Stopping smoking

This guide is psychoeducational content. It does not replace a consultation. If you have chest pain, unusual breathlessness, weakness on one side of the body or difficulty speaking, call the emergency services immediately. Any cough that persists, any blood-stained sputum, any hoarseness that lasts beyond a few weeks must be shown to a doctor. No treatment is started or stopped without medical advice, particularly during pregnancy, in the case of heart disease or where a treatment is under way. Allow fifty-five minutes to read.

1. Before you begin

You have already stopped. Three days, once. Three months, another time. You remember very well the moment you started again: an evening out, a drink, someone offering you one, and that sentence — 'one will not kill anyone'. Since then you have been telling yourself that you will not manage it, or that it is not the right time, or that you will stop later, after this project, after the summer, after the holidays.

Three things, straight away.

Stopping is not a matter of willpower. You have already demonstrated your willpower in other areas. What is involved here is dependence on a substance, combined with hundreds of ingrained habits. That is treated with tools, not with character.

Several attempts are the rule, not the exception. Most people who have stopped for good made several attempts. Each attempt teaches something and increases the chances of the next one. You have not failed three times: you have practised three times.

It is never too late, and the benefit is immediate. Large follow-up studies show that stopping lengthens life expectancy at any age, the more so the earlier it happens, and that it brings benefits even after sixty. Some effects appear within the first few hours.

Who this guide is for

For you if you smoke and wonder where to start.

For you if you have set a date and want to prepare for it seriously.

For you if you stopped and then started again, and want to understand why.

For you if you have not decided and want first to know what you would gain.

2. Nicotine and dependence

What nicotine does

Inhaled, nicotine reaches the brain within seconds. That speed is the key to everything: the faster a substance acts, the more likely it is to establish a strong dependence, because the link between the gesture and the effect is immediate and repeated thousands of times a year.

It produces a brief improvement in alertness, concentration and mood, and a sensation of calm. The United States Surgeon General's report devoted to this question in 1988 established that nicotine is a substance that produces a dependence comparable, in its mechanisms, to that of other drugs.

The trap of the calming effect

This is the central misunderstanding. A regular smoker is not in a neutral state between two cigarettes: they are in mild withdrawal, increasingly marked as time passes. The next cigarette does not take them above normal; it brings them back to normal.

The impression that 'a cigarette relaxes you' is therefore both accurate and misleading: it relieves a discomfort that it created itself. That is why smokers who have stopped several months earlier almost always describe a lower level of nervousness than before, not a higher one.

Physical dependence and behavioural dependence

They are distinct, and both must be treated.

• Physical dependence is linked to nicotine. It is what produces the withdrawal syndrome, and it is what nicotine replacement and medicines deal with.
• Behavioural dependence is made of gestures and associations: coffee, the car, the phone, the break, the end of a meal, the first drag of the morning, leaving work, waiting. It is what explains the cravings that arise months after stopping, when the body no longer needs nicotine.

The markers of strong dependence

Two simple indicators have long been used, because they predict the difficulty of stopping well:

• the time between waking and the first cigarette — less than thirty minutes, and above all less than five, indicates high dependence;
• the number of cigarettes a day.

To these are added: smoking at night, smoking when ill and in bed, and having already had a difficult withdrawal.

These indicators say nothing about your worth. They serve to choose the right dose of treatment, and that is their only use.

What smoke contains

Nicotine maintains the dependence; it is not what causes most of the illness, but the thousands of substances produced by combustion — tar, carbon monoxide, fine particles, carcinogenic compounds. This distinction is important for understanding why nicotine replacement products, which provide nicotine without combustion, bear no comparison with smoked tobacco.

3. What stopping repairs, and when

The first hours and the first days

Carbon monoxide, which takes the place of oxygen in the blood, is eliminated within a few hours. Oxygenation of the tissues improves from the first day. Taste and smell begin to come back after a few days, which is often the first benefit genuinely noticed.

The first weeks

The morning cough sometimes increases for one to two weeks — the cilia lining the bronchi start working again and clear what had accumulated — then it decreases markedly. Breathlessness on exertion improves. Skin, complexion and breath change. The resting heart rate falls.

The first months

Lung capacity improves, respiratory infections become less frequent, circulation and wound healing improve. It is also the period when the financial benefit becomes very visible.

Over the years

Large follow-up studies, starting with the British doctors study conducted by Richard Doll and Richard Peto over fifty years, showed that the risk of cardiovascular disease falls rapidly after stopping, and that the risk of lung cancer decreases progressively, without quite returning to the level of someone who has never smoked but coming closer to it the earlier the stopping.

Life expectancy

The work of Prabhat Jha and his colleagues, and that of Kirstin Pirie and her team, converge: continued smoking greatly reduces life expectancy, and stopping makes it possible to recover a substantial part of it, the greater the earlier it happens. Stopping before forty makes it possible to recover most of the risk lost. Stopping at sixty still brings a measurable benefit.

