# Smoking cessation

Smoking cessation (quitting smoking or stopping smoking) is a process of discontinuing tobacco smoking. Tobacco smoke contains the addictive substance nicotine, which often causes dependence. Nicotine withdrawal typically makes the process of quitting difficult. The commonly prescribed medications varenicline, nortriptyline, and/or bupropion help some individuals with smoking cessation. Vaping is likely to be far less harmful than tobacco smoking, but is harmful to health. Vaping might help many individuals to quit smoking, but vaping cessation could be quite difficult.

## Quotes

* Smoking increases mortality from all causes and has a crucial role in atherosclerotic cardiovascular disease (ASCVD). Active smoking and secondhand smoke exposure determine more than 30% of coronary heart disease (CHD) mortality. The exact mechanisms of cardiovascular damages are not well known, but the detrimental effect of smoking on endothelial function has long been recognized. Smoking elicits oxidative processes, negatively affects platelet function, fibrinolysis, inflammation and vasomotor function; all these proatherogenic effects double the 10-year risk of fatal events in smokers compared to non smokers. An intriguing issue about smoking is the vulnerability of female gender. The mortality from cardiovascular diseases (CVDs) is higher in female than male smokers and female smokers show a 25% higher risk of developing CHD than men with the same exposure to tobacco smoke. This female vulnerability seems to be related to genes involved in thrombin signaling. The effects of smoking cessation have also been extensively studied. Cessation at an early age (40 years) has an impressive 90% reduction in the excess risk of death.
** Giuseppina Gallucci, Alfredo Tartarone, Rosa Lerose, Anna Vittoria Lalinga, and Alba Maria Capobianco, (2020). "Cardiovascular risk of smoking and benefits of smoking cessation". Journal of Thoracic Disease 12 (7): 3866–3876. DOI:10.21037/jtd.2020.02.47.
* There is high‐certainty evidence that bupropion can aid long‐term smoking cessation. However, bupropion also increases the number of adverse events, including psychiatric AEs, and there is high‐certainty evidence that people taking bupropion are more likely to discontinue treatment compared with placebo. However, there is no clear evidence to suggest whether people taking bupropion experience more or fewer SAEs than those taking placebo (moderate certainty). Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo. Evidence suggests that bupropion may be as successful as NRT and nortriptyline in helping people to quit smoking, but that it is less effective than varenicline. There is insufficient evidence to determine whether the other antidepressants tested, such as SSRIs, aid smoking cessation, and when looking at safety and tolerance outcomes, in most cases, paucity of data made it difficult to draw conclusions.
** Seth Howes, Jamie Hartmann-Boyce, Jonathan Livingstone-Banks, Bosun Hong, and Nicola Lindson, (2020). "Antidepressants for smoking cessation". Cochrane Database of Systematic Reviews 4. DOI:10.1002/14651858.CD000031.
* Cigarette smoking is the primary cause of chronic obstructive pulmonary disease, and smoking cessation is the most effective means of stopping the progression of chronic obstructive pulmonary disease. Worldwide, approximately a billion people smoke cigarettes and 80% reside in low-income and middle-income countries. Though in the United States there has been a substantial decline in cigarette smoking since 1964, when the Surgeon General's report first reviewed smoking, smoking remains widespread in the United States today (about 23% of the population in 2001). Nicotine is addictive, but there are now effective drugs and behavioral interventions to assist people to overcome the addiction. Available evidence shows that smoking cessation can be helped with counseling, nicotine replacement, and bupropion. Less-studied interventions, including hypnosis, acupuncture, aversive therapy, exercise, lobeline, anxiolytics, mecamylamine, opioid agonists, and silver acetate, have assisted some people in smoking cessation, but none of those interventions has strong research evidence of efficacy. To promote smoking cessation, physicians should discuss with their smoking patients “relevance, risk, rewards, roadblocks, and repetition,” and with patients who are willing to attempt to quit, physicians should use the 5-step system of “ask, advise, assess, assist, and arrange.”
** Scott P. Marlow and James K. Stoller, (2003). "Smoking cessation". Respiratory Care 48 (12): 1238–1256.
* If I mention freebasing, I am sure most people in this room understandably think of cocaine — but freebasing was invented by the tobacco industry. You add ammonia and formaldehyde to the tobacco leaf mixture — the smoke that's produced is more basic, more alkaline. And, as a consequence, nicotine is delivered across the {[w|Pulmonary alveolus|alveolar membrane}} even more rapidly than would otherwise be the case. And we know that the rapidity — with which a drug is delivered and sating a need for a drug — is an important determinant of its propensity to induce and maintain addiction, et cetera, et cetera, et cetera. And we could take the entire hour talking about the elements of cigarette design. … It is important that we understand that we have the most addictive substance in our community — whose use is facilitated by a perversely engineered drug delivery device.
** Andrew Pipe, (July 25, 2014)"Dr. Andrew Pipe: The Zombies of Smoking Cessation". CAMH Professionals Video, YouTube. (quote at 4:14 of 45:59)
* Allen Carr’s (AC) method is a pharmacotherapy-free approach to quit smoking that is delivered through seminars, online courses, or in the form of a book. It has gained popularity, but its effectiveness remains controversial due to a lack of scientific evidence.
** Irene Possenti, Marco Scala, Alessandra Lugo, Luke Clancy, Sheila Keogan, and Silvano Gallus, (September 2023)"The effectiveness of Allen Carr's method for smoking cessation: A systematic review". Tobacco Prevention & Cessation 9 (29). DOI:10.18332/tpc/172314.

## See also

* Addiction
* Chewing tobacco
* Tobacco industry

## External links

* Encyclopedic article on Smoking cessation on Wikipedia
* (July 11, 2023)"Smoking Cessation - 3 steps to quitting". American Cancer Society, YouTube.