As 2018 comes to a close, cigarette smoking remains the leading cause of preventable death and disease in the United States, accounting for 480,000 premature deaths per year.1 The havoc cigarettes wreak on the body has been widely known for many years now among health professionals and the public, yet according to the latest data from the National Health Information Survey, 34.3 million U.S. adults still smoked cigarettes in 2017.2
What keeps people smoking even when they know cigarettes are harmful to their health? Nicotine. Nicotine, the highly addictive drug present in tobacco products, is the main reason that people continue to use tobacco even when they want to quit.3 According to a 2015 survey, about 70 percent of current adult smokers in the United States wanted to quit, and although about 55 percent had attempted to do so in the past year, only 7 percent were successful in quitting for 6-12 months.4
If you are in the majority of adult smokers who have made an unsuccessful quit attempt in the last year, do not give up. Try again. Cigarettes are designed to deliver nicotine quickly to the brain, and because your brain is addicted to the nicotine in cigarettes, they are difficult to quit, both physically and mentally. Although addiction makes quitting especially hard, remember it can be done.
Quitting Smoking: Closer with Each Attempt
When you first quit smoking, your body goes through withdrawal, or the physical manifestation of nicotine leaving your system. Withdrawal symptoms may include: temporary depression; disrupted sleep patterns; irritability; anxiety; difficulty concentrating; increased appetite.5 The first few days are the most uncomfortable, and physical symptoms of withdrawal should only last about three weeks. However, many smokers find that certain places, occasions, and behaviors—such as drinking coffee going out with friends, or particularly stressful events—can bring up an urge to smoke even after withdrawal symptoms have ended.6 While it may take longer to break these patterns, it is possible to live a completely smoke-free life.
Cigarettes’ addictive nature, the discomfort of withdrawal, and environmental factors associated with the act of smoking all play a role in making quitting a difficult and daunting task. But quitting is possible. It takes many smokers multiple tries to permanently quit smoking, but each quit attempt is not in vain, but rather, can be thought of as practice for quitting for good. With every attempt, you learn more about yourself and your addiction,7 including what techniques work for you to help you stave off cravings. Each of these practice tries gets you that much closer to quitting cigarettes forever.
Nicotine Replacement Therapy
If you have struggled with quitting in the past and are ready to try again, nicotine replacement therapy (NRT) may help. NRT can help get addicted smokers through the toughest part of quitting, by relieving cravings, lessening withdrawal symptoms, and helping to reduce stress. When you use FDA-approved NRTs, you gradually withdraw from smoking by receiving measured amounts of nicotine without the toxic chemicals from cigarette smoke. When used properly, NRTs are safe and effective cessation methods and can double a smoker’s chances of quitting cigarettes successfully.8 NRTs are available both by prescription and over-the-counter for adults age 18 and over, and include:
- Skin patches that deliver nicotine through the skin.
- Nicotine gum that releases nicotine as you chew it.
- Nicotine lozenges that dissolve in your mouth.
Although NRTs are intended to be used temporarily with the nicotine amounts decreased over time, and eventually removed completely, FDA and doctors recognize that some addicted smokers may need NRTs for longer lengths of time to avoid smoking.
If you have unsuccessfully attempted to quit smoking with NRTs, you may want to revisit this option. Many smokers need to experiment with different NRT options before finding one that works for their individual needs. NRTs are considered safe enough that multiple methods9—for instance the patch and the gum—can be used at the same time, and you may start using NRT prior to quitting cigarettes.10 This tactic may alleviate some withdrawal symptoms, as your brain will still receive nicotine during your transition from cigarettes to NRTs. Telephone quit line counseling is another effective strategy, and combining counseling with NRTs can be more successful for quitting smoking than nicotine replacement therapy alone.11
How Tobacco Regulation Plays a Role in Helping You Quit
FDA understands that quitting is a difficult process, and that NRTs may not work for everyone. The agency’s Nicotine Steering Committee is tasked with researching potential new harm reduction and cessation methods for addicted smokers. Additionally, in July 2017, FDA Commissioner Scott Gottlieb, M.D., announced the agency’s intention to lower nicotine levels in cigarettes to minimally addictive or nonaddictive levels. While this action would not remove cigarettes from the market, taking the addictive property out of cigarettes would provide addicted adult smokers with a chance to attempt to quit with the help of NRTs, or to switch to other potentially less harmful tobacco products, like e-cigarettes. While more research is needed to understand the potential health risks and benefits of e-cigarettes at both the individual and population level, a 2018 report by the National Academies of Science, Engineering, and Medicine found that completely switching from cigarettes to e-cigarettes may offer addicted adult smokers a significant harm-reduction opportunity.
Each Quit Attempt is a Step Forward
As 2019 approaches, if you are among the 34 million U.S. adults who smoke cigarettes in this country,12 and your New Year’s Resolution is to quit smoking, either for the first time or to make another attempt, do not give up, and know that you are not alone. Many smokers do not quit on their first attempt and need several tries before they succeed.. Even small successes are wins. For instance, you may find that the next time you try to quit, you are able to go longer without a cigarette than the last time; or you might discover exercise helps to stave off your cravings. Each time you make a quit attempt, you learn new techniques to implement and move one step closer to being able to call yourself a “former smoker.”
- Quit Resources from Smokefree.gov
- How Cigarettes Are Made and How You Can Make a Plan to Quit
- FDA's Comprehensive Plan for Tobacco and Nicotine Regulation
1. U.S. Department of Health and Human Services (USDHHS). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
2. Wang TW, Asman K, Gentzke AS, et al. Tobacco Product Use Among Adults — United States, 2017. MMWR Morb Mortal Wkly Rep 2018;67:1225–1232.
3. Fiore, M.C., C.R. Jaen, T.B. Baker, et al. “Treating Tobacco Use and Dependence: 2008 Update.” U.S. Department of Health and Human Services. 2008.
4. Centers for Disease Control and Prevention (CDC). Quitting smoking among adults – United States, 2000-2015. Morbidity and Mortality Weekly Report. 2017;65(52):1457-1464.
5. U.S. Department of Health and Human Services (USDHHS). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010.
6. U.S. Department of Health and Human Services (USDHHS). A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What It Means to You (Consumer Booklet). Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010.
7. Hughes JR. Motivating and helping smokers to stop smoking. Journal of General Internal Medicine. 2003; 18(12):1053-1057.
8. Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 5.
9. Sweeney CT, Fant RV, Fagerstrom KO, McGovern JF, Henningfield JE. Combination nicotine replacement therapy for smoking cessation: rationale, efficacy and tolerability. CNS Drugs. 2001;15(6): 453–467.
10. Carpenter MJ, Jardin BF, Burris JL, et al. Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: a review of the literature. Drugs. 2013;73(5): 407–426.
11. Hollis JF, McAfee TA, Fellows JF, Zbikowski SM, Stark M. The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tobacco Control. 2007; 16(Suppl 1): i53–i59.
12. Wang TW, Asman K, Gentzke AS, et al. Tobacco Product Use Among Adults — United States, 2017. MMWR Morb Mortal Wkly Rep 2018;67:1225–1232.