Smoking:  When It Comes to Quitting, One Size Does Not Fit All

November 17, 2015 Brigham and Women's Hospital


If you smoke, get ready for all sorts of “quit now” messages, as this year’s annual Great American Smokeout is November 19. That said, if you’re one of the majority of smokers who wants to quit, these messages can seem simplistic and frustrating.

Tobacco/nicotine dependence is what you have, and this addiction is a chronic condition that may require several courses of intervention before you’re cured. And there are numerous approaches to smoking cessation, some of which have a scientific base, and some of which don’t.

In an interview with Dr. Jennifer Haas, an internist at Brigham and Women’s Hospital who has conducted federally-funded research on smoking cessation, Dr. Haas provides an expert view on what works and why it can work for any individual who is motivated to quit (MTQ) or even cut down.

Here’s the menu of options and how they can help:

Nicotine replacement therapy (NRT) has been proven to help smokers reduce and stop smoking by providing low-dose nicotine to manage nicotine withdrawal and cravings. Dosage is generally decreased over time. This is often the first recommendation for MTQ smokers, as there are few side effects and risks.

The nicotine patch is the “gold standard” in NRT, with other options including nicotine gum, lozenges, inhalers, and nasal spray. According to Dr. Haas, MTQ smokers should work with their primary care physician (PCP) and pharmacist to use NRT properly, enhancing successful quitting. “Some of my patients initially find that the patch affects their ability to get a good night’s sleep or causes bad dreams,” says Dr. Haas. “I instruct them to remove the patch before bedtime. For those who normally smoke within 30 minutes of waking up, chewing nicotine gum, and/ or putting on a new patch first thing when they wake up is often a good strategy.”

In addition to using NRT, Dr. Haas strongly recommends combining NRT with some form of supportive counseling. “My patients who opt for short-term cognitive behavioral therapy, support groups, or even telephone hotlines have a higher chance of being successful,” Dr. Haas says. “QuitWorks ( is available to all smokers at no cost and offers phone-based counseling and often a free supply of NRT.”  One study that Dr. Haas and her team had published in JAMA Internal Medicine (JAMA Intern Med. 2015;175(2):218-226) indicated that helping smokers address underlying  stresses in their lives, through counseling and other social services, improved the quit rate.

According to Dr. Haas, prescription medications like varenicline (Chantix) or bupropion (Wellbutrin SR or Zyban) are very effective for some patients, but carry potential side effects and  greater risks. They generally are used with patients who have not been able to quit through using NRT or have serious medical conditions that require smoking cessation.

Four additional points from Dr. Haas:

  • Simply cutting back on smoking as part of the journey toward smoking cessation is important, as fewer daily cigarettes mean less toxins in the body.
  • It’s okay to have “slips” after you quit; sometimes it takes several tries to quit for good.
  • Weight gain related to smoking cessation is often a concern of smokers, yet research has shown that the average weight gain is only 5-10 pounds.
  • E-cigarettes are not recommended as a smoking cessation tool, as the manufacturing has limited oversight and may contain metals like lead and other toxins.

If you are a MTQ smoker, celebrate the Smokeout on November 19 by discussing options with your PCP or contacting QuitWorks.

– Vicki A.

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