Guide to Quitting Smoking

Help Is Available



Double your chances of quitting for good. Call 1-800-ACS-2345 to speak with someone who can help.

With the wide range of counseling services, self-help materials, and medicines available today, smokers have more tools than ever to help them quit smoking for good.

Remember, tobacco addiction has both a psychological and a physical component. For most people, the best way to quit will be some combination of medicine, a method to change personal habits, and emotional support. The following sections describe these tools and how they may be helpful to you.

Help With Psychological Addiction

Some people are able to quit on their own, without the help of others or the use of medicines. But for many smokers, it can be hard to break the social and emotional ties to smoking while getting over nicotine withdrawal symptoms at the same time. Fortunately, there are many sources of support out there -- both formal and informal.

Telephone-based Help to Stop Smoking

Most states run some type of free telephone-based program, such as the American Cancer Society’s Quitline® tobacco cessation program that links callers with trained counselors. These specialists help plan a quit method that fits each person's unique smoking pattern. People who use telephone counseling stop smoking at twice the rate of those who don't get this type of help. With guidance from a counselor, quitters can avoid common mistakes that may self-destruct a quit attempt.

Telephone counseling is also more convenient for many people than some other support programs. It doesn't require transportation or childcare, and it's available nights and weekends. Counselors may suggest a combination of methods including medicines, local classes, self-help brochures, and/or a network of family and friends.

Smokers can get help finding a Quitline® phone counseling program in their area by calling the ACS at 1-800-ACS-2345 (1-800-227-2345).

Support of Family, Friends, and Quit Programs

Many former smokers say a support network of family and friends was very important during their quit attempt. Other people who may offer support and encouragement are co-workers, your family doctor, and members of support groups for quitters. You can check with your employer, health insurance company, or local hospital to find support groups or call the ACS at 1-800-ACS-2345.

What to Look for in a Stop Smoking Program

Stop smoking programs are designed to help smokers recognize and cope with problems that come up during quitting and to provide support and encouragement in staying quit. Studies have shown that the best programs will include either one-on-one or group counseling. There is a strong link between the intensity of counseling and the success rate. In general, the more intense the program, the greater the chance of success.

For example, intensity may be increased by having more or longer sessions or by increasing the number of weeks over which the sessions are given. So, when considering a program, look for one that has the following:

  • session length -- at least 20 to 30 minutes per session 

  • number of sessions -- at least 4 to 7 sessions 

  • number of weeks -- at least 2 weeks

Make sure the leader of the group has training in smoking cessation.

Some communities have a Nicotine Anonymous group that holds regular meetings. This group applies the principles of Alcoholics Anonymous (AA) to the addiction of smoking. This may include admitting you are powerless over your addiction to nicotine and having a sponsor to talk with when you are tempted to smoke. There is no fee to attend.

Often your local American Cancer Society, American Lung Association, or your local health department will sponsor quit smoking classes. Call 1-800-ACS-2345 for more information.

There are some programs to watch out for as well. Not all programs are ethical. Be wary of programs that do the following :

  • promise instant, easy success with no effort on your part 

  • use injections or pills, especially "secret" ingredients (nicotine replacement is covered elsewhere) 

  • charge a very high fee--check with the Better Business Bureau if you have doubts 

  • are not willing to give you references from people who have used the program

Help With Physical Addiction: Nicotine Replacement Therapy and Other Medicines

Nicotine Replacement Therapy

As mentioned earlier, the nicotine in cigarettes leads to actual physical dependence, which can cause unpleasant symptoms when a person tries to quit. Nicotine replacement therapy (NRT) gives you nicotine -- in the form of gums, patches, sprays, inhalers, or lozenges -- but not the other harmful chemicals in tobacco. It can help relieve some of these symptoms so that you can focus on the psychological aspects of quitting.

How Nicotine Replacement Works

Nicotine substitutes treat the difficult withdrawal symptoms and cravings that 70% to 90% of smokers say is their only reason for not giving up cigarettes. Using a nicotine substitute, reduces a smoker's withdrawal symptoms.

Although many smokers can quit smoking without using a nicotine replacement, most of those who attempt quitting cannot do it on the first try. In fact, smokers usually need many tries -- sometimes as many as 8 to 10 -- before they are able to quit for good.

Lack of success is often related to the onset of withdrawal symptoms. And most quitters go back to smoking within the first 3 months of quitting. So don't be discouraged if you start smoking again. Just try to stop again and make your attempt more successful by adding another method or technique to help you quit. Reducing these symptoms with nicotine replacement therapy and a support technique, gives smokers who want to quit have a better chance of quitting and staying quit.

