Tobacco and Nicotine Cessation

Every year about 70% of smokers would like to quit their nicotine addiction, with 40% making an attempt to do so. Sadly, only about 7% succeed on their first attempt,40 but patients need to realize that it may take many attempts to finally be successful at quitting, even as many as30,41 but they should continue to try. There are various ways that people try to quit. These include cold turkey, nicotine replacement therapies (NRT), Bupropion (Zyban), Varenicline (Chantix, Champix), and counseling (Figure 4).42,43

Figure 4. Advantages of Behavioral Counseling.44
Graph showing the advantages of behavioral counseling

The fears of the user to quit include withdrawal symptoms, weight gain, the expense of NRT, and a fear of failure if they are unable to be successful in the attempt. Withdrawal symptoms include, dysphoria, anxiety, irritability, a decrease or increase in heart rate, insomnia, an increase in appetite, and a craving for more nicotine. Withdrawal symptoms can begin as soon as 4 hours after the last cigarette and peak at 3-5 days. Cravings usually last for 3-5 minutes. Most of these symptoms disappear in about 6 months, but as most tobacco users will tell you, they always fear relapsing back to their old habits.

Cessation Approaches

Research shows that people who use a combination of brief counseling, medication and follow-up advice are often successful in stopping. Various NRT’s can be combined, and under certain circumstances used with other drugs.