapy can be bought from pharmacies and some shops. It’s also available on prescription from a doctor.

It’s available as:

• skin patches
• chewing gum
• inhalators (which look like plastic cigarettes)
• tablets, oral strips and lozenges
• nasal and mouth spray

The most important thing to do with any form of nicotine replacement therapy is read and follow the package instructions very carefully.

Patches release nicotine slowly. Some are worn all the time and some should be taken off at night. Inhalators, gum and sprays act more quickly and may be better for alleviating cravings.

• There’s no evidence that any single type of nicotine replacement therapy is more effective than another. But there is good evidence to show that using a combination of nicotine replacement therapy is more effective than using a single product.

Often the best way to use nicotine replacement therapy is to combine a patch with a faster acting form such as gum, inhalator or nasal spray. The idea is to get a steady dose of nicotine with the patch and then use one of the shorter-acting products when you have strong cravings. If you’re thinking about using more than one nicotine replacement therapy product, be sure to talk to your health care provider first.

• Treatment with nicotine replacement therapy usually lasts 8-12 weeks, before you gradually reduce the dose and eventually stop.

Stopping nicotine replacement therapy

Nicotine replacement therapy (NRT) is meant to be used for a limited period of time. Use should be tapered down before nicotine replacement therapy is stopped. Studies to date have not shown that extending nicotine replacement therapy use longer than the recommended time greatly impacts quit success.

Research is still being done to refine the use of nicotine replacement therapy. If you feel that you need nicotine replacement therapy for a different length of time than is recommended, it’s best to discuss this with your health care provider.

Long-term nicotine replacement therapy dependence

Nicotine replacement therapy (NRT) has the potential for long-term dependence. Nicotine is addictive, and people can transfer their dependence from tobacco to the nicotine replacement therapy.

Use nicotine replacement therapy only as long as you need it, as prescribed by your health care provider. Talk to your provider if you’re having trouble stopping nicotine replacement therapy.

Nicotine patches (transdermal nicotine systems)

Patches can be bought with or without a prescription.

Patches give a measured dose of nicotine through the skin. You’re weaned off nicotine by switching to lower-dose patches over a course of weeks. Many different types and strengths are available. Package instructions tell you how to use them, and list special considerations and possible side effects.

The 16-hour patch works well if you are a light-to-average smoker. It’s less likely to cause side effects. But it doesn’t deliver nicotine during the night, so it may not be right if you have early morning withdrawal symptoms.

The 24-hour patch provides a steady dose of nicotine, avoiding highs and lows. It helps with early morning withdrawal. But there may be more side effects.

How to use nicotine patches: Depending on body size and smoking habits, most smokers should start using a full-strength patch (15-22 mg of nicotine) daily for 4 weeks, and then use a weaker patch (5-14 mg of nicotine) for another 4 weeks. The patch is changed every day. It should be put on in the morning on a clean, dry area of the skin without much hair. It should be placed below the neck and above the waist – for instance, on the upper arm or chest. The FDA has approved using the patch for a total of 3 to 5 months.

Possible side effects of the nicotine patch include:

• Skin irritation (redness and itching)
• Dizziness
• Racing heartbeat
• Sleep problems or unusual dreams
• Headache
• Nausea
• Muscle aches and stiffness

No one has all of the side effects, and some people have none. Some side effects, such as racing heart, may occur because the dose of nicotine is too high for you. Stop using the patch and talk to your health care provider if this happens. You can also have nicotine withdrawal symptoms during this time if your NRT dose is too low.

What to do about side effects

• Try a different brand of patch if your skin becomes irritated.
• Reduce the amount of nicotine by using a lower-dose patch.
• Sleep problems may go away in 3 or 4 days. If not, and you’re using a 24-hour patch, try switching to a 16-hour patch.
• Stop using the patch and try a different form of nicotine replacement therapy.

Nicotine gum (nicotine polacrilex)

Nicotine gum can be bought without a prescription.

Nicotine gum is a fast-acting form of replacement. Nicotine is taken in through the mucous membrane of the mouth. You can buy it over the counter (without a prescription). It comes in 2 mg and 4 mg strengths.

How to use nicotine gum

For best results, follow the instructions in the package. Chew the gum slowly until you get a peppery taste or tingle. Then tuck it inside your cheek until the taste fades. Chew it to get the peppery taste back, and hold it again. Do this off and on for 20 to 30 minutes. Food and drink can affect how well the nicotine is absorbed, so don’t eat or drink for at least 15 minutes before and during gum use.

In choosing your dose, think about whether you:

• Smoke 25 or more cigarettes per day
• Smoke within 30 minutes of waking up
• Have trouble not smoking in restricted areas

If any of these describe you, you may need to start with the higher 4mg gum dose.

Chew no more than 24 pieces of gum in one day. Nicotine gum is usually recommended for 6 to 12 weeks, with the maximum being 6 months. Tapering down the amount of gum you use as you approach 3 months may help you stop using it.

Another advantage of nicotine gum is that it allows you to control the nicotine doses. The gum can be used as needed or on a fixed schedule during the day. The most recent research has shown that scheduled dosing works better. A schedule of 1 to 2 pieces per hour is common. On the other hand, with an as-needed schedule, you can use it when you need it most – when you have cravings.

Possible side effects of nicotine gum include:

• Bad taste
• Throat irritation
• Mouth sores
• Hiccups
• Nausea
• Jaw discomfort
• Racing heartbeat
• Nausea

The gum can also stick to and damage dentures and dental work.

Stomach and jaw discomfort are usually caused by improper use of the gum, such as swallowing the nicotine or chewing too fast. No one has all of the side effects, and some people have none. If your heart is racing or beating irregularly, stop using the gum and talk to your health care provider. You can also have nicotine withdrawal symptoms during this time if your nicotine replacement therapy dose is too low.

Nicotine nasal spray

Nicotine nasal spray is only available by prescription.

The nasal spray delivers nicotine to the bloodstream quickly because it’s absorbed through the nose. It relieves withdrawal symptoms very quickly and lets you control your nicotine cravings. Smokers usually like the nasal spray because it’s easy to use when you need it.

