Guidance

Stop smoking options: guidance for conversations with patients

Published 20 August 2018

This document supports clinicians in their conversations with patients on the different available options for stopping smoking and their effectiveness.

Different approaches suit different people so if the first thing a smoker tries does not help, they should try another way.

Stopping smoking has a range of benefits for:

• health (reducing risks of cancer and cardiovascular disease)
• saving money (on average people save £250 per month from stopping smoking)
• families and children (passive smoking)

Available options

Available options include:

• unassisted quitting
• self-managed quitting
• quitting with expert support
• temporarily quitting
• cutting down

1. Available treatment

1.1 Unassisted quitting

An attempt to stop smoking with willpower alone sometimes referred to as going ‘cold turkey’.

1.2 Self-managed quitting

An attempt to stop smoking with over-the-counter stop smoking aids – nicotine replacement therapy (NRT) or e-cigarettes – to help reduce nicotine craving. Other available options include digital apps and alternative therapies.

Nicotine replacement therapy (NRT)

NRT is a medicine that provides you with nicotine without the tar, carbon monoxide and other poisonous chemicals present in tobacco smoke. While nicotine is the addictive substance in cigarettes, it is relatively harmless. NRT has been widely used for many years to help people to stop smoking and is a safe form of treatment.

NRT can be bought in pharmacies and other outlets or is available on prescription.

NRT is available as:

• skin patches
• chewing gum
• inhalers
• oral strips and lozenges
• nasal and mouth sprays

E-cigarettes

An e-cigarette is a device that allows you to inhale nicotine through a vapour rather than smoke. E-cigarettes come in a variety of models and work by heating a solution that typically contains nicotine, propylene glycol or vegetable glycerine, and flavourings. Using an e-cigarette is not completely risk free, but it carries a small fraction of the risk of smoking. Unlike cigarettes, e-cigarettes do not produce tar and carbon monoxide. The vapour contains some potentially harmful chemicals also found in cigarette smoke but at much lower levels. You can buy e-cigarettes from specialist vape shops, some pharmacies and other outlets.

Other options

There are other options available such as text message support, websites, apps, hypnotherapy, acupuncture, acupressure and laser therapy.

1.3 Quitting with expert support

An attempt to stop smoking with support from a trained stop smoking advisor at your local stop smoking service. Depending on the locality, these services can be based in a range of community and healthcare settings including pharmacies and GP practices. Your advisor will talk them through which stop smoking aid, or aids, might suit you best and provide additional support including advice on managing cravings. The following stop smoking medicines are also available as tablets on prescription when seeing a stop smoking advisor:

Champix (varenicline)

Champix reduces cravings for nicotine by blocking the rewarding and reinforcing effects of smoking which take place in the brain.

Zyban (bupropion)

Zyban reduces urges to smoke and helps with withdrawal symptoms.

1.4 Temporarily quitting

An attempt to stop smoking for a fixed period of time. A health professional may encourage you to do this if you do not want to quit for good, particularly before planned surgery. This method may include the use of stop smoking aids and/or support from a stop smoking advisor.

1.5 Cutting down

An attempt to reduce the number of cigarettes smoked. This method may include the use of stop smoking aids.

2. Effect of the treatment

2.1 Unassisted quitting

Around 3 to 4 in 100 people remain non-smokers after a year when they choose to make an unassisted quit attempt.

2.2 Self-managed quitting

Success rates for self-managed quitting vary depending on the type of support used. Some stop smoking aids including nicotine replacement therapy (NRT) and e-cigarettes can improve success when compared to an unassisted quit attempt. Some options are not proven to improve success at all.

NRT

NRT can help reduce some of the unpleasant effects patients might feel from stopping smoking, known as withdrawal symptoms, such as irritability and cravings. NRT can increase your chance of stopping smoking for 6 months or more by more than half. To further increase the chance of quitting successfully, patients can use a combination of NRT products. A nicotine patch releases nicotine slowly into your system to help keep you on a constant level, while a fast-acting product such as an inhaler, lozenge or gum helps you deal with immediate cravings.

E-cigarettes

E-cigarettes can help people quit smoking, with similar or better results than NRT. Like NRT, if you use an e-cigarette too little or too rarely, they will be less successful at stopping smoking, because not enough nicotine is obtained to reduce the urge to smoke. If you want, you can use an e-cigarette together with an NRT product such as a patch.

