Quitting or Reducing Smoking

By Dorothy Hatsukami, Ph.D.
(Sept. 5, 2004, Revised Oct. 19, 2005)

Ask any medical professional and they’ll tell you that the best and easiest way to quit using tobacco is to never start in the first place. But if you’ve already stumbled down the path of becoming a smoker, that advice is too little, too late. Instead, consider nicotine replacement treatments, other prescription drugs, and behavioral therapy.

Nicotine replacement products--such as the nicotine patch, gum, lozenge, nasal spray, or inhaler--are effective. These products allow nicotine to be absorbed in the mouth instead of the lungs, with the exception of the patch and nasal spray. They have several benefits, including that they are not addictive, they aren’t known to cause cancer or other lung diseases, and they are easy to use over-the-counter medications (except the nasal spray and inhaler, which require a prescription).

Several medicinal products that do not contain nicotine also have been shown to be effective. One prescription medication recently approved by the U.S. Food and Drug Administration (FDA) is called Zyban or bupropion-SR, and it’s a pill taken two times a day. Additionally, some other prescription drugs not approved by the FDA for smoking cessation are still helpful for that use. An anti-depressant called nortriptyline and a high blood pressure medication called clonidine have been effective treatments for people trying to quit smoking in clinical trials. If smokers find that one medication is not effective, they may need to try another. In some cases, they may need to use more than one medication, but only under the direction of a physician.

To increase success in quitting smoking, it’s essential to pair one of these medication therapies with behavioral changes. Nicotine addiction is not just the result of physical addiction; there are a number of psychological and emotional ties to using tobacco, as well. Whether it’s smoking after a meal or having a cigarette with your first cup of coffee in the morning, it’s critical that you change such behaviors. So get up and take a walk after a meal instead of lighting up, or wait until you get to work to have that first cup of java. Other people find it effective to chew sugarless gum or suck on a candy instead of reaching for a cigarette. If stress is a cue that leads to smoking, think of more healthy ways to deal with the stress, such as exercise.

While it’s certainly best to quit smoking all together, for some people that’s a tough mountain to conquer. Smokers who are not interested in quitting right now may consider reducing the number of cigarettes they smoke. But the end goal should always be quitting completely. A recent University of Minnesota study found that smokers who reduced their cigarette smoking by an average of 75 percent only reduced the amount of exposure to cancer-causing agents by less than one-third. This modest reduction is unlikely to result in beneficial health effects. Also, our studies show that switching to light or ultralight cigarettes does not necessarily lead to health benefits.

In short, the best way for smokers to improve their health is to quit smoking entirely. If you need help, call the Minnesota Quit Plan (1-888-354-PLAN). If you aren’t successful the first time, keep trying. Your body and your loved ones will thank you for years to come.

Dorothy Hatsukami, Ph.D., is a professor of psychiatry at the University of Minnesota Medical School, and a member of The Cancer Center at the University. This column is an educational service of the University of Minnesota. Advice presented should not take the place of an examination by a health-care professional. For more health-related information, go to http://www.healthtalk.umn.edu/