How to use nicotine nasal spray

Most people are told to use 1 to 2 doses per hour. (1 dose = 2 sprays, 1 in each nostril.) At least 8 doses (16 sprays) each day may be needed when you first start, but use as directed by your health care provider. You should not use more than 40 doses (80 sprays) per day. Instructions can vary. Talk to your provider about the plan that’s best for you.

The FDA recommends that the spray be prescribed for 3-month periods and that it not be used for longer than 6 months.

Possible side effects of nicotine spray:

The most common side effects of the spray get better in about 1 to 2 weeks and can include:

• Nasal irritation
• Runny nose
• Watery eyes
• Sneezing
• Throat irritation
• Coughing

Other side effects are related to nicotine:

• Racing heart
• Nervousness
• Headache

No one has all of the side effects, and some people have none. Some side effects, such as racing heart, may occur because you’ve gotten too much nicotine. Stop using the spray to see if the feelings get better and talk to your health care provider if this happens. You may need to use it less often. You can also have nicotine withdrawal symptoms during this time if your nicotine replacement therapy dose is too low.

If you have asthma, allergies, nasal polyps, or sinus problems, your provider may suggest another form of nicotine replacement therapy.

Special note: This form of nicotine replacement therapy poses a more serious risk to small children and pets because the empty bottles of nasal spray contain enough nicotine to harm them. Do not get the liquid on your skin. If there’s any skin contact, rinse thoroughly with plain water right away. If a bottle breaks or liquid leaks out, put on plastic or rubber gloves to clean it up. Call Poison Control and get emergency help if there’s any question of overdose.

Nicotine inhalers

Inhalers are available only by prescription.

The nicotine inhaler is a thin plastic tube with a nicotine cartridge inside. Unlike other inhalers, which deliver most of the medicine to the lungs, the nicotine inhaler delivers most of the nicotine vapor to the mouth where it’s absorbed into the bloodstream. Nicotine inhalers are the FDA-approved nicotine replacement method that’s most like smoking a cigarette, which some smokers find helpful.

At this time, inhalers are the most expensive form of nicotine replacement therapy available. They are not the same as electronic cigarettes, which are not approved by the FDA to help people quit smoking.

How to use the nicotine oral inhaler

You puff on the inhaler and the cartridge sends a pure nicotine vapor into your mouth. You may use up the cartridge all at once over about 20 minutes, or puff on it only a few minutes at a time. The recommended dose is between 4 and 20 cartridges a day, slowly tapering off over 6 months.

Possible side effects of the nicotine inhaler:

The most common side effects, especially when first using the inhaler, include:

• Coughing
• Mouth and/or throat irritation
• Runny nose
• Upset stomach

Other side effects are related to nicotine:

• Racing heart
• Nervousness
• Headache

No one has all of the side effects, and some people have none. Some side effects, such as racing heart, may occur because you’ve gotten too much nicotine. Stop using the inhaler to see if the feelings get better and talk to your health care provider if this happens. You may need to use it less often. You can also have nicotine withdrawal symptoms during this time if your nicotine replacement therapy dose is too low.

Special note: This form of nicotine replacement therapy poses an extra risk to small children and pets because the used cartridges still have enough nicotine in them to cause harm if it gets on skin or mucous membranes (for instance, if licked or touched to the eyes, mouth, or other mucous membrane). Be sure to store and dispose of the cartridges away from children and pets. Call Poison Control and get emergency help if there’s any question of overdose.

Nicotine lozenges

Nicotine lozenges can be bought without a prescription.

The lozenge is available in 2 strengths: 2 mg and 4 mg. Smokers choose their dose based on how long after waking up they normally have their first cigarette. If you smoke your first cigarette within 30 minutes of waking up, use 4 mg nicotine lozenges. If you smoke your first cigarette more than 30 minutes after waking up, use 2 mg-nicotine lozenges.

How to use nicotine lozenges

The recommended dose is 1 lozenge every 1 to 2 hours for 6 weeks, then 1 lozenge every 2 to 4 hours for weeks 7 to 9, and finally, 1 lozenge every 4 to 8 hours for weeks 10 to 12. The lozenge makers also recommend:

• Do not eat or drink for at least 15 minutes before using a lozenge or while using a lozenge. (Some drinks can reduce how well the lozenge works.)
• Do not use more than 1 lozenge at a time and do not use one right after another.
• Suck on the lozenge until it is fully dissolved, about 20 to 30 minutes. Move it from side to side in your mouth. Do not bite or chew it like a hard candy, and don’t swallow it. The nicotine absorbs through the mucous membranes of the mouth.
• Do not use more than 5 lozenges in 6 hours, or more than 20 lozenges per day.
• Stop using the lozenge after 12 weeks. If you still feel you need to use the lozenge, talk to your doctor.

Possible side effects of the nicotine lozenge include:

• Nausea
• Hiccups
• Sore throat
• Coughing
• Heartburn
• Headache
• Gas
• Trouble sleeping
• Racing heart

Who can use nicotine replacement therapy

Most people are able to use nicotine replacement therapy, including:

• Adults and children over 12 years of age – although children under 18 shouldn’t use the lozenges without getting medical advice first
• Pregnant women – your doctor may suggest nicotine replacement therapy if they think it would help you quit; read more about stopping smoking in pregnancy
• Breastfeeding women – your doctor can advise you how to do this safely

Always read the packet or leaflet before using nicotine replacement therapy to check whether it’s suitable for you.

Sometimes it may be advisable to get medical advice first, for example if you have kidney or liver problems, or you’ve recently had a heart attack or stroke.

Who should not use nicotine replacement therapy

The US Agency for Healthcare Research and Quality states that nicotine replacement therapy is safe for all adult who want to quit smoking except pregnant women and teens. Still, it’s best to discuss nicotine replacement therapy use with your health care provider before starting it. You may have medical problems that should be considered. When looking at nicotine replacement therapy use, the benefits of quitting tobacco must outweigh the potential health risks of nicotine replacement therapy for each person.

People who are still smoking or using any other form of tobacco should not use nicotine replacement therapy. The companies that make nicotine replacement therapy products warn that you should not use them if you’re still using tobacco, and the FDA has not approved them to be used in this way. Get the advice of a health care provider if you want to use nicotine replacement therapy and smoke or chew.

