Giving up smoking is hard to do; multiple approaches help

Quitting smoking is notoriously difficult. Persistence, along with smoking-cessation treatment and social support, can lead to success.

Giving up smoking often requires about six attempts and may involve using a prescription medication or nicotine-replacement therapy, along with counseling and social support, said Aruni Bhatnagar, PhD, co-director of the American Heart Association Tobacco Center for Regulatory Science.

“It takes a multi-pronged approach,” said Bhatnagar, a professor of medicine and a professor of biochemistry and molecular biology at the University of Louisville.

Progress has been made in reducing smoking in the United States, but 28.8 million American adults smoked cigarettes in 2022. Two-thirds of those wanted to quit, and about half tried. However, fewer than 10% succeeded.

Cigarette smoking is the leading cause of preventable disease and death in the United States, killing more than 480,000 people per year. Smoking costs more than $600 billion a year in health care expenses and lost productivity.

Nicotine addiction

Tobacco dependence is a chronic condition driven by nicotine addiction. Nicotine is a drug that can increase attention, focus and a sense of calm, Bhatnagar explained.

“It is, in some measure, maybe more addictive than cocaine,” he said. “So, it becomes very difficult to quit.”

More than 7,000 chemical compounds are found in cigarette smoke; hundreds of them are harmful to humans. Smoking can increase your heart rate and blood pressure. It can narrow the arteries that carry blood and can contribute to the hardening of the arterial walls, which can lead to a heart attack. Smoking can also increase the risk for lung and other cancers. Bhatnagar noted that more smokers die from heart disease than any other smoking-related illness.

Most people who start smoking do so before age 21, when the brain is not fully formed. That makes it particularly hard to quit because the brain has developed while being fixated on nicotine, Bhatnagar said.

“That’s very difficult to shake off,” he said, adding that those who start smoking later in life may find it easier to stop.

Ways to quit

A “life-changing event” threatening one’s health or even their life, such as a heart attack or stroke, may serve as a trigger for some people to quit smoking, Bhatnagar noted.

In other circumstances, those trying to quit smoking may be helped by a prescription medication including as varenicline, also known as Chantix, which blocks receptors of nicotine in the brain, or with a nicotine replacement gum, lozenge or patch, as well as counseling and support from social contacts.

Bhatnagar cautioned against using e-cigarettes to try to quit using traditional combustible cigarettes. Though some companies have marketed e-cigarettes that way, he said he and the American Heart Association recommend that people trying to quit smoking should try proven smoking cessation therapies. Science clearly indicates vaping is not a safe or healthy alternative to smoking traditional cigarettes.

Researchers are looking at new ways to help young people stop using nicotine, including through technology social support, Bhatnagar said. He said smoking-cessation medications for youth don’t have federal regulatory approval, so counseling and social support are the only options.

The Food and Drug Administration is working with the National Institutes of Health to develop new cessation approaches for all smokers. The groups recently held a joint meeting to discuss clinical and community perspectives, promising target areas and regulatory paths. The event was in support of a U.S. government initiative to promote innovative research and eliminate smoking and cessation-related disparities. Some groups of U.S. adults – Native Americans, Black men and people living in rural areas, for example – have higher smoking prevalence than others.

A healthier future

When embarking on a plan to quit smoking, the earlier the better, Bhatnagar said. No matter how long ago someone quit, the craving for nicotine doesn’t totally go away. “That never really happens,” he said.

How quickly health benefits kick in after stopping smoking depends on the duration and intensity of one’s smoking habit, he said. But, he noted, even long-term smokers can experience better cardiovascular health within a few years after quitting.

Despite the obstacles to quitting, it’s encouraging that in the United States, overall smoking rates have declined and there are more ex-smokers than smokers, Bhatnagar said.

“It takes multiple attempts and multiple modalities to successfully quit,” he said. “It can be done.”