What counts more than the quantity

Two ideas to remember, which run against intuition.

• How long you have smoked counts for more than the number of cigarettes a day. Smoking little but for a long time is not harmless.
• There is no risk-free threshold. A few cigarettes a day retain a substantial part of the cardiovascular risk.

That is why cutting down alone, without stopping, brings little health benefit — even if, as we shall see, it can have its place as a step towards stopping.

What you will see for yourself

People who have stopped mention, in this order: the taste of food, the sense of smell, their breath on the stairs, the absence of a morning cough, the money, the smell of clothes and of the house, the end of permanently organising life around the next packet, and — almost always — pride.

4. Withdrawal: what to expect

The features

The nicotine withdrawal syndrome is well described and it is predictable. It combines:

• strong cravings to smoke;
• irritability, nervousness, sometimes anger;
• anxiety;
• difficulty concentrating;
• restlessness or impatience;
• sleep disturbance, falling asleep or waking;
• increased appetite;
• lowered mood;
• sometimes headaches, constipation, mouth ulcers, a passing cough.

The timeline

This is the most useful information in this section, because it stops you interpreting the third day as proof of failure.

• The first hours: cravings begin, often as early as the second or third hour.
• Days 1 to 3: the peak. This is the most uncomfortable period, physically.
• The first week: the discomfort remains marked but begins to decrease.
• Weeks 2 to 4: clear improvement in irritability, anxiety and concentration.
• Beyond a month: most of the features have gone. Appetite and cravings linked to situations may persist for longer.

John Hughes's work on the course of withdrawal shows that most features ease markedly over two to four weeks. What lasts is not the physical symptoms: it is the associations.

What greatly reduces this discomfort

A suitable treatment. That is precisely the function of the nicotine replacement products and medicines described in section 10: they do not eliminate the effort, they remove a large part of the physical craving, and they clearly increase the chances of success.

What is not withdrawal

A deep sadness that settles in and lasts beyond a few weeks, dark thoughts, major and persistent anxiety: these situations call for medical advice. They are rare, but they are taken seriously, particularly in people with a psychiatric history.

The fog of the first days

Many people describe a real difficulty concentrating for one to two weeks. It is sensible to take that into account: if possible, avoid setting your quit date the day before an exam, a major deadline or starting a new job.

5. What the research says

Nicotine replacement works

This is one of the best-established findings in the whole of preventive medicine. The Cochrane reviews conducted by Jamie Hartmann-Boyce and colleagues, covering a very large number of trials, conclude that nicotine replacement products significantly increase the chances of lasting abstinence compared with a placebo or with no treatment, whatever the form used. Combining two forms — a sustained-release form and a fast-acting form — does better than one alone.

Behavioural support does too

The reviews of individual, group and telephone counselling interventions all conclude that they increase the chances of stopping. The effect is proportional to the intensity: the more contacts there are, and the longer they are, the better the results.

And above all, combining the two

This is the central message. The reviews that have compared strategies, notably those of Lindsay Stead and her colleagues, show that combining a drug treatment with behavioural support does markedly better than either alone. Stopping with a treatment and follow-up multiplies the chances compared with stopping unaided.

Telephone lines and apps

The reviews devoted to remote helplines show that proactive telephone support — that is, where it is the service that calls back — increases the chances of stopping. Interventions by text message on mobile phones have also shown a benefit. These are free resources in many countries, and they remain little used.

A quit date is better than tapering down

The trial conducted by Nicola Lindson-Hawley and her colleagues, published in 2016, directly compared stopping abruptly on a set date with gradually cutting down before stopping, in people who were motivated and receiving the same support. Stopping cleanly gave better results. It is counter-intuitive, and it is one of the rare points on which research gives a clear answer.

Mood improves after stopping

Many smokers fear that stopping will worsen their anxiety or their depression. The meta-analysis published by Gemma Taylor and her colleagues in 2014 concludes the opposite: stopping smoking is associated with a reduction in anxiety, depression and stress, and with an improvement in mood and quality of life, including in people with psychiatric disorders. It is a major argument, and almost nobody knows it.

Weight gain exists, and it is limited

The analysis published by Henri-Jean Aubin and his colleagues in 2012 confirms that stopping is accompanied on average by a weight gain of a few kilos in the first year, with wide individual variation. Set against the health benefit, this weight gain bears no comparison with the risk of continuing to smoke — and it can be limited, as section 16 explains.

The electronic cigarette

The Cochrane review devoted to this question, and the trial published by Peter Hajek and his colleagues in 2019, conclude that electronic cigarettes containing nicotine help people to stop smoking, with results at least comparable and, in several analyses, superior to those of nicotine replacement products. Section 18 sets out the honest state of knowledge, including what is not known.

