Is It Better to Stop Smoking Abruptly or Gradually?

Michael Craig Miller, MD

Harvard Health Letters

Q. I've tried to quit smoking three times. A friend suggested that instead of giving cigarettes up all at once that I try to kick the habit gradually. Which method is best?

A. The traditional view has been that establishing a "quit day" to stop smoking helps increase the chance that people will actually be able to kick the habit. But a review by the international Cochrane Collaboration concluded that a more gradual approach is just as effective and may be more appealing to smokers who want to quit.

The authors reviewed 10 randomized controlled studies, involving 3,760 participants, comparing the outcomes of quitting abruptly or gradually. They found that abstinence rates were about the same regardless of whether people quit smoking abruptly or gradually, whether they used nicotine replacement therapy, and whether they tried to quit on their own or participated in a support group.

Unfortunately, the analysis further confirmed the sad reality that you are not alone -- most people were unable to kick the habit after one try. Over all, 202 of 1,979 smokers (10.2 percent) who stopped smoking gradually remained abstinent at least six months later, compared with 192 of 1,781 smokers (10.7 percent) who quit smoking abruptly.

Still, smokers who want to quit have other options. Research on smoking cessation suggests that combining methods -- such as using both a support group and nicotine replacement therapy -- boosts the odds of quitting. In addition, the Cochrane review did not examine the impact of medications such as bupropion (Zyban), which can be used in combination with nicotine replacement therapy.

Another option is varenicline (Chantix), which both imitates and blocks the effects of nicotine, reducing craving in some smokers. Whatever you do, keep trying. Many smokers make multiple attempts before succeeding.

-- Michael Craig Miller, M.D., Editor in Chief, Harvard Mental Health Letter

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