Nicotine replacement therapy has not yet been proven to help people who smoke fewer than 10 cigarettes a day. You might want to talk with your health care provider about a lower dose of nicotine replacement therapy if you smoke less than that but feel you need nicotine replacement.

Possible side effects of nicotine replacement therapy

Side effects of nicotine replacement therapy can include:

• skin irritation when using patches
• irritation of nose, throat or eyes when using a nasal spray
• difficulty sleeping (insomnia), sometimes with vivid dreams
• an upset stomach
• dizziness
• headaches

Any side effects are usually mild. But if they’re particularly troublesome, contact your doctor as the dose or type of nicotine replacement therapy may need to be changed.

Getting the most from nicotine replacement therapy

Nicotine replacement therapy (NRT) only deals with the physical dependence. It’s not meant to be the only thing you use to help you quit smoking. You’ll need other methods that help with the psychological (emotional and mental) part of tobacco, such as a quit program. Use these support systems during treatment with nicotine replacement therapy and for at least a few months after you quit. Studies have shown that this approach – pairing nicotine replacement therapy with a program that helps to change behavior – can improve your chances of quitting and staying quit compared to approaches that use only one method.

The best time to start nicotine replacement therapy is when you first quit. Often people first try to quit tobacco on their own then decide to try nicotine replacement therapy a day or more into quitting. This does not give you the greatest chance of success, but don’t let this discourage you. There are many options for quitting and staying quit. Just remember that it often takes many tries.

The Food and Drug Administration (FDA) has approved the nicotine replacement therapy products discussed here as effective aids for helping people quit smoking. None of these products has been FDA-approved specifically to help people quit smokeless tobacco. Still, studies are being done, and some have shown the lozenge form may help.

Can you get too much nicotine from nicotine replacement therapy?

Nicotine overdose is rare, but possible. Nicotine replacement therapy (NRT) products are labeled to match the amount of nicotine you get from nicotine replacement therapy to the amount you got from tobacco. If used this way, you should get a nicotine dose fairly close to what you’ve been getting. You don’t want to get more than that, because higher doses of nicotine can cause harm. To avoid this, follow dosing instructions carefully. Also, don’t use heat (like a heating pad or heat lamp) on the skin near your nicotine patch – you could absorb more nicotine due to the increased blood supply.

Nicotine absorbs through the skin and mucous membranes, so you must store and dispose of your nicotine replacement therapy safely. Nicotine overdose can cause death. Overdose is more of a problem in children and pets because of their smaller size. Keep nicotine replacement therapy and used gum, patches, empty cartridges, bottles, etc., safely away from children and pets. Never drop them on the street or in open trash cans where kids and animals can reach them.

Symptoms of nicotine overdose

Here are some symptoms of too much nicotine:

• Headache
• Nausea and vomiting
• Belly pain
• Diarrhea
• Agitation, restlessness
• Fast or irregular heartbeat
• Cold sweat
• Pale skin and mouth
• Weakness
• Tremors (shaking)
• Confusion
• Disturbed vision and hearing
• Weakness
• High blood pressure, which then drops
• Dizziness or faintness due to low blood pressure
• Seizures
• Fast breathing in early poisoning, breathing may stop later

Call Poison Control and get emergency help if you suspect an overdose. If you’re taking nicotine replacement therapy as prescribed and are still having mild symptoms such as headache, vomiting, diarrhea, or sweating, lower your dose and talk to your health care provider.

How do I know if I’m a light, average, or heavy smoker?

Most nicotine replacement therapy products are recommended on the basis of how much you smoke. But there’s no formal category in any textbook or group that defines a light, average, or heavy smoker.

These are general guidelines:

• Light smoker: Smokes fewer than 10 cigarettes per day
• Heavy smoker: Smokes a pack a day or more
• An average smoker falls in between.

How do I know what nicotine replacement therapy dose to use based on my smokeless tobacco use?

For smokeless tobacco users, certain types of nicotine replacement therapy may help more than others. If you look at the way the tobacco is used, nicotine gum and lozenges are most like using smokeless tobacco. They also let you control your dose to help keep nicotine cravings down.

Nicotine replacement therapy products are supposed to roughly match the amount of nicotine you typically took in through tobacco. It can be more of a challenge to get the dose right for smokeless tobacco users, since nicotine replacement therapy products are labeled for smokers.

To avoid withdrawal symptoms, you want to aim for a nicotine dose fairly close to what you got from snuff or tobacco use.

These are general guidelines:

• A heavy user is a person who uses more than 3 cans of snuff or 3 pouches of tobacco a week, and would typically use the higher doses of nicotine replacement therapy (the dose for heavy smokers).
• Those who use 2 to 3 cans or pouches per week would usually try the moderate doses.
• Those who use less than 2 would start with the lowest doses of nicotine replacement therapy.

If you’ve decided to try nicotine replacement therapy, discuss your dose with a health care provider before you quit tobacco.

Prescription Drugs to Help You Quit Tobacco

There are prescription drugs that have been shown to help smokers quit. Some can be used along with nicotine replacement therapy (NRT). You often need to start taking them in the weeks before your Quit Day (the day you plan to quit).

Varenicline (Chantix)

Varenicline (also called Chantix®) is a prescription medicine developed to help people stop smoking. It works by interfering with nicotine receptors in the brain.

This means it has 2 effects:

• It lessens the pleasure a person gets from smoking.
• It reduces the symptoms of nicotine withdrawal.

You typically start taking varenicline (a pill) about a month to a week before your Quit Day. Take it after meals, with a full glass of water. The daily dose increases over the first 8 days you take it. If you have problems with the higher doses, a lower dose may be used while you try to quit.

Typically, varenicline is given for 12 weeks, but people who quit during that time may get another 12 weeks of treatment to boost their chances of staying off tobacco. It’s important to keep up with other support systems during this time and for at least a few months after quitting.

Tell your provider about any medical conditions and allergies you have before you start varenicline, including if you might be pregnant.

Who can use varenicline

Varenicline is safe for most people to take, although there are some situations when it’s not recommended.

