MSD Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Smoking Cessation


Judith J. Prochaska

, PhD, MPH, Stanford Prevention Research Center, Stanford University

Reviewed/Revised Nov 2023
Topic Resources

Most people who smoke want to quit and have tried doing so with limited success. Effective tools to help quit smoking include counseling, nicotine replacement products, and medications.

While often very challenging, quitting smoking is one of the most important things people who smoke can do for their health.

  • Quitting smoking brings immediate health benefits that increase over time.

  • People who stop smoking may become irritable, anxious, sad, and restless; these symptoms decline over time.

  • Quitting smoking also provides health benefits for people around them.

  • Most people who smoke want to quit and have tried doing so without success.

  • Counseling and support in changing behavior, nicotine replacement products, and certain medications double the chances of quitting smoking for good.

Smoking is harmful to almost every organ in the body, and quitting smoking brings immediate health benefits that increase over time. Within 30 minutes from the last cigarette, blood pressure and pulse decline and return to normal. Within 8 hours, carbon monoxide levels return to normal. After 24 hours, the chance of heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or a heart attack (myocardial infarction), depending on the location and amount... read more Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) declines, and within 3 years the risk of heart attack is similar to that of people who have never smoked. Over time, cancer Lung Cancer Lung cancer is the leading cause of cancer death in both men and women. About 85% of cases are related to cigarette smoking. One common symptom is a persistent cough or a change in the character... read more Lung Cancer risk decreases as well.

Most people who smoke who quit do so for health or economic reasons. About 70% of people who smoke in the United States say they want to quit and have already tried to quit at least once. Withdrawal symptoms are a major barrier to quitting (smoking cessation).

The Costs of Smoking

Quitting smoking can save significant amounts of money and time.

Money: Nationally, a pack of cigarettes averages $8.00. This means that someone who smokes a pack a day spends over $2,900 a year on cigarettes alone. This does not include lighters, air fresheners, and other smoking-related products or accessories. Medical costs and time lost from work are additional major costs over the long term.

Time: It takes about 8 minutes to smoke a cigarette plus time to earn money to purchase that cigarette and find a place to smoke it. Because many places have adopted smoke-free policies, finding a smoking-friendly spot is not as easy as it used to be. As a result, a person who smokes one pack a day may end up devoting about 3 hours each day to smoking.

Quitting smoking improves the health and finances of those who quit and brings immediate benefits to those who are exposed to exhaled smoke and smoke emitted from the end of a lit cigarette. Someone who successfully quits smoking can become a role model and support to other people who want to quit. Quitting smoking can be challenging, but it is possible and evidence-based treatments are available.

Nicotine Withdrawal

Quitting smoking causes strong cravings for cigarettes and also symptoms such as anxiety, depression (mostly mild, but sometimes severe), inability to concentrate, irritability, restlessness, hunger, tremor, sweating, dizziness, headaches, abdominal pains, nausea, and disrupted sleep. Nicotine withdrawal symptoms tend to be most intense in the first 2 to 3 days of going smoke-free and then subside within 2 to 4 weeks. Medications are available to reduce the symptoms of nicotine withdrawal.

Because nicotine suppresses appetite and slightly increases the rate at which calories are burned, people who quit smoking may gain weight. Food also starts to taste and smell better, because smoking dulls the sense of smell and harms taste buds. Exercise helps prevent weight gain and may reduce the craving for nicotine. Drinking water is recommended along with other strategies for coping with oral cravings (for example, using a toothpick or chewing on a straw or carrot sticks). Use of nicotine gum may help delay weight gain. A temporary cough may develop as the lungs start to heal themselves.

Below are examples of common nicotine withdrawal symptoms, their estimated time of duration, and behavioral strategies for relieving them.


Symptoms of Withdrawal*

Withdrawal Symptom


Behavioral Strategies

Chest tightness

A few days

Deep breathing


1–2 weeks

Drink fluids

Eat fiber-rich foods


A few days

Drink fluids

Cigarette cravings

2–3 days frequently, then decreases

Distract yourself


Depressed mood

1–2 weeks

Increase pleasurable activities

Ask family and friends for support

Difficulty concentrating

A few weeks

Plan workload in advance


1–2 days

Change positions slowly and use caution


2–4 days

Take naps

Do not push yourself


Up to several weeks

Drink water

Eat low-calorie snacks


1 week

Limit caffeine (do not drink it after noon)

Practice relaxation techniques


2–4 weeks

Take walks

Take hot baths

Practice relaxation techniques

* Reproduced with permission from Rx for Change: Clinician-Assisted Tobacco Cessation program. The Regents of the University of California. Copyright © 1999-2018. RxforChange.

Treatment for Smoking Cessation

  • Counseling and support in changing behavior

  • Using nicotine replacement products

  • Using certain medications

Quitting is most likely to be successful by combining counseling and support with medication therapy (except for unusual cases). Seven medications are effective for smoking cessation.

Health care practitioners can recommend ways to change behavior, provide education on cessation medications, write prescriptions, and offer helpful referrals for additional support. All U.S. states have telephone quit lines that can provide additional support for people trying to quit. People can call the national 1-800-QUIT-NOW (1-800-784-8669) number to connect with counseling services for their state. Quit lines seem to be at least as effective as in-person counseling. The National Cancer Institute's web site ( is a comprehensive resource for quitting smoking with information, treatment planning, and personalized behavioral counseling via text and live chat.

Hypnosis, lasers, herbal treatments, and acupuncture have not proved to be effective for smoking cessation. For people who use smokeless tobacco products, counseling and support in changing behavior appear to be effective, while the evidence for nicotine replacement and other medications is weaker.