Other options

Some options such as text message support, websites and mobile digital apps may slightly improve quitting success. There is evidence that acupuncture, acupressure and laser therapy do not improve the chances of quitting smoking. Hypnotherapy is no more effective than counselling.

2.3 Quitting with expert support

Around 16 in 100 people remain non-smokers a year later when they choose to quit with support from a trained stop smoking advisor and use a stop smoking aid.

Champix increases the chances of long-term quitting success between 2 and 3 times compared to a quit attempt without the use of a stop smoking aid.

The likelihood of staying smokefree using Zyban is similar to that for NRT.

2.4 Temporarily quitting

Going through the process of temporarily quitting and getting familiar with stop smoking aids is likely to make you more prepared for quitting permanently at some point in the future. There is also a lower risk of developing complications during and after surgery if you are smokefree.

2.5 Cutting down

Getting familiar with stop smoking aids can help you to be more prepared for quitting completely at some point in the future. However, you will still be exposed to the poisonous chemicals found in tobacco smoke and the benefits to your health will be limited.

3. Treatment length

3.1 Unassisted quitting

There is no limit on how long someone can keep trying to stop smoking. If you are finding it difficult to stay smokefree, you may want to suggest using a stop smoking aid or seeking expert support from a stop smoking advisor.

3.2 Self-managed quitting

NRT should be used for at least 8 to 12 weeks. You can then gradually reduce the dose and eventually stop. However, if you feel that they still need it to prevent you from starting smoking again, they can use it for longer. Similarly, with an e-cigarette, you should continue to use it for as long as you need to stop smoking and stay smokefree.

3.3 Quitting with expert support

This can be up to 12 weeks of face-to-face group or one-to-one support. This behavioural support can be accompanied by one or more stop smoking aids, including NRT, e-cigarettes and Champix or Zyban.

Champix is taken as 1 to 2 tablets a day. You should start taking it a week or two before you try to quit. A course of treatment usually lasts around 12 weeks, but it can be continued for longer if necessary.

Zyban is taken as 1 to 2 tablets a day. You should start taking it a week or two before you try to quit. A course of treatment usually lasts around 7 to 9 weeks.

3.4 Temporarily quitting

The longer you manage to stay smokefree, the more likely you are to stay stopped for good. Using stop smoking aids will improve your chance of success.

3.5 Cutting down

Using stop smoking aids should make it easier for you to cut down and help with withdrawal symptoms. When you have cut down, you could think about how to replace the remaining cigarettes and quit smoking for good.

4. Possible side effects of treatment

4.1 Unassisted quitting

Possible withdrawal symptoms when you stop smoking can include:

• urges to smoke or cravings
• depression
• restlessness
• poor concentration
• Irritability
• aggression
• increased appetite and weight gain

These are likely to be more severe if no stop smoking aid is used.

4.2 Self-managed quitting

Nicotine replacement therapy (NRT)

Possible side effects of NRT can include:

• skin irritation when using patches
• irritation of nose, throat or eyes when using a nasal spray
• difficulty sleeping (insomnia), sometimes with vivid dreams
• an upset stomach
• dizziness
• headaches

E-cigarettes

E-cigarettes are not licensed as medicines and so far there is limited evidence available on possible side effects from use, however, these can include dry mouth and throat irritation.

4.3 Quitting with expert support

Possible side effects of Champix can include:

• feeling and being sick
• difficulty sleeping (insomnia), sometimes with vivid dreams
• dry mouth
• upset stomach
• headaches
• drowsiness
• dizziness

Possible side effects of Zyban can include:

• dry mouth
• difficulty sleeping (insomnia)
• headaches
• feeling and being sick
• upset stomach
• difficulty concentrating
• dizziness

4.4 Temporarily quitting

Depending on the method you choose, you might experience smoking withdrawal symptoms and possible side effects of the stop smoking aid.

4.5 Cutting down

There is no safe level of exposure to tobacco smoke, so if you continue to smoke, even a small amount, you will be exposed to the harmful effects of smoking. Depending on the method you choose, you may experience smoking withdrawal symptoms and possible side effects of the stop smoking aid.

5. Pros and cons of each option

Choosing the treatment option that is best for you means considering how the consequences of each treatment option will affect your life. There is strong evidence that expert support from a stop smoking advisor combined with one or more stop smoking aids is the most effective quitting method. Other options are available for smokers to choose but research has shown them to be less effective.

6. Further information

For further advice on stopping smoking and to find your local stop smoking service, visit NHS Smokefree.