Getting the Most from Nicotine Replacement

Nicotine replacement therapy only deals with the physical addiction. It is not meant to be the only method used to help you quit smoking. You should combine it with other smoking cessation methods that help the psychological (emotional and habitual) components of smoking, such as a stop smoking program. Studies have shown that approach -- pairing NRT with a program that helps to change behavior -- can double your chances of successfully quitting.

The US Agency for Healthcare Research and Quality (AHRQ) Clinical Practice Guideline on Smoking Cessation in 2000 recommended NRT for all smokers except pregnant women and people with heart or circulatory diseases. However, recent data suggests that nicotine replacement (specifically the nicotine patch) can be used safely even in people who have heart or blood vessel (cardiovascular) disease under a doctor's careful monitoring. These studies have found the benefits of quitting smoking outweigh the risks of nicotine replacement therapy in patients with cardiovascular disease. In all situations, the benefits of smoking cessation must outweigh the potential health risks. Smokers who are pregnant should also talk with their doctor before using over-the-counter nicotine replacements.

The best time to start NRT is when you first quit. Many smokers ask if it is possible to start a program of nicotine replacement while you are still smoking. There is some research being done with smokers using NRT while still smoking, but it is still too early to tell if this is dangerous to your health. The most important thing is to make sure that you are not overdosing on nicotine, which can have effects on your heart and blood circulation. It is safest to be under a doctor's care if you wish to try smoking and using NRT while you are tapering down your cigarette use.

Often smokers first try to quit on their own then decide to try NRT. This method does not give you the greatest chance of success, but do not let this discourage you. There are still many options available for quitting smoking and staying quit.

When May I Begin Using NRT?

You may start using nicotine replacement products as soon as you throw away that last cigarette. You do not need to wait a certain period of time to put on the patch or start using the method you have chosen. You should double check this information with the instructions on your chosen method of nicotine replacement, but in general there is no need to wait to start using nicotine replacement.

Some NRT products make their recommendations based on whether you consider yourself a light, regular or heavy smoker. How are these categories determined?

There is no formal category in any textbook or group that defines a light, average, or heavy smoker. You will find different definitions for these categories. In general, a light smoker is someone who smokes less than 10 cigarettes per day. Someone who smokes a pack a day or more would be considered a heavy smoker.

Sometimes a doctor will use the term pack year to describe how long and how much a person has smoked. A pack year is defined as the number of packs of cigarettes a person has smoked every day multiplied by the number of years he or she has smoked. Since 1 pack is 20 cigarettes, a person who has smoked 20 cigarettes a day for a year is considered to have smoked 1 pack year. Someone who has smoked 30 cigarettes a day (1˝ packs) for 3 years has smoked 4.5 pack years (1˝ x 3), and so on.

Types of Nicotine Substitutes

The Food and Drug Administration (FDA) has approved five types of nicotine replacement therapy.

Nicotine patches (transdermal nicotine systems): Patches give a measured dose of nicotine through the skin. You are weaned off nicotine by switching to lower nicotine dose patches over a course of weeks. Patches can be bought with or without a prescription. Many types and different strengths are available. Package inserts describe how to use the product, as well as special considerations and possible side effects.

The 16-hour patch works well if you are a light-to-average smoker. It is less likely to cause side effects like skin irritation, racing heartbeat, sleep problems, and headache. But it does not deliver nicotine during the night, so it is not helpful for early morning withdrawal symptoms.

The 24-hour patch provides a steady dose of nicotine, avoiding peaks and valleys. It helps with early morning withdrawal. But, there may be more side effects such as disrupted sleep patterns and skin irritation.

Depending on body size, most smokers should start using a full-strength patch (15-22 mg of nicotine) daily for 4 weeks, and then use a weaker patch (5-14 mg of nicotine) for another 4 weeks. The patch should be put on in the morning on a clean, dry area of the skin without much hair. It should be placed below the neck and above the waist -- for example, on the arm. The FDA recommends using the patch for a total of 3 to 5 months.

Side effects are related to:

  • the dose of nicotine 

  • the brand of patch 

  • skin characteristics (such as the person’s tendency to have a skin reaction to the patch) 

  • how long the patch is used 

  • how it is applied


Some possible side effects of the nicotine patch include:

  • skin irritation -- redness and itching 

  • dizziness 

  • racing heartbeat 

  • sleep problems or unusual dreams 

  • headache 

  • nausea 

  • vomiting 

  • muscle aches and stiffness


What to do about side effects:

  • Do not smoke while you are using a patch.

  • Try a different brand of patch if your skin becomes irritated.

  • Reduce the amount of nicotine by using a lower dose patch.

  • Sleep problems may be short-term and pass within 3 or 4 days. If not (and you're using a 24-hour patch), try switching to a 16-hour patch.

  • Stop using the patch and try a different form of nicotine replacement.