Changing behavior

Behavioral strategies are recommended for quitting smoking. Behavioral strategies are focused on

  • Making the surroundings smoke-free (for example, throwing out all cigarettes, ashtrays, and lighters and avoiding places where people typically buy cigarettes and/or smoke)

  • Recognizing cues to smoking that occur during normal daily activities (such as phone conversations, coffee breaks, meals, sexual activity, boredom, traffic problems and other frustrations, as well as on awakening)

  • After recognizing a cue to smoke, changing the behavior triggering the cue (for example, taking a walk instead of a coffee break) or substituting another behavior for smoking (for example, sucking on candy, chewing on a toothpick, holding ice, doodling, chewing gum, or doing puzzles such as crosswords)

  • Engaging in pleasant activities and rewarding efforts to stay smoke-free (for example, listening to music, talking with friends, putting saved money into a money jar)

Other recommended strategies include engaging in physical activities, deep breathing, and relaxation techniques as well as drinking water and eating low-calorie snacks and fiber-rich foods. People may want to avoid drinking alcohol or using marijuana because both substances can temporarily lower a person's resolve to quit smoking.

Selection of a quit date is very helpful. The quit date may be selected arbitrarily or set on a special occasion (such as a holiday or anniversary). A stressful time, such as when a deadline (for example, a tax deadline) needs to be met, is not a good time to try to quit. If others in the home also smoke, it is important to make the home smoke-free.

Quitting cigarettes completely (cold turkey) is better than gradually decreasing the number of cigarettes smoked. People who smoke fewer cigarettes may unconsciously inhale more deeply or smoke down to the filter, and thus get as much nicotine as they did before.

Medication-supported therapies

Nicotine replacement therapy (NRT), bupropion, and varenicline are all medication-based therapies that help minimize the discomfort of nicotine withdrawal, thus allowing people to focus on the behavioral aspects of quitting smoking.

Nicotine replacement therapy is available in a variety of formulations, including patch, gum, lozenge, and nasal spray. All provide nicotine to the brain but without the quick hit of a cigarette. The speed at which a medication reaches the brain increases its addiction potential. Hence, very few people become dependent on the nicotine replacement products. The patch, gum, and lozenges are available for purchase over-the-counter; the nasal spray is available in the United States by prescription only. Previously available by prescription, the nicotine inhaler was discontinued in the United States in 2023. The nicotine mouth spray is available in many countries outside of the United States, but is not approved in the United States.

Combination nicotine replacement, which typically combines the long-acting nicotine patch with a shorter-acting formulation (gum, lozenge, or nasal spray) is a particularly effective strategy, which more than doubles the chances of quitting smoking over the long term.

Nicotine replacement products have a few cautions:

  • People with jaw (temporomandibular) disorders should not use the gum.

  • People with severe skin sensitivity should not use the patch.

  • These products may have harmful effects in pregnant women.

  • People who have had heart attacks recently or certain blood vessel disorders should talk to their doctor before using one of these products.

Bupropion is a prescription antidepressant that was found to help with smoking cessation in people with and without depression. Bupropion can be used in combination with a nicotine replacement product. Together, they have a higher success rate than either alone. The results of both medications are best when used with a behavior modification program. People at risk for seizures should not use bupropion.

Varenicline, another prescription medication, helps lessen cravings and withdrawal symptoms, makes smoking less rewarding, and increases success with quitting over the long term. Varenicline works in two ways:

  • It partially blocks the receptors in the brain that are affected by nicotine, which eases withdrawal symptoms.

  • It stops nicotine from attaching to the receptors, so that a person who smokes a cigarette while taking varenicline finds the activity less rewarding.

Some people taking bupropion SR or varenicline have developed serious nervous system or behavioral side effects, such as hostility, agitation, depressed mood, other behavioral abnormalities, suicidal thoughts, and attempted or completed suicide. Anyone who experiences any of these should immediately stop taking the medication and notify their health care provider.

Therapies under investigation for smoking cessation include the medications cytisine, bromocriptine, and topiramate. Vaccine therapy has been studied and found to be ineffective.

Nicotine replacement and other smoking cessation medications (bupropion and varenicline) are typically taken for 8 to 12 weeks; some may be taken longer to help prevent relapse to smoking.

At this time, cessation medications and nicotine replacement products are not routinely recommended for people who are

  • Pregnant

  • Not smoking daily or smoke only a few cigarettes a day

  • Adolescents (under age 18)

  • Using smokeless tobacco

In general, all people should talk with their health care provider about the different medications available to help them quit smoking, to determine which is best for them. People should also be sure to read the package inserts that come with all smoking cessation products.

E-cigarettes Vaping Vaping refers to inhaling vapor (volatilized liquid) produced by battery-powered devices. The vapor can contain nicotine, tetrahydrocannabinol (THC) and cannabinoid (CBD) oils, and other substances... read more may sometimes be considered for use in smoking cessation programs, although the evidence for their effectiveness is not strong. There is also concern that because nicotine inhaled from some e-cigarette devices is delivered to the brain as rapidly as nicotine from smoked cigarettes, people might remain similarly addicted.

Cessation in children and adolescents

Parents should maintain a smoke-free household and communicate the expectation to their children that the children will not smoke.

The counseling approach is similar to that for adults, but children and adolescents typically are not given smoking cessation medications.

Prognosis for Smoking Cessation

About 20 million people who smoke in the United States (almost half of all people who smoke) make a 24-hour quit attempt each year. Most do not use any supportive counseling or other proven aids to quitting. Only about 5% of such people are successful long term. In contrast, the 1-year success rate for people using proven methods to achieve long-term success in quitting is higher.

More Information

The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.

quiz link

Test your knowledge

Take a Quiz!