Smoking cessation

Smoking cessation refers to the process of stopping smoking. Many people who smoke cigarettes become addicted to nicotine, a drug found in tobacco. This means that people experience cravings and withdrawal symptoms during smoking cessation, making it difficult to stop smoking. Many smokers find that it takes more than one attempt to quit successfully.

Although difficult, smoking cessation has many benefits, including improved mental and physical health. Several effective interventions can help, typically involving a combination of therapy and medication.

Read on for more information about smoking cessation and explore treatment options right for you.

Prevalence of smoking

According to the Centers for Disease Control and Prevention (1):

• 13.7% of US adults were currently smoking cigarettes in 2018
• Men were more likely to be cigarette smokers (15.6%) than women (12%)
• People who experienced serious psychological distress were more likely to be smokers (31.6%) compared to those who had not (13%)
• More people are addicted to nicotine than any other drug

Smoking and health

Smoking tobacco has been linked to many physical health problems, such as:

• Cancer
• Coronary heart disease
• Stroke
• Diabetes

Smoking is also associated with mental health problems, such as:

• Anxiety
• Stress
• Depression

Additionally, the DSM-5, the manual used by professionals to diagnose mental health conditions, includes a diagnostic category called Tobacco Related Disorders. This reflects a pattern of smoking that causes clinically significant levels of distress or impairment.

That said, anyone who smokes tobacco will benefit from quitting - you do not need to have a diagnosis of a tobacco related disorder.

Symptoms of addiction to smoking

If you experience some of the following symptoms, consider enlisting the support of a professional to help you quit smoking:

• Difficulty reducing or quitting tobacco use
• Cravings or intense desires to smoke
• Spending a lot of time smoking or on activities required to obtain tobacco
• Smoking more cigarettes or needing an increased amount of tobacco to feel the desired effect
• Experiencing withdrawal symptoms when not smoking, like irritability, anxiety, or attention problems
• Smoking is impacting on your ability to go about daily life activities

Treatment options for smoking cessation

If you’d like to quit smoking, consider a combination of the following options:

• Therapy: Successful interventions for smoking cessation tend to include some form of therapeutic support to assist with behavior change, coping strategies, and relapse prevention. Evidence suggests that group support may be more effective than one-to-one (2). See more tips below on types of therapy and selecting a therapist.
• Check-up: See your primary care doctor before you stop smoking, particularly if you are taking medication for a mental health condition. This is also an opportunity to discuss medical treatments for smoking cessation.
• Nicotine replacement: Many people find that quitting is easier with the support of medication. Nicotine replacement therapy can help reduce withdrawal symptoms and cravings. Typically, patches, gum, and lozenges are available over the counter, while other nicotine replacement options need a prescription from your doctor.
• Other stop-smoking medicines: See your doctor to discuss the possible role of stop-smoking medication. Medication can help manage cravings, as well as reducing the reinforcing effects if you do have a cigarette.
• Social support and support groups: Many people find it easier to commit to quitting if they are doing it alongside a friend or family member, or with a group of people going through the same experience.
• Hotlines: Trained counselors provide support via a Quitline on 1-800-784-8669. Alternatively, the National Cancer Institute’s LiveHelp chat support can also provide information and assistance.
• Online self-help resources: The government’s smokefree website has helpful information, self-help tools, tips, and live online chat support. Having a quit plan is a helpful component of maintaining cessation over the long-term, and the website provides great ideas for this.

Therapy for smoking cessation

Typically, some type of therapy is an important component of smoking cessation; whether it’s behavioral support in a group setting, or more intensive individual counseling. Common therapeutic approaches include:

• Cognitive Behavioral Therapy (CBT): CBT helps people become aware of triggers and unhelpful thinking patterns. Alternative behaviors and coping strategies are learned to avoid smoking.
• Motivational Interviewing: Motivational interviewing helps build motivation and commitment to the behavior change necessary for smoking cessation, exploring goals and reasons for wanting to quit.
• Acceptance and Commitment Therapy (ACT): ACT involves components of both CBT and mindfulness as well as other strategies. An ACT technique called urge surfing teaches smokers to cope with cravings by watching the intensity of urges to smoke rise and fall without acting. People build a willingness to experience discomfort and act in a values-guided manner to quit smoking.
• Mindfulness Practices: Mindfulness for smoking cessation involves increasing awareness of sensations and thoughts associated with smoking and cravings, without automatically reacting or acting on them.

What to look for in a therapist for smoking cessation

There are several factors to keep in mind when selecting a therapist, including:

Specialization: Look for a therapist with experience and specialized training in smoking cessation or the therapy type that resonates with you. They often include this information in their biography on their website or online profile.

Qualifications: With so many different provider types available, it can be difficult to decide which type of mental health professional to see. The most important thing is to look for a currently licensed therapist.

Personal fit: The trusting relationship between you and your therapist, known as the “therapeutic alliance” can have a huge impact on the efficacy of therapy. The best way to judge how you might feel about a therapist is to ask for a preliminary phone call. This also allows you to ask about their experience, which therapy modality they recommend, and what that will be like. Try to speak to a few different therapists before deciding on a provider.

Sources and references

• (1) Centers for Disease Control and Prevention, “Smoking & Tobacco Use”. Accessed online January 2020 at https://www.cdc.gov/tobacco/
• (2) Royal College of Physicians, “Smoking and mental health”. PDF accessed online January 2020 at https://www.ncsct.co.uk/usr/pub/Smoking%20and%20mental%20health.pdf
• smokefree.gov website
• Tobacco in Australia website
• National Institute on Drug Abuse, “Tobacco, Nicotine, and E-Cigarettes”. Accessed online January 2019 at https://www.drugabuse.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/introduction