For example, it’s NOT suitable for:

• children under 18 years of age
• women who are pregnant or breastfeeding
• people with severe kidney problems

Side effects of varenicline

Reported side effects have included:

• Nausea
• Vomiting
• Headache
• Trouble sleeping, unusual dreams, or sleepwalking
• Constipation
• Difficulty sleeping (insomnia), sometimes with vivid dreams
• Dry mouth
• Gas
• Changes in taste
• Skin rashes
• Seizures
• Heart or blood vessel problems (mostly in people who already have these problems)
• Mood or behavior changes, such as depression, hallucinations, delusions, aggression, hostility, agitation, anxiety, panic, or even suicidal thoughts

Talk to your health care provider about what to expect while taking this drug, and what to do if you or others notice possible side effects. Be sure to let your provider know if you’ve ever had depression or other mental health problems, or if you start feeling depressed or have thoughts about suicide.

Using varenicline along with nicotine replacement therapy (NRT) or bupropion for quitting smoking

Research is being done to find out if varenicline can be used at the same time as nicotine replacement therapy (NRT). A few studies have suggested that using varenicline along with NRT is well-tolerated and safe, but others have found this has no long-term benefit in helping people quit. More research is needed.

Research on using both varenicline and bupropion at the same time is also being done. While there may be a benefit to combining the drugs vs. taking only varenicline, more research is needed to understand if this could cause more severe side effects.

Bupropion (Zyban)

Bupropion also may be called by the brand names Zyban®, Wellbutrin®, or Aplenzin®. It’s a prescription antidepressant in an extended-release form that helps reduce cravings and symptoms of nicotine withdrawal. It does not contain nicotine. This drug acts on chemicals in the brain that are related to nicotine craving. Bupropion works best if it’s started 1 or 2 weeks before you quit smoking. The usual dosage is one or two 150 mg tablets per day.

If you’re still not using tobacco after taking bupropion for 7 to 12 weeks, your provider may have you keep taking it for some time afterward to help stop you from going back to smoking. Keep up with your other support systems during this time and for at least a few months after you quit.

This drug should NOT be taken if you have or have ever had:

• Seizures (it can cause or worsen seizures)
• Heavy alcohol use
• Cirrhosis
• A serious head injury
• Bipolar (manic-depressive) illness
• Anorexia or bulimia (eating disorders)
• Children under 18 years of age
• Women who are pregnant or breastfeeding

You also shouldn’t take it if you’re taking sedatives or have recently taken a monoamine oxidase inhibitor (MAOI, an older type of antidepressant).

Tell your doctor about any medical conditions and allergies you have before you start bupropion, including if you might be pregnant.

Side effects of bupropion

Reported side effects of bupropion include:

• Dry mouth
• Stuffy nose
• Trouble sleeping and nightmares
• Tiredness
• Difficulty concentrating
• Dizziness
• Constipation
• Nausea
• Headaches
• High blood pressure
• Seizures
• Feeling depressed, anxious, agitated, hostile, aggressive, overly excited or hyperactive, or confused; or having suicidal thoughts

If you are using bupropion, call your health care provider if you feel depressed or start thinking of suicide. Also be sure to ask what to expect while taking this drug, and what to do if you or others notice possible side effects.

Bupropion can cause drug interactions and shouldn’t be used with certain other drugs or supplements. Be sure your provider knows about everything you take, such as prescription drugs, vitamins, herbs, supplements, and any medicines you take on your own when you need them, like acetaminophen (Tylenol) or aspirin. Also be sure to tell every provider you see that you’re taking bupropion.

Other prescription drugs used to help smokers quit

For those who can’t use any of the US Food and Drug Administration (FDA)-approved drugs for helping smokers quit, or for those who haven’t been able to quit using them, other drugs have shown promise in studies. They’re recommended by the Agency for Healthcare Research and Quality for this kind of use, but have not been approved by the FDA for this purpose and so are used “off-label.” These drugs are only available with a prescription and are not recommended for pregnant smokers, teens, or people who smoke fewer than 10 cigarettes a day.

Nortriptyline

This is an older anti-depressant drug that helps reduce tobacco withdrawal symptoms. It has been found to increase chances of success in quitting smoking when compared to those taking no medicine. It’s typically started 10 to 28 days before a person stops smoking to allow it to reach a stable level in the body.

Some people have side effects like a fast heart rate, blurred vision, trouble urinating, dry mouth, constipation, weight gain or loss, and low blood pressure when they stand up. The drug can affect a person’s ability to drive or operate machinery, and certain drugs cannot be used along with it.

If you and your health care provider decide to use this drug, be sure your provider and pharmacist know exactly what other drugs you’re taking before you start this medicine. Also be sure you know how to take it and how to taper off it when you are ready to stop. The dose of nortriptyline must be slowly lowered, since the drug cannot be stopped suddenly without the risk of serious effects. People with heart disease should use this drug cautiously. Be sure to tell all your health care providers that you are taking this drug.

Clonidine

Clonidine is another older drug that has been shown to help people quit. It’s FDA- approved to treat high blood pressure. When used to quit smoking, it can be taken as a pill twice a day or worn as a skin patch that’s changed once-a-week.

If you’re planning to use this drug, be sure your health care provider and pharmacist know exactly what else you’re taking before you start taking it. The most common side effects of clonidine are constipation, dizziness, drowsiness, dry mouth, and unusual tiredness or weakness. There are rarely more severe side effects, such as allergic reactions, a slow heart rate, and very high or very low blood pressure. Your health provider might want to watch your blood pressure while you are on this drug. The drug can affect your ability to drive or operate machinery.

You can start taking clonidine up to 3 days before you quit smoking, but can also be started the day you quit. It shouldn’t be stopped suddenly. The dose must be lowered over a few days to prevent a rapid increase in blood pressure, agitation, confusion, or tremors.

Other drugs being studied to help smokers quit

A drug called cytisine has shown promise and is being studied in the United States.

Naltrexone is a drug used to help those with alcohol and opioid abuse disorders. Studies are looking at ways to combine it with varenicline to help people quit smoking, especially smokers who are also heavy drinkers.

