Attempts to quit smoking often fail because the person is not adequately prepared. Preparation is essential and should not be rushed. There are a number of strategies that can be pursued when one is preparing to quit. These include:

• Choosing a quitting date and marking it on the calendar.
  
  
• Switching to a less appealing brand of cigarettes, particularly one that is “light” or has less tar. However, it should be noted that there is no “safe” cigarette and this move should be a temporary step towards quitting altogether.
  
  
• Talking to one’s physician about nicotine replacement therapy (NRT) or other smoking cessation aids.
  
  
• Telling people about quitting. Seek support from family, friends and the community.
  
  
• Identifying situations where one is more likely to want a cigarette (e.g., a party or a coffee break), and planning ahead for these situations.
  
  
• Buying healthy snacks for the home or office that one can “munch” on (e.g., carrot sticks, celery sticks, grapes, raisins, apple slices and so forth).
  
  
• Collecting cigarette butts in a see-through container, such as a two-liter plastic soda bottle with the label removed.
  
  
• Scheduling a dental appointment to have the tobacco stains removed from the teeth.

After making the firm decision to quit smoking, people are encouraged to choose a quitting date. One suggestion is to set the date on a Sunday or Monday because people will need time off on the previous day to make some important changes (as discussed later in this article). Because smoking is often associated with parties and socializing, it is recommended that people avoid setting a quitting date during the holiday season or any other day normally associated with social smoking. However, choosing the birthday of one’s child or spouse may be appropriate if a small family celebration is planned. Also, choosing the Sunday or Monday of a one-week vacation is popular because it may be easier to quit while away from the office, and it is easier to quit when having fun.

After choosing a quitting date, people are encouraged to switch to a different brand of cigarettes that is not as fulfilling as the brand they are currently smoking. For example, they may switch to a “light” cigarette or a cigarette that does not have quite the same flavor as their favorite brand. Although this will not decrease their physical addiction to nicotine, it may help break some of the habits related to smoking: buying that brand, opening that package, pulling a certain-looking cigarette out of a full package and so forth. Research has shown that people who switched to “light” cigarettes were more likely to quit completely within the year. However, people need to avoid the temptation to smoke more often or more deeply after switching to a “lighter” brand. They are still dangerous and quitting completely is the only way to significantly improve a person’s health when it comes to tobacco.

Before quitting, it may be helpful to gradually reduce the number of cigarettes smoked each day. This will begin to prepare the body for reduced nicotine levels and may make it easier to sustain quitting.

A recent study revealed that smokers were eager to enlist the help of their physician in kicking the habit. The study refuted beliefs among many physicians that smokers did not want their doctors to intervene. More promising, however, were the results of the cessation programs. More than 75 percent of the participants freely chose counseling in addition to nicotine replacement therapy. The study clearly showed that physicians have a crucial role to play in helping people overcome nicotine addiction.

Nicotine replacement therapy is designed to deliver decreasing amounts of nicotine in a safe, nonaddictive form to help people quit smoking. There are numerous types of NRT products approved by the U.S. Food and Drug Administration (FDA). Smokers are encouraged to talk with their physician about these products, which include:

• Nicotine inhaler. Available only by prescription, this is a small plastic device shaped like a cigarette that is filled with a replaceable cartridge containing nicotine and menthol. People can puff on it to reduce strong cravings for nicotine, because it delivers relatively safe doses of nicotine primarily into the mouth instead of the lungs.
  
  The nicotine inhaler has proven quite successful for short-term temptations when other long-term strategies are already in place. However, it should not be used right after someone has had a heart attack, and may not be appropriate for someone with either coronary artery disease or abnormal heart rhythms (arrhythmias). Most people will be prescribed 6 to 16 cartridges a day, for up to 6 months.  The most common side effects associated with inhalers inlude mouth and throat irritation, coughing and nausea.
  
  
• Nicotine gum. Available over the counter, the gum comes in 2 miligram (mg) or 4 mg strengths. Individuals should chew the gum for 20 to 30 minutes to reduce their cravings for nicotine, if they were not heavy smokers. Heavy (“chain”) smokers who tend to smoke immediately upon waking might benefit more from either the 4-milligram dose or the nicotine patch. People should not chew more than 20 pieces per day and it is typically not recommended for longer than six months.
  
  The gum is chewed slightly differently than other types of gum, which could take some time to get used to. People who do not like the peppery taste can also choose a Food and Drug Administration (FDA)-approved nicotine gum in mint flavor. Mild side effects mouth sores, throat irritation, upset stomach and jaw discomfort. One disadvantage to nicotine gum is the potential for long-term dependence on the product. Studies have shown that 15 to 20 percent of people who successfully quit smoking continued to chew the gum for one year or longer. Using nicotine gum for an extended period of time is better than returning to smoking, however, the effects of long-term use needs additional research.
  
