Quitting is hard, but half of all smokers have done it. New medications and a solid plan can more than double your chances
Mark Twain once joked, “Quitting smoking is easy — I’ve done it a thousand times.” If that line feels familiar, you’re not alone. Breaking a nicotine habit is genuinely difficult. But here’s something worth knowing: half of all adult smokers have managed to quit for good. And today, there are medications that more than double your chances of success.
Medications That Help
Two prescription medications work directly on the nicotine receptors in your brain, blocking the addictive pull of cigarettes.
Varenicline (Chantix)
Varenicline targets the nicotine receptor directly, dulling the brain’s reward response to smoking. It starts working within the first week. The most common side effects are nausea and trouble sleeping.
Bupropion (Wellbutrin or Zyban)
Bupropion is an antidepressant that also blocks the nicotine receptor. It takes two to six weeks to build up in your system, so you’ll want to start it well before your quit date. Side effects include anxiety, insomnia, headache, stomach upset, tremor, and agitation. Don’t double up on doses — higher amounts increase the risk of seizures. Bupropion also may not be safe if you have bipolar disorder or an eating disorder, so check with your doctor first.
Both medications are safe to take while you’re still smoking or using nicotine replacement products. Other options that help some people include clonidine and N-acetylcysteine.
Step 1: Set a Quit Date
Pick a date that works for you. A low-stress stretch of time is ideal, though some people do better on a busy day that keeps their mind off cigarettes.
Your medication timeline matters here. Varenicline works within the first week. Bupropion needs two to six weeks, so start it early.
Step 2: Prepare Before Your Quit Date
Before your quit date, keep smoking your usual amount, but limit yourself to one location. Choose somewhere you can avoid after you quit, not your car or bedroom. The goal is to break the ties between place and habit.
People tend to have more success quitting cold turkey, stopping all at once rather than tapering. Plan for it:
- Write down every reason you want to quit. Pull that list out when cravings hit.
- Tell people your quit date. Put it on your calendar.
- List your triggers, the situations or feelings that make you reach for a cigarette. Think ahead about how you’ll handle them.
- If you’ve tried quitting before, review what worked and what got in your way. Use that knowledge this time.
Step 3: Handle Cravings and Withdrawal
Cravings are intense, but they pass quickly, usually within a few minutes. Withdrawal symptoms like irritability, trouble concentrating, poor sleep, fatigue, headaches, increased appetite, and digestive issues are normal. For most people, they fade within a few weeks. Some people don’t get them at all.
For Nicotine Cravings
Distract yourself with a walk, a chore, or a conversation with a non-smoker. Give your hands and mouth something to do: toothpicks, sugarless gum, drawing, or light exercise all work.
For Trouble Sleeping
Try the free CBT-i Coach app or find sleep tips at moodtreatmentcenter.com/sleep.
For Constipation
A brisk 30-minute walk each day, more fruits and vegetables, and plenty of fluids help most people. Over-the-counter options like docusate-senna (the generic of Pericolace) also work. Talk to your doctor if you’re not having daily bowel movements.
For Weight Gain
Diet and exercise are your best tools, but don’t pressure yourself to diet while quitting. Some weight gain comes from snacking, so swap chips and soda for raw vegetables, pretzels, fruit, or sparkling water. Sugarless gum and sugar-free hard candy help curb the urge to eat between meals.
For Anxiety and Irritability
Warn the people around you that you might be on edge for a while. Cigarettes often serve as a stress reliever, so this is a good time to build new coping habits. Mindfulness apps like Headspace, Insight Timer, and Smiling Mind help, as does the deep-breathing app Breath2Relax.
For Fatigue
Outdoor sunlight, nature, and a brisk 30-minute walk can gradually lifts energy.
If You Live With a Smoker
Ask them to limit their smoking to one room or to smoke outside while you’re quitting.
Nicotine Replacement Options
These products are available over the counter, but they can cause side effects and may not be safe for people with heart disease, blood vessel problems, or those who are pregnant. Talk to your doctor before using them.
- Transdermal Patch: Start at 21 mg per day for 8 weeks, stepping down to 14 and then 7 mg as you go. Common side effects: skin irritation and insomnia.
- Nicotine Gum (Polacrilex): 2 or 4 mg pieces, one per hour as needed, for 8 to 12 weeks. Common side effects: mouth irritation, sore jaw, hiccups, and stomach discomfort.
- Vapor Inhaler: 6 to 16 cartridges per day for 3 to 6 months. Common side effects: mouth and throat irritation, cough.
- Nasal Spray: 1 to 2 doses per hour, up to 40 mg per day, for 3 to 6 months. Common side effects: nasal irritation, sneezing, cough, and watery eyes.
- Lozenge: 2 or 4 mg dose for 12 weeks. Common side effects: hiccups, nausea, and heartburn.
Vaping (E-Cigarettes)
Vaping is far safer than cigarettes, but it isn’t safe. The aerosol from e-cigarettes contains cancer-causing chemicals and tiny particles that lodge deep in the lungs. If you use vaping to get off cigarettes, plan to taper off after a few months.
Don’t start vaping unless you’re using it to quit smoking, and don’t combine smoking and vaping. That just piles on more toxic exposure. Stick with an FDA-cleared product from makers like Logic Technology, NJOY, or Vuse.
Nicotine Pouches
Pouches like Zyn, On!, VELO, and Rogue deliver nicotine through the lip membrane in 3 mg and 6 mg doses. They use synthetic nicotine, so they avoid some of the carcinogens in tobacco leaf. But they’re not risk-free: they can cause cardiovascular problems, gum damage, and nausea. As with vaping, plan to taper off after using them to quit, and don’t start unless you’re using them to stop smoking.
What Happens to Your Body After You Quit
The recovery starts faster than most people expect. Here’s what the US Surgeon General’s report tells us:
- 20 minutes: Your blood pressure drops. Your hands and feet warm up.
- 8 hours: Carbon monoxide levels in your blood return to normal.
- 24 hours: Your heart attack risk begins to fall.
- 2 weeks to 3 months: Circulation improves. Lung function increases up to 30%.
- 1 to 9 months: Coughing, congestion, fatigue, and shortness of breath decrease. The tiny hairs that sweep mucus out of your lungs regrow and start working again.
- 1 year: Your risk of coronary heart disease drops to half that of a smoker.
- 5 years: Your stroke risk falls to that of a non-smoker.
- 10 years: Your lung cancer death rate is about half that of someone who kept smoking. Cancer risks for the mouth, throat, esophagus, bladder, kidney, and pancreas also drop.
- 15 years: Your risk of coronary heart disease matches that of someone who never smoked.
Free Help Is Available
You don’t have to do this alone. We provide therapy for nicotine cessation, and free supports are below:
- Phone: 1-800-QUIT-NOW (1-800-784-8669) | Spanish: 1-855-335-3569 | Chinese: 1-800-838-8917 | Korean: 1-800-556-5564 | Vietnamese: 1-800-778-8440
- Text: Text QUITNOW to 333888, or visit smokefree.gov/smokefreetxt
- App: quitSTARTapp
- Self-help videos: whyquit.com
- CDC on nicotine replacement: cdc.gov/tobacco
Smoking raises your risk of dying from lung cancer 14 times over, doubles your risk of heart attack, and harms nearly every organ in the body. But quit for 5 to 15 years, and those risks return to normal. The damage isn’t permanent. Your body wants to heal — give it the chance.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