Also being tested are possible anti-smoking vaccines that are given as injections.

So far these new options seem to be safe, but larger studies are needed to show that they work before the FDA can approve them for this use.

Getting Help with the Mental Part of Tobacco Addiction

Nicotine is the drug in tobacco that causes pleasant feelings and distracts the user from unpleasant feelings. Over time, a person becomes physically dependent on and emotionally addicted to nicotine. This physical dependence causes unpleasant withdrawal symptoms when you try to quit smoking or other forms of tobacco. There are mental and emotional effects, too. Nicotine actually actually affects brain chemistry and emotions.

What you might feel when you quit tobacco:

• Depression
• Sadness or grief
• A sense of loss
• Frustration
• Impatience
• Anger
• Anxiety
• Irritability
• Trouble concentrating
• Restlessness or boredom

What you can do

There are many tools to help quit smoking or other forms of tobacco for good. In most cases, tobacco users are aware of the annoying physical symptoms and think about things like nicotine replacement therapies and medicines to help with them. But they may not be ready for the mental effect, which can be a bigger challenge.

The emotional and mental dependence (addiction) make it hard to stay away from nicotine after you quit. To quit and stay quit, tobacco users must deal with both the physical and mental dependence. Fortunately, there are counseling services, self-help materials, and support services available to help you get through this time. And just like the physical symptoms, the emotional changes get better over time.

You can prepare yourself for the mental effects of tobacco withdrawal.

Quit-tobacco programs

Telephone-based help to stop using tobacco

All 50 states and the District of Columbia offer some type of free, telephone-based program that links callers with trained counselors. These specialists help plan a quit method that fits each person’s unique pattern of tobacco use. People who use telephone counseling have twice the success rate in quitting smoking as those who don’t get this type of help. Research has shown that telephone counseling also helps people who are trying to quit smokeless tobacco.

Counselors may suggest a combination of methods including medicines, local classes, self-help brochures, and/or a network of family and friends. Help from a counselor can keep quitters from making many common mistakes.

Telephone counseling is also easier to use than some other support programs. It doesn’t require driving, transportation, or child care, and it’s available nights and weekends.

The effectiveness of phone-based services has led to the development of many web-based quit aids and mobile apps. These offer another easy-to-use support resource to people trying to quit.

Support groups for quitters

Support groups for quitters can be helpful, too. One long-standing peer help program is Nicotine Anonymous® (NicA). This group holds regular meetings and applies the 12-step program of Alcoholics Anonymous (AA) to tobacco addiction. This includes attending meetings and following the program. People new to NicA may choose a sponsor to help them through the steps and when they are tempted to use tobacco. The NicA meetings are free, but donations are collected to help cover expenses. NicA also has phone meetings and web meetings, and offers online support.

You can find out if there’s a Nicotine Anonymous group near you ². But this is only one of many types of support programs.

Often your American Cancer Society or local health department will sponsor quit classes, too.

Some workplaces, hospitals, and wellness centers have quit-tobacco programs, groups, or classes. They may be led by professionals and focus on information and education, or they may be run by volunteers. Some programs may be set up like classes, while others focus on sharing by members of the group. Some groups are set up for just a few weeks, and others go on indefinitely. There are lots of options, and different types of groups work better for different people. Find one that works for you.

For people who can’t go to support group meetings, there are online support systems as well as phone- and web-based support (see above).

Check with your employer, health insurance company, or local hospital to find a support group that fit your needs. Or call your American Cancer Society at ³ to find out what support services might be available where you live.

What to look for in a tobacco cessation program

Tobacco cessation or quit programs are designed to help tobacco users recognize and cope with problems that come up while quitting. The programs should also provide support and encouragement in staying quit. This helps the ex-tobacco user avoid many of the common pitfalls of quitting.

Studies have shown that the best programs include either one-on-one or group counseling. There’s a strong link between how often and how long counseling lasts (its intensity) and the success rate – overall, the more intense the program, the greater the chance of success.

Intensity may be increased by having more or longer sessions or by increasing the number of weeks over which the sessions are given. So when looking for a program, try to find one that has the following:

• Each session lasts at least 15 to 30 minutes
• There are at least 4 sessions
• The program lasts at least 2 weeks (longer is usually better)

Make sure the leader of the group is trained in smoking cessation.

Not all programs are honest, so be careful. Think twice about any programs that:

• Promise instant, easy success with little to no effort on your part
• Use injections or pills, especially “secret” ingredients
• Advertise 100% success rate with no ill effects
• Charge a very high fee (check with the Better Business Bureau if you have doubts)
• Won’t give you references and phone numbers of people who have used the program

Support of family and friends

Many former tobacco users say a support network of family and friends was very important during their quit attempt. Other people, such as your co-workers and your family doctor, may offer support and encouragement. Tell your friends about your plans to quit. Try to spend time with non-tobacco users and ex-tobacco users who support your efforts to quit. Talk with them about what you need – for instance, patience as you go through cravings, taking your late-night or early-morning phone calls, and plans for doing things in places where it’s harder to use tobacco. Find out what you can count on each friend or family member to do.

Other Ways to Quit Smoking

You may hear or read about other tools or methods to quit smoking besides nicotine replacement therapy or prescription drugs. While these may help some people, there’s no strong proof that they can improve the chances of quitting smoking.

Cold turkey and gradual withdrawal

There’s no one right way to quit. A lot of smokers quit cold turkey – they stop completely, all at once, with no medicines or nicotine replacement. Some may start by smoking fewer cigarettes for a few weeks before they quit.

Another way is gradual withdrawal – cutting down on the number of cigarettes you smoke a little bit each day. This way, you slowly reduce the amount of nicotine in your body. You might cut out cigarettes smoked with a cup of coffee, or you might decide to smoke only at certain times of the day. It makes sense to cut down before your quit date in order to reduce withdrawal symptoms, but this can be hard to do.

Filters

Filters that reduce tar and nicotine in cigarettes do not work. In fact, studies have shown that smokers who use filters tend to smoke more.

Smoking deterrents

Other methods have been used to help stop smoking, such as over-the-counter products that change the taste of tobacco, stop-smoking diets that curb nicotine cravings, and combinations of vitamins. At this time there’s no scientific evidence that any of these work.