Nicotine gum (nicotine polacrilex): Nicotine gum is a fast-acting form of replacement in which nicotine is taken in through the mucous membrane of the mouth. You can buy it over the counter without a prescription. It comes in 2 mg and 4 mg strengths.

For best results, follow the instructions on the package insert. Chew the gum slowly until you note a peppery taste. Then "park" it against the cheek, chewing it and parking it off and on for about 20 to 30 minutes. Food and drink can affect how well the nicotine is absorbed. You should avoid acidic foods and drinks such as coffee, juices, and soft drinks for at least 15 minutes before and during gum use.

If you smoke a pack or more per day, smoke within 30 minutes of waking up, or have trouble not smoking in restricted areas, you may need to start with the higher dose (4 mg). Chew no more than 20 pieces of gum in one day. Nicotine gum is usually recommended for 1 to 3 months, with the maximum being 6 months. Tapering the amount of gum chewed may help you stop using it.

If you have sensitive skin, you may prefer the gum to the patch. Another advantage of nicotine gum is that it allows you to control the nicotine doses. The gum can be chewed as needed or on a fixed schedule during the day. The most recent data have shown that scheduled dosing works better. A schedule of 1 to 2 pieces per hour is common. On the other hand, with an as-needed schedule, you can chew more gum during a craving.

Some possible side effects of nicotine gum:

  • bad taste 

  • throat irritation 

  • mouth sores 

  • hiccups 

  • nausea 

  • jaw discomfort 

  • racing heartbeat

Symptoms related to the stomach and jaw are usually caused by improper use of the gum, such as swallowing nicotine or chewing too fast. The gum can also damage dentures and dental prostheses.

Long-term dependence is one possible disadvantage of nicotine gum. In fact, research has shown that 15% to 20% of gum users who successfully quit smoking continue using the gum for a year or longer. Although the maximum recommended length of use is 6 months, continuing to use the gum is probably safer than going back to smoking. But since there is little research on the health effects of long-term nicotine gum use, most health care providers still recommend limiting its use to 6 months.

Nicotine nasal spray: The nasal spray delivers nicotine to the bloodstream as it is quickly absorbed through the nose. It is available only by prescription.

The nasal spray relieves withdrawal symptoms very quickly and lets you control your nicotine cravings. Smokers usually like the nasal spray because it is easy to use. However, the FDA warns users that since this product contains nicotine, it can be addictive. It recommends that the spray be prescribed for 3-month periods and should not be used for longer than 6 months.

The most common side effects last about 1 to 2 weeks and can include the following:

  • nasal irritation 

  • runny nose 

  • watery eyes 

  • sneezing 

  • throat irritation 

  • coughing

There is also the danger of using more than is needed. If you have asthma, allergies, nasal polyps, or sinus problems, your doctor may suggest another form of nicotine replacement.

Nicotine inhalers: Introduced in 1998, these inhalers are available only by prescription. The nicotine inhaler is a thin plastic tube with a nicotine cartridge inside. When you puff on the inhaler, the cartridge puts out a nicotine vapor. Unlike other inhalers, which deliver most of the medicine to the lungs, the nicotine inhaler delivers most of the nicotine vapor to the mouth. In terms of similar behavior, nicotine inhalers are the closest thing to smoking a cigarette, which some smokers find helpful.

The recommended dose is between 6 and 16 cartridges a day, for up to 6 months.

The most common side effects, especially when first using the inhaler, include:

  • coughing 

  • throat irritation 

  • upset stomach

At this time, inhalers are the most expensive forms of NRT available.

Nicotine lozenges: Nicotine-containing lozenges as an over-the-counter aid in smoking cessation are the newest form of NRT on the market. As with nicotine gum, the Commit® lozenge is available in 2 strengths: 2 mg and 4 mg. Smokers choose their dose based on how long after waking up they normally have their first cigarette.

The lozenge manufacturer recommends using it as part of a 12-week program. The recommended dose is one lozenge every 1 to 2 hours for 6 weeks, then one lozenge every 2 to 4 hours for weeks 7 to 9, and finally, one lozenge every 4 to 8 hours for weeks 10 to 12. The manufacturer also recommends the following:

  • Stop all smoking when you begin to use the lozenge.

  • Do not eat or drink for 15 minutes before using the lozenge. (Some drinks can reduce how well the lozenge works.)

  • Suck on the lozenge until it is fully dissolved, about 20 to 30 minutes. Do not bite or chew it like a hard candy, and do not swallow it. The medicine is taken in through the tissues of the mouth.

  • Do not use more than 5 lozenges in 6 hours, or more than 20 lozenges total per day.

  • Stop using the lozenge after 12 weeks. If you still feel you need to use the lozenge, talk to your doctor.

