smoking cessation

Smoking Cessation / Quit Smoking

Smoking cessation is important in the adolescent population because intervention at this time may prevent nicotine dependence and severe health consequences later in life.

Psychosocial counselling and medications are effective, and that combinations of the two methods achieve the best results in smoking cessation.


You can make changes in your lifestyle behavior to help you quit smoking on your own or you can participate in individual or group sessions. Using lifestyle behavioral changes with a medication increases your chances of success. 

1.Problem solving/skills training 

Make lifestyle changes to reduce stress and improve quality of life, such as starting an exercise program or learning relaxation techniques. Vigorous exercise can enhance the ability to stop smoking and avoid relapse and also helps to minimize or avoid weight gain.

  • Reduce spending time with smokers and in places where smoking is allowed.
  • Recognize that cravings frequently lead to relapse. Cravings can be prevented to some degree by avoiding situations associated with smoking, by minimizing stress, and by avoiding alcohol.
  • Keep oral substitutes (such as sugarless gum, carrots, sunflower seeds, etc) handy for when cravings develop.
  • Avoid thoughts like “having one cigarette will not hurt”; one cigarette typically leads to many more.
Tips to relieve smoking cessation cravings

2.Support — Support can be very helpful in quitting smoking and staying off cigarettes. Support can come from family and friends, a health care provider, a counselor, a telephone hotline (in the United States, 1-800-QUIT-NOW), a text messaging program (in the United States, sign up at, or support groups.

3.Group counseling — Group programs are offered by a number of organizations. It include lectures, group meeting, a tapering method leading to a “quit day,” development of coping skills, and suggestions for preventing relapse.

4.Hypnosis and acupuncture — Hypnosis and acupuncture are popular stop-smoking methods. Although scientific support for these two methods is weak, some people who have failed with other techniques feel these treatments were helpful.

What should I do if I want to quit smoking? — The letters in the word “START” can help you remember the steps to take:

S = Set a quit date.

T = Tell family, friends, and the people around you that you plan to quit.

A = Anticipate or plan ahead for the tough times you will face while quitting.

R = Remove cigarettes and other tobacco products from your home, car, and work.

T = Talk to your doctor about getting help to quit.

How can my doctor or nurse help? —  Doctor or nurse can give you medicines to:

●Reduce your craving for cigarettes and reduce the unpleasant symptoms that happen when you stop smoking (called “withdrawal symptoms”).

What are the symptoms of withdrawal?

The symptoms include :

  • Trouble sleeping
  • Being irritable, anxious or restless
  • Getting frustrated or angry
  • Having trouble thinking clearly


There are several medications that may help you stop smoking; some of these are available without a prescription while others require aprescription.

Here are list of medications used for smoking cessation :

  • Nicotine replacement therapy
    • – Skin patches
    • – Gum
    • – Lozenges
    • – Inhaler
    • – Nasal spray
  • Varenicline
  • Bupropion


Nicotine replacement therapy is designed to reduce the intensity of withdrawl symptoms and make the smoker more comfortable when quitting, but it will not prevent symptoms completely.

Nicotine replacement therapy is safe, even in people with known heart disease

Skin patches — Nicotine patches deliver nicotine to the blood through a skin patch. Several doses are available. The highest dose patch (21 mg/patch) is usually appropriate for people smoking 10 cigarettes (half a pack) or more daily. Lighter smokers might choose the 14 mg/patch. Patches reduce withdrawal symptoms but do not eliminate them.

Nicotine Patch - FDA prescribing information, side effects and uses

Treatment with nicotine patches is generally recommended at “full dose” for four to six weeks.

Use of nicotine at night may interfere with sleep, causing vivid dreams.

Is the Nicotine Patch a Good Way to Stop Smoking?

Use of nicotine patches at night increases morning blood nicotine levels, which may help prevent difficult early morning withdrawal symptoms. There is a low risk of addiction with nicotine patches.

Gum — Nicotine gum contains nicotine that is slowly released with chewing. It is available in 2 and 4 mg pieces.

nicotine gum for smoking cessation

People who smoke 25 cigarettes per day or less can use 2 mg of nicotine gum when needed.

Smokers who smoke more than 25 cigarettes per day can use the 4 mg dose; this produces blood levels of nicotine 40 percent lower than smoking.

Smokers may use up to 24 pieces of gum per day.

Withdrawal symptoms are not prevented by gum use, but the intensity of the symptoms may be reduced.

