Quitting smoking: Things that can help
Most people who smoke decide to quit at some time or another. Yet it is often difficult to act on this decision. It usually takes several attempts until they are able to go without tobacco. There are a number of strategies that can help you to quit smoking.
If you would like to quit smoking, there are different things you can try out to kick the habit. Around half of those who try to quit smoking don't need any extra help. Many people receive important support from their partner, friends or family. Another option is to get advice on quitting smoking from a doctor or a pharmacist. Nicotine replacement therapy (NRT) and certain medications can help you break your nicotine addiction and deal with withdrawal symptoms.
Maybe it also helps to think about how much money you can save by not smoking. You can find out how much money you personally spend on cigarettes by using our cigarette calculator. Setting personal goals can also be a good motivation, for example rewarding yourself for not smoking for a month with a nice meal or some new clothes.
There are lots of brochures, materials and online offers that provide support for people who want to quit smoking, for example the www.rauchfrei-info.de (in German) website from the German Federal Center for Health Education (BZgA). Stop smoking courses are also available. Some health insurers cover part of the costs of such courses.
Nicotine replacement therapy: Helpful and well-tolerated
Quitting smoking is usually especially difficult in the first week. The body does not get its usual nicotine and there are withdrawal symptoms: Restlessness, irritability, feeling down, and a craving for cigarettes. Many people find it harder to concentrate as well, and have more appetite than usual. Nicotine replacement therapy (NRT) can reduce these withdrawal symptoms. Around 6 out of 100 people find it easier to quit smoking with nicotine replacement therapy.
Even though the term “nicotine replacement therapy” implies something quite different, nicotine is not replaced by another substance in this type of treatment. The body is still provided with nicotine but only for treatment purposes. Scientific studies prove that nicotine replacement therapies are effective.
Nicotine replacement is available in various forms, for example nicotine gum, inhalers, plasters, tablets and lozenges. In Germany, these products are available without prescription from the pharmacy and are not covered by health insurers.
Bupropion (Zyban): Better success rates, but often difficulty sleeping
Bupropion was originally developed as an antidepressant medication. It is also approved as an aid to quit smoking under the trade name Zyban, because it was found to also help relieve nicotine withdrawal symptoms. It is prescription-only, so it has to be prescribed by a doctor. Health insurers in Germany do not cover the costs for Zyban.
Researchers systematically analyzed studies of this medication. They showed that bupropion helped about 7 out of 100 people to quit smoking.
However, bupropion often causes side effects: Around 12 out of 100 people experience difficulty sleeping. Other side effects were dry mouth and nausea. Very rarely bupropion also causes seizures. A small number of people had depression or suicidal thoughts and behaved unusually after using bupropion.
The researchers analyzed studies of other antidepressants to find out whether they were also effective in helping to quit smoking. Yet they did not find any indications that other antidepressants also have a benefit for people quitting smoking.
Varenicline (Champix): Can help, but often causes nausea
Another drug that is available for people trying to quit smoking is varenicline (trade name Champix). It was approvied in Europe in 2006 and has two effects: on the one hand it relieves nicotine withdrawal symptoms; on the other, it reduces the pleasure taken in smoking.
Varenicline can make it easier to stop smoking: Studies show that it helps about 13 out of every 100 people to stop smoking for at least half a year.
But varenicline also has some side effects. The most common is nausea: About 20 out of 100 people who take varenicline experience nausea. Other frequent side effects are insomnia, headaches and unusual dreams.
It is also suspected that varenicline may increase the risk of cardiovascular diseases and lead to dizziness. It cannot be ruled out that varenicline could affect some people's mental health, like bupropion. Such serious side effects are rare. Until you know how you react to the medication you should be especially careful when driving or operating heavy machinery.
Hypnosis, acupuncture and other treatments
Other methods used to quit smoking include hypnosis and acupuncture. But they are not as well researched as nicotine replacement therapy, for example.
A recent analysis of 33 studies on conventional acupuncture with needles, acupressure, as well as laser and electro acupuncture had contradictory results. It therefore remains unclear whether any of these interventions increases the chances of successfully quitting smoking in the long term. More research is needed to reliably assess the effects.
What helps in pregnancy?
Smoking during pregnancy increases the risk of a miscarriage, and of the baby being born prematurely or underweight. For this reason, many women stop smoking before or during pregnancy. But this is not easy for all women and many need support to quit.
There are different kinds of programs designed to help pregnant women stop smoking. In these programs they receive counseling and are able to speak with others in the same situation. These types of programs do not make use of medication.
Studies show that stop smoking programs can actually help pregnant women: With these programs, an additional 4 out of every 100 women succeed in not smoking in pregnancy.
Will I put on weight if I stop smoking?
Most people who quit smoking do gain some weight. Especially in the first year the gain in weight can be noticeable. Weight gain during this time averages about 5 kilograms. The reason is not only eating more or snacking more often– your metabolism changes as well. Smoking also suppresses your appetite.
But weight gain doesn't have to be permanent.
Arzneimittelkommission der deutschen Ärzteschaft (AkdÄ). Drug Safety Mail 2008-026. Neuropsychiatrische Symptome unter Vareniclin (Champix®). Berlin: AkdÄ. 18 July 2008 (in German).
Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Sys Rev 2012; (4): CD006103.
Farley AC, Hajek P, Lycett D, Aveyard P. Interventions for preventing weight gain after smoking cessation. Cochrane Database Sys Rev 2012; (1): CD006219.
Fiore MC, Novotny TE, Pierce JP, Giovino GA et al. Methods used to quit smoking in the United States. Do cessation programs help? JAMA 1990; 263 (20): 2760-2765.
Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation. Cochrane Database Sys Rev 2014; (1): CD000031.
Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Sys Rev 2009; (3): CD001055.
Singh S, Loke YK, Spangler JG, Furberg CD. Risk of serious adverse cardiovascular events associated with varenicline: a systematic review and meta-analysis. CMAJ 2011; 183(12): 1359-1366.
Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Sys Rev 2012; (11): CD000146.
US Food and Drug Administration (FDA). FDA Drug Safety Communication: Chantix (varenicline) may increase the risk of certain cardiovascular adverse events in patients with cardiovascular disease. 16.06.2011.
US Food and Drug Administration (FDA). Information for Healthcare Professionals: Varenicline (marketed as Chantix) and Bupropion (marketed as Zyban, Wellbutrin, and generics). 01.07.2009
White AR, Rampes H, Liu JP, Stead LF, Campbell J. Acupuncture and related interventions for smoking cessation. Cochrane Database Sys Rev 2011; (1): CD000009
IQWiG health information is written with the aim of helping
people understand the advantages and disadvantages of the main treatment options and health
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