What is smoking?

Smoking is when you breathe in and breathe out smoke from a burning plant (for example, tobacco leaf stems) which is rolled into the form of a cigarette. When smoking, people use a lighter on the end of the cigarette, before inhaling the plant smoke from the other end of the cigarette. After you have inhaled this smoke, it reaches your lungs and enters the bloodstream. Once the smoke is in your bloodstream, it can travel around your body and affect multiple organs, including your brain. 

There are different kinds of cigarettes that people smoke, varying depending on what material is burned. Smoking is never good for you, but most people smoke because they find it enjoyable due to the effects of nicotine on the brain. As a result, smoking can be hard for people to stop, especially if it’s something you have been doing for a long time.

What are the benefits to stopping smoking?

If smoking is enjoyable for someone, you may be wondering why some people want to quit. This is because smoking can have several damaging effects to your body. The greatest benefit to stopping smoking is the benefit to your health.

The effects of smoking are widespread, visibly affecting the health of your skin and nails, reducing your sense of smell, increasing your risk of tooth decay and gum disease, and increasing your risk of respiratory infections and lung diseases like COPD.

When the chemicals from smoking travel around in the bloodstream, smoking has even more effects on your health, including:

• Weakening your bones
• Impairing your vision
• Weakening your immune system
• Affecting your fertility
• Increasing the risk of miscarriage
• For people assigned male at birth, smoking can also cause erectile dysfunction

As a result, even though smoking may be enjoyable in the short term, there are serious long-term damaging effects on your health which are associated with smoking. A lot of people who smoke decide that it is not worth the damage to their health and their interpersonal relationships. Stopping smoking is not easy, but there are several different programs available to help you get there.

Why can stopping smoking be hard?

The biggest challenge when stopping smoking is the onset of withdrawal. Withdrawal is an unpleasant set of symptoms you experience, such as nausea, anxiety, anger, and pain, when abstaining from a substance you have been dependent on. Withdrawal effects are also experienced by people quitting drinking alcohol and taking other drugs.

Some people also struggle to stop smoking because they view smoking as a coping mechanism for personal struggles. This can be hard to let go of if you don’t feel like you have an equally effective alternative way to cope.

Types of smoking cessation programs

There are different types of smoking cessation programs available to help you stop smoking. Which one works best for you will depend on your own individual circumstances and medical history. Some of the options available to you include:

• Nicotine replacement therapy
• Prescription medications
• Counselling
• Alternative therapies

Efficacy of nicotine replacement therapy

Nicotine replacement therapy can help you stop smoking by providing you with low doses of nicotine, in the form of gum or a nicotine patch, to reduce your cravings and withdrawal symptoms. This might be particularly suitable for you if your biggest concern about quitting smoking is overcoming cravings and experiencing withdrawal.

Nicotine replacement therapy is safer than smoking standard cigarettes because you are only receiving nicotine, not the carcinogens that regular smoking exposes you to.

If you use nicotine replacement therapy, you may experience some side effects. The most commonly experienced side effects include: nausea, headaches, increased heart rate, and sleep problems. People who experience multiple side effects of greater intensity will find nicotine replacement therapy less effective, and should talk to their healthcare provider about trying a different smoking cessation program. It is important that you do not give up on quitting smoking, even if your first attempt doesn’t go as planned.

Different nicotine replacement therapy products work differently; for example, some act over long periods by delivering slow doses of nicotine, while others are quicker to alleviate cravings. You might benefit from using a slow-acting product in combination with a longer-acting product at the same time. Your healthcare provider will advise as to whether this is likely to be the most effective option for you.

Multiple studies suggest that nicotine replacement therapy is an effective option if you want to stop smoking, regardless of where the therapy is done.¹

Efficacy of prescription medications

There are some medications you can be prescribed which will reduce your cravings for nicotine and lessen the severity of withdrawal symptoms. For example, varenicline and bupropion are just two examples of FDA-approved medications which can help you stop smoking. There are also off-label medications - these are medications which have FDA approval, but not specifically for stopping you smoking even though there is experimental evidence that suggests they could be useful. Your healthcare provider is most likely to start you off with medications specifically designed to stop people smoking, such as varenicline and bupropion. These medications do not contain nicotine.

Varenicline works by reducing your cravings for smoking cigarettes, so that you don’t feel as compelled to smoke anymore. Your healthcare provider will ask about your medical history and lifestyle, as these can affect the efficacy and suitability of varenicline for you. You should only take this medication when prescribed.

Bupropion works by reducing your cravings and withdrawal symptoms. Just like varenicline, bupropion can interact with different medications and be less effective or even dangerous depending on your medical history and lifestyle. 

Both medications can cause side effects, which may make you less willing to take the medications. You should discuss this with your healthcare provider.

Multiple studies have supported the use of varenicline and bupropion for aiding smoking cessation, however, varenicline appears more effective in the long term when maintaining abstinence.²

Efficacy of counselling

Talking therapies, including cognitive behavioural therapy, operate on the principle that your thoughts and feelings influence your behaviour. For example, certain emotional struggles may have predisposed you to smoking. Counselling can help you to address these thoughts, reframe them, and propose healthier coping strategies for when you feel the need to smoke.

Counselling takes a much more personalised route to addressing smoking, as you are at the very heart of the discussion. Your counselling provider will learn about you, and you’ll work with your counsellor together to learn more about why you might smoke (risk factors) and how to reduce the chances that you will.

Counselling is more effective in people who have a strong commitment to stopping smoking. This is because counselling often takes several sessions before any observable effects are noticed. Counselling also requires some ‘introspection’ on your part, meaning that you should be willing to examine your internal thought processes. This can feel very vulnerable and challenging to start with, but your counsellor will be there to help you along the way and take things at your own pace.

There is a good volume of evidence suggesting that individual counselling is effective at helping people stop smoking. There is also a small, additional benefit to combining medications with counselling, suggesting that different smoking cessation programs work better together.³

Efficacy of alternative therapies

Alternative therapies differ slightly from conventional, standard treatments. Examples of alternative therapies for smoking cessation include hypnosis, acupuncture, and laser therapy. It is currently thought that acupuncture and laser therapy work by reducing withdrawal symptoms, which makes stopping smoking more tolerable. Hypnosis is thought to help strengthen your impulse control, so you think more carefully before smoking.

Alternative therapies vary much more widely regarding efficacy in stopping people smoking. There is currently not enough quality evidence available to suggest that alternative therapies should be prescribed at the same rate as standard smoking cessation programs.⁴

Conclusion

Standard smoking cessation programs have a more reliable body of evidence indicating success at smoking cessation. There is some evidence to suggest that alternative therapies can be helpful in quitting smoking, although efficacy is more variable and evidence is usually of lower quality.

Smoking cessation programs are most effective when psychological techniques like counselling are combined with pharmacotherapy like prescription medications or nicotine replacement therapy.

Summary

• Smoking is when you breathe in and breathe out smoke from a burning plant
• Most people smoke because they find it enjoyable due to the effects of nicotine on the brain
• Many smokers think about quitting due to the long-term damaging effects of smoking on their health and relationships
• There are several smoking cessation programs out there, including: nicotine replacement therapy, prescription medications, counselling, and alternative therapies
• Alternative therapies have a smaller body of evidence supporting their use, so they are not typically recommended 
• To improve the chances of long-term smoking cessation, sometimes different techniques are combined