When used with an intensive behavioral program, nicotine gum can double your chances of quitting.

Without a behavioral program, quit rates with gum are usually lower. Gum use is generally recommended for three to six months.

The gum is meant to be chewed differently than regular chewing gum. To be effective, the nicotine must be absorbed through the cheek or gums.

If chewed too quickly, the nicotine is instead swallowed, which can cause stomach upset and is not very effective for treating nicotine withdrawal.

To be absorbed well, the user chews it just enough to feel the tingling of nicotine being released, then parks the gum in the cheek until the tingling goes away. At that point, the user chews it again until the tingling is felt, then parks it in the cheek. This cycle is repeated for 30 minutes, and then the gum is discarded.

Gum users should avoid drinking coffee, sodas, or orange juice while chewing the gum or for 15 minutes beforehand, because these fluids make saliva acidic, which limits nicotine absorption.

Lozenges — Nicotine lozenges slowly release nicotine into the saliva in the mouth. The nicotine works similarly to the gum, as it must be absorbed in the mouth and not swallowed. Because the lozenges do not require chewing, they may be easier for some people to use. They come in 2 and 4 mg doses.

Inhaler — The nicotine inhaler is made up of a mouthpiece and a plastic cartridge that contains nicotine. Nicotine is released when you inhale through the device. Most of the nicotine is deposited in the mouth and throat. It does not actually reach the lungs. Therefore, nicotine is absorbed more slowly than it is when inhaling on a cigarette.

Nicotine Inhaler | NICORETTE® Inhalator | NICORETTE®

Irritation of the mouth or throat is common, particularly in the beginning. People with asthma or chronic cough may not be able to use the inhaler due to throat irritation.

Nasal spray — Nicotine nasal spray delivers a liquid solution of nicotine to the nose. Compared with the patch and gum, the nasal spray produces a relatively rapid rise in nicotine levels in the blood, more similar to what happens when you smoke. However, nasal irritation is common. Nasal sprays are safe. They are available only by prescription in the United States.


Varenicline in smoking cessation

VARENICLINE ( Brand name : CHANTIX ) is a prescription medication that works in the brain to reduce nicotine withdrawal symptoms and cigarette cravings.

It should be taken after eating with a full glass of water as follows:

  • One 0.5 mg tablet daily for three days
  • One 0.5 mg tablet twice daily for the next four days
  • One 1.0 mg tablet twice daily starting at day 7

You should plan to quit smoking between one and four weeks after starting varenicline.

You should continue it for 12 weeks before concluding if it is working; if you successfully quit at 12 weeks, you may continue taking it for an additional 12 weeks.

If you have not quit after taking varenicline for 12 weeks, talk to your health care provider about the next step.

Options include working harder to make behavioral changes and continuing varenicline or switching to another treatment.

Common side effects of varenicline include nausea and abnormal dreams.

In 2011, the US Food and Drug Administration (FDA) issued an advisory that, in people who already have heart or blood vessel disease, varenicline may increase the risk of acute heart problems .


Bupropion — Bupropion (brand names: Zyban, Wellbutrin) is an antidepressant that can be used to help you stop smoking.

It is usually taken once daily for three days, then increased to twice daily starting two weeks before the quit date; it is typically continued for 7 to 12 weeks.

Bupropion is generally well-tolerated, but it may cause dry mouth and difficulty sleeping.

The drug should not be used by people who have a seizure disorder or bipolar (manic-depressive) disorder, and it is not recommended for those who have head trauma, anorexia nervosa, or bulimia, or for those who drink alcohol excessively.


Talk to your health care provider about the method you plan to use to quit. Behavior changes should usually be combined with one or more medications (eg, varenicline, nicotine replacement therapy, or bupropion).

●Pick a date to quit smoking. Tell friends and family about your plan.

●Seek support through free telephone quitlines (eg, in the United States, 1-800-QUIT-NOW), text messages, or other tools that can be accessed online (

●Begin making changes in your behavior; avoid situations that lead you to smoke.

●Start varenicline (one to four weeks before your quit date) or bupropion (two weeks before your quit date) or start nicotine replacement (on the day you quit).

●Deal with withdrawal symptoms as they develop. Consider using nicotine replacement therapy (such as nicotine patch, gum, or lozenge) to help manage withdrawal symptoms. Do not smoke “just one” to get through a rough day. Consult support groups for more tips on coping with withdrawal.