Electronic cigarettes

An e-cigarette is an electronic device that delivers nicotine in a vapor. Electronic cigarettes (e-cigarettes) are not supposed to be sold to help quit smoking and are not regulated by the FDA. Still, many smokers view them as quit aids.

A few studies have found that e-cigarettes may help reduce the number of cigarettes smoked, but more research is needed to know whether they help people quit. The overall safety of e-cigarettes is also unknown and is being studied. Electronic cigarettes and other electronic nicotine delivery devices (or ENDS) are a hot research topic.

Tobacco lozenges and pouches

The FDA has ruled that lozenges, strips, and sticks that contain tobacco and small pouches of tobacco that you hold in your mouth are types of oral tobacco products much like snuff and chew, and are not smoking cessation aids.

There’s no evidence that these products can help a person quit smoking. And we know that oral tobacco products like snuff and chewing tobacco cause cancer.

Other forms of nicotine not approved by the FDA

Nicotine has been added to drinks, lollipops, straws, and lip balms which are marketed as quit tools. None of these are approved by the FDA, and, in fact, some are illegal in the US. None have been shown to help people quit smoking. They also pose a risk for children and pets if they are not well-labeled, carefully stored, and disposed of safely.

Hypnosis

Hypnosis methods vary a great deal, which makes it hard to study as a way to stop smoking. For the most part, reviews that looked at controlled studies of hypnosis to help people quit smoking have not found that it’s a quitting method that works. Still, some people say that it helps. If you’d like to try it, ask your health care provider to recommend a good licensed therapist who does hypnotherapy.

Acupuncture

This method has been used to quit smoking, but there’s little evidence to show that it works. Acupuncture for smoking is usually done on certain parts of the ears.

Magnet therapy

Magnet therapy to quit smoking involves 2 small magnets that are put in a certain spot, opposite each other on either side of the ear. Magnetism holds them in place. There’s no scientific evidence to date to suggest that magnet therapy helps smokers stop. There are many on-line companies that sell these magnets, and they report various “success” rates. But there’s no clinical trial data to back up these claims.

Cold laser therapy

This is also called low level laser therapy, and is related to acupuncture. In this method, cold lasers are used instead of needles for acupuncture. Despite claims of success by some cold laser therapy providers, there’s no scientific evidence that shows this helps people stop smoking.

Herbs and supplements

There’s little scientific evidence to support the use of homeopathic aids and herbal supplements as stop-smoking methods. Because they are marketed as dietary supplements (not drugs), they don’t need FDA approval to be sold. This means that the manufacturers don’t have to prove they work, or even that they’re safe.

Be sure to look closely at the label of any product that claims it can help you stop smoking. No dietary supplement has been proven to help people quit smoking. Most of these supplements are combinations of herbs, but not nicotine. They have no proven track record of helping people to stop smoking.

Mind-body practices

Some studies have looked at cessation programs using yoga, mindfulness, and meditation to aid in quitting smoking. Results were not clearly in favor of these methods, but some did show lower craving and less smoking. More research is needed, and studies of these practices are still going on. Cognitive processing methods (cognitive-behavioral approaches) are also being studied.

Other forms of nicotine not approved by the FDA

Nicotine has been added to drinks, lollipops, straws, and lip balms and marketed as quit tools. None of these are approved by the FDA, and, in fact, some are illegal in the US. None have been shown to help people quit smoking. They also pose a risk for children and pets if they are not well-labeled, carefully stored, and disposed of safely.

Home remedies and non-tobacco options

There are products made from “natural” things like tea, clover, and mint that are said to help people quit using smokeless tobacco. Some people also recommend cayenne pepper or coffee ground pouches. Often these fake dip and fake tobacco products can be bought in cans and pouches. Homeopathic aids and herbal supplements may also be suggested as quit methods. Because herbs are marketed as dietary supplements (not drugs), they don’t need FDA approval to be sold. This means that the manufacturers don’t have to prove they work, or even that they’re safe.

Be sure to look closely at the label of any product that claims it can help you stop tobacco. No dietary supplement has been proven to help people quit. Most of these supplements are combinations of herbs, but not nicotine. They have no proven track record of helping people stop using smokeless tobacco.

What happens when you quit smoking

Benefits of quitting smoking

Within minutes of smoking your last cigarette, your body begins to recover:

20 minutes after quitting

Your heart rate and blood pressure drop ⁴

12 hours after quitting. The carbon monoxide level in your blood drops to normal ⁵

2 weeks to 3 months after quitting. Your circulation improves and your lung function increases ⁶

1 to 9 months after quitting. Coughing and shortness of breath decrease. Tiny hair-like structures that move mucus out of the lungs (called cilia) start to regain normal function in your lungs, increasing their ability to handle mucus, clean the lungs, and reduce the risk of infection ⁷

1 year after quitting. The excess risk of coronary heart disease is half that of someone who still smokes. Your heart attack risk drops dramatically ⁸

5 years after quitting. Your risk of cancers of the mouth, throat, esophagus, and bladder is cut in half. Cervical cancer risk falls to that of a non-smoker. Your stroke risk can fall to that of a non-smoker after 2 to 5 years ⁹

10 years after quitting. Your risk of dying from lung cancer is about half that of a person who is still smoking. Your risk of cancer of the larynx (voice box) and pancreas decreases ¹⁰

15 years after quitting. Your risk of coronary heart disease is that of a non-smoker’s ¹¹

These are just a few of the benefits of quitting smoking for good. Quitting smoking lowers your risk of diabetes, lets blood vessels work better, and helps your heart and lungs.

Life expectancy for smokers is at least 10 years shorter than that of non-smokers. Quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90%.

Quitting while you’re younger will reduce your health risks more, but quitting at any age can give back years of life that would be lost by continuing to smoke.

Right away you’ll save the money you spent on tobacco! And here are just a few other benefits you may notice:

• Food tastes better.
• Your sense of smell returns to normal.
• Your breath, hair, and clothes smell better.
• Your teeth and fingernails stop yellowing.
• Ordinary activities leave you less out of breath (for example, climbing stairs or light housework).
• You can be in smoke-free buildings without having to go outside to smoke.

