“You have to really want to quit or you’re not going to,” says Relia Merrifield, a 63-year-old former medical transcriptionist from Santa Rosa, California. Merrifield was a smoker for 35 years and tried many different quitting methods — from hypnosis to the patch to acupuncture — that she lost track. In hindsight she believes she couldn’t quit because she wasn’t fully devoted to the effort. It took a cigarette tax hike in 2000 to finally make her leave the pack behind. At the time she envisioned rolling up a $20 bill and smoking it; that permanently ended her three-decade battle.
Unfortunately, research has shown that the desire to quit— while improving the chances that a person will try — is not enough to make an attempt stick. No one knows exactly what does the trick, but there are several choices a hopeful quitter can make to improve their chances.
If you seek support, be clear about the kind of support you want. Some studies have found that letting others know about your quit attempt doesn’t make much of a difference. However, Professor Sue Curry, Dean of the University of Iowa, College of Public Health – along with the Mayo Clinic – advises seeking support. Curry also says that people who make their commitment public should also be very clear about how their supporters can help. After all, she says, “one person’s help is another person’s nag.”
Get evidence-based help. According to Nicola Lindson-Hawley, a research fellow at the University of Birmingham in England, quit attempts are more likely to work when they have structure. Her evidence? A 2004 review found that smokers who attempted to quit unassisted generally relapsed within one week, with only about four percent remaining smoke-free for an entire year. This is compared to the 15 percent success rate achieved by the UK National Health Services smoking cessation program, according to a 2005 study. Lindson-Hawley says the advantage that structured attempts have over self-constructed attempts is likely that they employ the use of very specific goals: For example, deciding to cut your cigarette use by 50 percent by next week.
In November, Lindson-Hawley was the co-author of a Cochrane review — a systematic review of multiple evidence-based, controlled studies— which found that when people used structured assistance to quit, gradual reduction in cigarettes was just as successful of a method as cold turkey (about 11 percent are able to maintain year-long abstinence). If they solicit cessation assistance, people will often be given the choice between the two.
Consider using smoking cessation medication. Both Lindson-Hawley and Curry agree that medication can be a big help. Nicotine gum and the patch are nicotine replacement therapies, which contain low doses of nicotine to help ease cravings. Another Cochrane review found that the use of nicotine replacement therapy increases the likelihood of success by 50 to 70 percent, regardless of the type of quitting method used. Pills, like Zyban or Chantix, also alleviate cravings. They do so without nicotine but have different risks.
Downsides to smoking cessation medications include side effects and cost. Some cause irritation on the skin or in the mouth. Headaches, nausea, and sleep problems can also occur. While evidence has not backed up concerns that Zyban or Chantix increase the risk of heart attack, they do carry black box warnings for connections to suicidal behavior and other changes in mood. Prices for these medications range from about $80 for six weeks of the patch (for someone who smokes a pack-and-a-half a day) to around $330 for Zyban. However, in some states this is comparable to the cost of smoking for the same amount of time. But no one says that any of these drugs are magic bullets. “I’ve seen a lot people use the patch or the gum or the pills and continue to smoke anyway,” says former smoker Merrifield.
If you are still going to do it on your own, consider cold turkey. If someone really wants to go it alone, Lindson-Hawley discusses in her review that studies have found quitting abruptly is almost twice as successful as gradual reduction among people who don’t use a program or assistance — one study reported 22 and 27 percent success from the former versus 12 and 16 percent from the latter*. She says that gradual reduction can still work without outside help, but that people attempting to quit this way should use specific target dates, just as they would if they were in a program.
It may not work the first time. If quitting were easy, cigarette smoking wouldn’t be the number one cause of preventable death in our country. Both Curry and Lindson-Hawley say that people commonly change the type of method they’re trying after they’ve started their attempt. Changing methods is fine, but the same advice applies: When changing to a new quitting plan, people should still try setting concrete goals and communicating their plans to others.
Cigarette cravings don’t just magically go away after someone quits. Merrifield, who was diagnosed with lung cancer six years ago and is now in remission, says that she craved a cigarette just the other day. She has resisted these cravings by taking a moment to reflect on how much effort it took to quit, and by realizing that she would never want to repeat that ordeal. This has kept her smoke-free since the start of 2000.
*Correction, January 26, 2013:
Originally, this article read that Dr. Lindson-Hawley found in her research that quitting abruptly was almost twice as successful as gradual reduction among people who don’t use a program or assistance to quit. This has been changed to reflect that Dr. Lindson-Hawley only discussed this finding in her research but did not produce these results herself.