  • Do not use the lozenge if you continue to smoke, chew tobacco, use snuff or any other product containing nicotine (e.g., nicotine patch or gum).


Possible side effects of the nicotine lozenge include:

  • trouble sleeping 

  • nausea 

  • hiccups 

  • coughing 

  • heartburn 

  • headache 

  • flatulence (gas)

Which Type of Nicotine Replacement May Be Right for You?

There’s no evidence that any one type of nicotine replacement therapy is any better than another. When choosing which type of NRT you will use, think about which method will best fit your lifestyle and pattern of smoking. Do you want/need something to chew or occupy your hands? Or are you looking for once-a-day convenience?

Some important points to consider:

  • Nicotine gums, lozenges, and inhalers are oral substitutes that allow you to control your dosage to help keep cravings under better control. 

  • Nicotine gums and lozenges are generally sugar-free, but if you are diabetic and have any doubts, check with the manufacturer. 

  • Nicotine nasal spray works very quickly when you need it. 

  • Nicotine inhalers allow you to mimic the use of cigarettes by puffing and holding the inhaler. 

  • Nicotine patches are convenient and only have to be applied once a day. 

  • Both inhalers and nasal sprays require a doctor’s prescription. 

  • Some people may not be able to use patches, inhalers, or nasal sprays because of allergies or other conditions.

Combination of the patch and other nicotine replacement products

Using the nicotine patch along with shorter-acting products such as the gum, lozenge, nasal spray, or inhaler is another method of NRT. The idea is to provide a steady dose of nicotine with the patch and to use one of the shorter-acting products when you have strong cravings.

The few studies that have been done on combination NRT have found that it may be slightly better than a single product. Still, more research is needed to prove this and to find safe and effective doses. The combined use of nicotine replacement products has not yet been approved by the FDA. If you are considering using more than one NRT product, be sure to discuss this with your doctor first.

High-Dose Nicotine Replacement Therapy

One of the newer concepts in nicotine replacement therapy is to give smokers a higher dose specifically based on the amount of nicotine that they have been getting from cigarettes. Sometimes this method has required larger doses of nicotine replacement than have been used before. High-dose NRT with patches has been studied with patients getting from 35 mg to 63 mg of nicotine per day. The research suggests that patients' withdrawal symptoms disappear with these higher doses and their cravings improve without harmful effects on the heart and circulation. Patient were carefully watched in these studies to make sure they were doing well and were not becoming ill or having any problems. This is still a new procedure that should be considered only with a doctor's guidance and supervision.

Stopping Nicotine Replacement Therapy

As mentioned before, most forms of NRT should be used for limited periods of time, and are often tapered down to a low dose before being stopped. Research is still being done to refine the use of NRT. For example, even though the patch is usually used for 3 to 5 months, some studies have suggested that using it for 8 weeks or less works just as well. However, other researchers have noted that the risk of relapse goes up when nicotine replacement is stopped, even after it has been used for 5 months. These differences have not been fully explained. More studies are needed to learn which smokers are likely to be successful using shorter or longer NRT than usual. If you feel that you need NRT for a different length of time than is recommended, it is best to discuss this with your doctor.

Bupropion (Zyban®)

Bupropion (Zyban®) is a prescription antidepressant in an extended-release form that reduces symptoms of nicotine withdrawal. It does not contain nicotine. This drug acts on chemicals in the brain that are related to nicotine craving. It can be used alone or together with nicotine replacement. Bupropion works best if it is started 1 or 2 weeks before the quit date. The usual dosage is one or two 150 mg tablets per day.

This drug should not be taken if you have ever had seizures, heavy alcohol use, serious head injury, bipolar (manic-depressive) illness, anorexia or bulimia (eating disorders).

Some doctors may recommend combination drug therapy for heavily addicted smokers, such as using bupropion along with a nicotine replacement patch and/or a short-acting form of nicotine replacement (such as gum or lozenges).

Varenicline (Chantix™)

Varenicline (Chantix™) is a newer prescription medicine developed for the sole purpose of helping people stop smoking. It works by interfering with nicotine receptors in the brain, which has two effects. It lessens the pleasurable physical effects a person gets from smoking, and it reduces the symptoms of nicotine withdrawal.

Several studies have shown varenicline can more than double the chances of quitting smoking. Some studies have also found it may be more effective than bupropion, at least in the short-term.

Reported side effects of varenicline have included headaches, nausea, vomiting, trouble sleeping, unusual dreams, flatulence (gas), and changes in taste. Although these side effects may occur, varenicline is usually well-tolerated. Since varenicline is a new drug, research has not been done to find out if it is safe to use along with nicotine replacement products.

Revised: 10/16/2007