Quitting also helps stop the damaging effects of tobacco on how you look, including premature wrinkling of your skin, gum disease, and tooth loss.

Broken addiction cycle

Quitting smoking can re-wire your brain and help break the cycle of addiction. The large number of nicotine receptors in your brain will return to normal levels after about a month of being quit.

Sharp hearing

Quitting smoking will keep your hearing sharp. Remember, even mild hearing loss can cause problems (like not hearing directions correctly and doing a task wrong).

Better vision

Quitting smoking will improve your night vision and help preserve your overall vision by stopping the damage that smoking does to your eyes.

Clean mouth

Nobody likes a dirty mouth. After a few days without cigarettes, your smile will be brighter. Quitting smoking now will keep your mouth healthy for years to come.

Clear skin

Quitting smoking is better than anti-aging lotion. Quitting can help clear up blemishes and protect your skin from premature aging and wrinkling.

Decreased heart risks

Smoking is the leading cause of heart attacks and heart disease. But many of these heart risks can be reversed simply by quitting smoking. Quitting can lower your blood pressure and heart rate almost immediately. Your risk of a heart attack declines within 24 hours.

Thin blood

When you quit smoking, your blood will become thinner and less likely to form dangerous blood clots. Your heart will also have less work to do, because it will be able to move the blood around your body more easily.

Lower cholesterol

Quitting smoking will not get rid of the fatty deposits that are already there. But it will lower the levels of cholesterol and fats circulating in your blood, which will help to slow the buildup of new fatty deposits in your arteries.

Stop lung damage

Scarring of the lungs is not reversible. That is why it is important to quit smoking before you do permanent damage to your lungs. Within two weeks of quitting, you might notice it’s easier to walk up the stairs because you may be less short of breath. Don’t wait until later; quit today!

Prevent emphysema

There is no cure for emphysema. But quitting when you are young, before you have done years of damage to the delicate air sacs in your lungs, will help protect you from developing emphysema later.

Return of cilia

Cilia start to regrow and re-gain normal function very quickly after you quit smoking. They are one of the first things in your body to heal. People sometimes notice that they cough more than usual when they first quit smoking. This is a sign that the cilia are coming back to life. But you’re more likely to fight off colds and infections when you’re cilia are working properly.

Lower cancer risk

Quitting smoking will prevent new DNA damage from happening and can even help repair the damage that has already been done. Quitting smoking immediately is the best way to lower your risk of getting cancer.

Smaller belly

Quitting smoking will reduce your belly fat and lower your risk of diabetes. If you already have diabetes, quitting can help you keep your blood sugar levels in check.

Normal estrogen levels

If you’re a woman, your estrogen levels will gradually return to normal after you quit smoking. And if you hope to have children someday, quitting smoking right now will increase your chances of a healthy pregnancy in the future.

Sexual healing

If you quit smoking now, you can lower your chances of erectile dysfunction and improve your chances of having a healthy sexual life.

Normal white blood cell count

When you quit smoking, your body will begin to heal from the injuries that smoking caused. Eventually, your white blood cell counts will return to normal and will no longer be on the defensive.

Proper healing

Quitting smoking will improve blood flow to wounds, allowing important nutrients, minerals, and oxygen to reach the wound and help it heal properly.

Stronger immune system

When you quit smoking, your immune system is no longer exposed to tar and nicotine. It will become stronger, and you will be less likely to get sick.

Strong muscles

Quitting smoking will help increase the availability of oxygen in your blood, and your muscles will become stronger and healthier.

Stronger bones

Quitting smoking can reduce your risk of fractures, both now and later in life. Keep your bones strong and healthy by quitting now.

Help for Cravings and Tough Situations

What does it take to stay tobacco-free?

Quitting smoking can be a long and hard process. But staying tobacco-free is the longest and most important part of it. Every day you must decide not to smoke today.

Each day that you don’t smoke is a small victory. These all add up to a huge victory over time.

How do I get through the rough spots after I stop smoking?

• For the first few days after you quit smoking, spend as much free time as you can in public places where smoking is not allowed. (Libraries, malls, museums, theaters, restaurants without bars, and churches are most often smoke-free.)
• Take extra care of yourself. Drink water, eat well, and get enough sleep. This could help you have the energy you might need to handle extra stress.
• Don’t drink alcohol, coffee, or any other drinks you link with smoking for at least a couple of months. Try something else instead – maybe different types of water, sports drinks, or 100% fruit juices. Try to choose drinks that are low- or no-calorie.
• If you miss the feeling of having a cigarette in your hand, hold something else – a pencil, a paper clip, a coin, or a marble, for example.
• If you miss the feeling of having something in your mouth, try toothpicks, cinnamon sticks, sugarless gum, sugar-free lollipops, or celery. Some people chew on a straw or stir stick.
• Avoid temptation – stay away from activities, people, and places you link with smoking.
• Create new habits and a non-smoking environment around you.
• Get ready to face future situations or crises that might make you want to smoke again, and think of all the important reasons you’ve decided to quit. To remind yourself of these reasons, put a picture of the people who are the most important to you somewhere you see it every day, or keep one handy on your phone.
• Take deep breaths to relax. Picture your lungs filling with fresh, clean air.
• Remember your goal and the fact that the urge to smoke will lessen over time.
• Think about how awesome it is that you’re quitting smoking and getting healthy. If you start to weaken, remember your goal. Remember that quitting is a learning process. Be patient with yourself.
• Brush your teeth and enjoy that fresh taste.
• Exercise in short bursts (try alternately tensing and relaxing muscles, push-ups, lunges, walking up the stairs, or touching your toes).
• Call a friend, family member, or a telephone stop-smoking help-line when you need extra help or support.
• Avoid sugary or spicy foods that could trigger a desire to smoke.
• Above all, reward yourself for doing your best. Give yourself rewards often if that’s what it takes to keep going. Plan to do something fun.