  
• Nicotine patch. Available with or without a prescription, the nicotine patch painlessly delivers nicotine through the skin and into the bloodstream. Several different types and strengths are available and the dose is lowered over a period of weeks. The patch comes in different durations, depending on the needs of the smoker. The 16-hour patch is typcially used by light-to-average smokers. This patch does not deliver nicotine during the night and may not be effective for early morning withdrawal symptoms. The 24-hour patch provides a continual dose of nicotine and helps people who experience early morning withdrawal. However, this patch may interfere with sleep and cause more skin irritation. 
  
  Depending on body size, the patch is usually used at maximum strength (15 to 22 mg) for the first month, and then at a weaker strength (5 to 14 milligrams) for the next month. The FDA recommends the patch be used for a total of 3 to 5 months but some studies have shown that using for 8 weeks or less is just as effective.
  
  The patch should be applied somewhere between the neck and the waist and should be moved to new areas from day to day to avoid any skin irritation in one spot. The side effects depend on a number of factors including the brand of the patch, the length of time it is used, the person’s skin type and how it is applied. Users of the patch have reported skin irritation, dizziness, fast heartbeat, headache, nausea and muscle stiffness. 
  
  
• Nicotine nasal spray. Available only by prescription, the nasal spray delivers nicotine to the body very quickly through the nasal passages. It offers immediate relief from withdrawal symptoms and smokers report great satisfaction with use. However, since the product contains nicotine, the FDA warns individuals that it can be addictive. It recommends that the product should not be used for longer than 6 months. People with asthma, allergies or sinus problems may be prescribed another form of NRT. The most common side effects from nicotine nasal spray include nasal and throat irritation, runny nose, watery eyes and coughing. 

In some people, the nicotine patch may be combined with another nicotine replacement product, such as gum or lozenges. The patch provides continuous dosing while the second product can help with strong cravings. Some studies have indicated a combination may be slightly more effective than a single product but additional research is needed. The combined use of NRT products has not yet been approved by the FDA. Individuals should discuss this method with their physician before using combined NRT products.

In addition to – or instead of – nicotine replacement therapy, the physician may prescribe a type of antidepressant that has proven to help some people to quit smoking. The drug, bupropion, is nicotine-free and appears to reduce the symptoms of nicotine withdrawal. It should not be used by individuals with a history of seizures, anorexia or heavy alcohol use.

Scientists have recently developed drug called varenicline (Chantix) to work specifically as a smoking cessation aid. The drug targets nicotine receptors in the brain to reduce the pleasurable effects people get from smoking. In addition, it works to lessen the symptoms of nicotine withdrawal. Several studies have found the drug can more than double the odds of a person quitting smoking.

There are a number of other methods that may help people quit smoking. Although there is no definitive evidence that these methods or products can improve the chances of quitting, many people chose them as aids. These include:

• Acupuncture
• Hypnosis
• Atropine and scopolamine therapy (drugs commonly prescribed for digestive problems, motion sickness or Parkinson’s disease)
• Cold laser therapy
• Tar and nicotine reducing filters for cigarettes
• Herbal supplements and smoking deterrent dietary products

There are many smoking cessation products on the market that have not been reviewed or approved by the FDA, including:

• Tobacco lozenges and pouches. These are products that contain nicotine and are marketed as a method for smokers to get nicotine when they are unable to smoke (e.g., nonsmoking restaurants, airplanes). These products are not considered smoking cessation aids but instead have been classified by the FDA as types of smokeless tobacco products.  There is no evidence that these products can help smokers quit the habit.
  
  
• Nicotine lollipops. These products were made by some pharmacies in the past and marketed as a method to obtain nicotine. They often contained nicotine salicylate, a product not approved for pharmacy use by the FDA.  Several pharmacy companies have been warned by the FDA to stop selling nicotine lollipops on the Internet. Other products, such as lip balm, also have been manufactured with nicotine salicylate.

People tend to get rather grouchy or irritable when they first quit smoking. By letting family and friends know what is happening and what to expect, needless conflict may be avoided. Some experts believe that it’s easier for someone to quit when a friend or family member quits with them at the same time. However, other experts point out that if one person in this quitting team goes back to smoking, the other is much more likely to do so, as well. All experts agree that it is helpful for friends and family members to avoid smoking in front of someone who is trying to quit. Group support may also take the form of group counseling, which may include lectures, exercises and quitting en masse.

There are many resources that can offer support, which include:

• Self-help books
  
  
• Online support groups, such as Nicotine Anonymous
  
  
• Educational materials (e.g., for parents, coaches or teachers of teens who smoke)
  
  
• Community support groups (usually available at a local hospital)
  
  
• Local smoking cessation programs (e.g., through the local chapter of the American Lung Association or the American Cancer Society)
  
  
• National agencies, including:
  
• American Cancer Society: 1-800-ACS-2345
• American Heart Association: 1-800-AHA-USA1
• American Lung Association: 1-800-LUNG-USA
• National Cancer Institute: 1-800-4-CANCER
• Office on Smoking and Health: 1-800-CDC-1311

Physicians or employers may offer other resources that can help individuals quit smoking. In addition, other healthcare professionals may offer advice and support.