When you get the “crazies”

Cravings are real – it’s not just your imagination. When you feel the “crazies” you may also notice that your mood changes, and your heart rate and blood pressure may go up, too. Try these tips to get through these times, and hang in there – the cravings will get better:

• Keep substitutes handy that you can suck or chew on, such as carrots, pickles, apples, celery, raisins, or sugar-free gum or hard candy.
• Know that anger, frustration, anxiety, irritability, and even depression are normal after quitting and will get better as you learn ways to cope that don’t involve tobacco. See your doctor if these feelings last for more than a month.
• Take 10 deep breaths, and hold the last one while lighting a match. Exhale slowly and blow out the match. Pretend it’s a cigarette and put it out in an ashtray.
• Go for a walk. Exercise can improve your mood and relieve stress.
• Take a shower or bath.
• Learn to relax quickly and deeply. Go limp. Think about a soothing, pleasing situation, and imagine yourself there. Get away from it all for a moment. Focus on that peaceful place and nothing else.
• Light incense or a candle instead of a cigarette.
• Tell yourself “no.” Say it out loud. Practice doing this a few times, and listen to yourself. Some other things you can say to yourself might be, “I’m too strong to give in to smoking,” “I’m not a smoker now,” or “I will not let my friends and family down.” And most important, “I will not let myself down.”
• Never let yourself think that “one cigarette won’t hurt,” because it very likely will.
• Wear a rubber band around your wrist. Whenever you think about smoking, snap it against your wrist to remind yourself of all the reasons that made you want to quit in the first place. Then remember that you won’t always need a rubber band to help you stay with your plans to quit.

Other ways to stay active

You might have a lot of pent-up energy while trying to quit and stay tobacco-free. When you’re looking for something to do besides smoking, think about ways you can be active and productive, or maybe you can try something new! Do some yardwork or housework. Organize or clean out a closet, a room, or even the entire basement. Get involved in a new sport or hobby you like. Some of these “distractions” can help keep you from gaining weight after quitting, too.

Find activities that are free or fairly cheap. You can rent a DVD for beginner’s yoga, tai chi, or aerobics – or maybe even borrow one from the library. A walk in a park, a local mall, or around your neighborhood is a good way to get moving, too. You’ll notice over time that it gets easier to do these things. And watch how much better you can breathe as each day passes without smoking.

Staying tobacco-free over holidays

The first few weeks after quitting smoking can be hard for anyone. And staying away from smoking may be extra tough during a holiday season, when stress and the temptation to overindulge are often worse. Some special efforts can help you celebrate the holidays without giving in to the urge to smoke. Many of these ideas can also help throughout the year.

Celebrate being an ex-smoker and try these tips to keep your mind off smoking:

• Be a host. Consider hosting the family dinner to keep yourself busy. Shopping and cooking will certainly take up a lot of your time. If you’d prefer being a guest this year, maybe you can make a special dish to take with you.
• Don’t overdo it. Without smoking, you might be inclined to go overboard with the holiday feasting. Be aware of how much you’re eating and drinking; it may be easy to give in to these other temptations. If you do overdo it, forgive yourself. Remember, next year it won’t be as hard.
• Try to stay away from alcohol. Stick to sugar-free seltzer, punch without alcohol, club soda, or apple cider. This will curb the urge to light up when drinking and can also help keep off extra pounds.
• Avoid spicy and sugary foods. Spicy and sugary foods tend to make people crave cigarettes more.
• Nibble on low-calorie foods. Low-calorie foods such as carrot sticks, apples, and other healthy snacks, can help satisfy your need for crunch without adding extra pounds.
• Stretch out meals. Eat slowly and pause between bites to make a meal more satisfying. For dessert, grab an orange or tangerine, or crack some nuts – something that will keep your hands busy, too.
• Keep busy at parties. Playing bartender, serving snacks, and meeting guests will help keep your mind off smoking. If the urge to smoke presents itself, put something in your hand other than a cigarette. A bartender’s mixing straw is a perfect substitute.
• Treat yourself to something special. Celebrate staying quit. Think about buying yourself that special something you’ve been wanting.
• Cope with frustration. Any added frustration can leave you wanting a cigarette. Take along your favorite magazine or book, check your email, or text a friend while waiting in lines. When you feel you’re about to lose control, stop and think. Take hold of yourself and start talking with someone in line next to you, or start looking at what you brought with you.

More suggestions

If you have a weak moment and slip during the holidays, don’t panic. Take a deep breath. Remind yourself of your commitment to quit, and all the reasons you quit. Commit to going back to your quit program right away. Destroy any cigarettes you have before you’re tempted to smoke another one. Try to figure out why you had a setback and learn from it. Here are more ideas that have helped smokers kick the habit for good:

• Take one day at a time. When you wake up each morning, make the promise you won’t smoke a cigarette that day. A day at a time keeps the whole thing more manageable.
• Picture your success. Plan ahead and think of how you’ll deal with stressful situations without turning to cigarettes.
• Take a breather. Relaxation exercises can help relieve your urge to smoke. Take a deep breath, hold it for a second, then release it very slowly. Or, stand up and stretch while you take a few deep breaths. Remember, the urge to smoke is only temporary. It will pass.
• Work out. Physical activity helps relieve tension and the urge to smoke. Exercise will also help burn off any extra pounds.
• Make friends with ex-smokers and non-smokers. Ex-smokers and non-smokers can be your partners to help keep you busy and away from cigarettes. Plan time together and explore new outlets you might enjoy. Remember, you’re learning to be a non-smoker, and you need to find new places and activities to replace your old smoking-centered ones.

Get support you can count on

If you’re thinking about reaching for a cigarette, reach for help instead. Ask your friends and family to encourage the new non-smoking you, reach out to a support group, visit Nicotine Anonymous ². You can always call your American Cancer Society at ³. They want you to quit smoking and we’re here to help you do it!

1. https://smokefree.nci.nih.gov/build-your-quit-plan[↩]
2. Nicotine Anonymous. https://nicotine-anonymous.org/[↩][↩]
3. American Cancer Society. https://www.cancer.org/[↩][↩]
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6. US Surgeon General’s Report, 1990, pp. 193, 194, 196, 285, 323[↩]
7. US Surgeon General’s Report, 1990, pp. 285-287, 304[↩]
8. US Surgeon General’s Report, 2010, p. 359[↩]
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