Common misconceptions

'It is a question of willpower.' No. It is dependence on a substance, combined with thousands of behavioural repetitions. Treatments and support multiply the chances, and doing without them as a matter of principle serves no purpose.

'Patches do not work.' They do work. When they fail, it is most often because the dose was too low, the duration too short, or because no fast-acting form was combined with them.

'Nicotine causes cancer.' It is the products of combustion that are responsible. Nicotine maintains the dependence; it is not the main cause of tobacco-related cancers.

'If I stop, I will become unbearable and depressed.' The irritability of the first weeks is real and temporary. In the medium term, anxiety and mood improve; the data are clear on this point.

'I have smoked too much, it is too late.' The benefit exists at any age, including after sixty, and it begins within the first few hours.

'Cutting down is already something.' For health, the benefit of cutting down alone is small: cardiovascular risk stays high even at a few cigarettes a day. Cutting down is only of interest as a step towards stopping.

'Just one does not count.' That is the sentence that precedes the great majority of returns to smoking. One cigarette after stopping reactivates the whole circuit.

'I will stop when I have less stress.' That moment never comes, and tobacco raises the baseline level of nervousness rather than lowering it.

6. Taking stock: measuring before acting

A week of observation

For seven days, you change nothing: you record. This record serves two purposes — knowing your real level of dependence, and identifying the cigarettes that really count, which are far fewer than people think.

What you record, for each cigarette

• The time.
• Where and with whom.
• What triggered it: waking, coffee, the car, a call, a break, boredom, an annoyance, the end of a meal, alcohol.
• The craving felt beforehand, from 0 to 10.
• The actual satisfaction afterwards, from 0 to 10.

The table

Time	Context	Trigger	Craving beforehand (0-10)	Actual satisfaction (0-10)
7.10 a.m.	Balcony, alone	Waking	9	8
10.30 a.m.	Outside the office	Break with colleagues	4	3
1.15 p.m.	Pavement	End of the meal	7	6
4 p.m.	Car	Journey, boredom	3	2
10.45 p.m.	Balcony	End of the day	6	5

What the record reveals

Almost always the same thing: out of twenty cigarettes, three or four are genuinely satisfying — the first of the morning, the one after the meal, the one at the end of the day — and all the others are automatic. This discovery is useful: it shows that most of what you smoke is not a pleasure, it is a habit.

The two figures that count

Note them down; they will be used by the doctor or the pharmacist to work out the dose of any treatment:

• How long between waking and the first cigarette?
• How many cigarettes a day, on average, over the week?

The cost

Work out the expense over a month, then over a year, then over ten years. Add the time spent buying, going outside, smoking. This figure is not a moral argument: it is information, and it often strikes home more than health warnings.

The list of associations

Write down the ten situations in which smoking is automatic for you. They are the ones you will prepare for in section 14, and they, rather than the lack of nicotine, are what will cause you trouble in the second month.

7. Finding your reasons

Yours, not other people's

The reasons that hold are not those of prevention campaigns or those of the people around you. They are yours, written in your own words, and preferably concrete. 'Cancer' is an abstract and distant reason. 'Being able to climb three flights without stopping', 'not smelling bad when I kiss my children', 'no longer organising my evenings around a packet' are reasons that work.

The four boxes

As with any decision of this kind, fill in all four, including those that speak in favour of tobacco: without them, the decision will not hold.

• What it brings me now: a break, pleasure, managing stress, belonging, ritual, a pause.
• What it costs me now: breath, money, smell, cough, dependence, shame, time, the way my children look at me.
• What I would gain by stopping: health, money, freedom, taste, pride, the example set.
• What I would lose by stopping: a ritual, breaks, a way of handling tension, shared moments.

The two questions

'If I carry on exactly like this for ten years, what does my life look like?' Then: 'And if I stop this month?'

The two scores

Note today, from 0 to 10, the importance you attach to stopping and the confidence you have in your ability to manage it. Then ask yourself, for each: 'why that number rather than a lower one?' and 'what would it take to gain a point?'. The answer to the second question is often your action plan.

If your confidence is very low, that is not an obstacle: it is an indication. It rises with a suitable treatment and with support, not with exhortations.

The card

Write your three main reasons on a card, one line each, and keep it in your pocket or as a screen background. You will need it on the third day, and then on the thirtieth.

What does not work as motivation

Shaming yourself, promising yourself great distant rewards, or stopping solely because someone demands it. Changes imposed from outside rarely hold beyond a few weeks.

8. Stopping cleanly or cutting down gradually?

What the direct comparison says

This is one of the rare points on which research gives a clear answer. The trial published by Nicola Lindson-Hawley and her colleagues in 2016 compared, in people who were equally motivated and equally supported, stopping abruptly on a set date with cutting down gradually over two weeks before stopping. Stopping cleanly gave better abstinence rates, in the short term and in the longer term.

Why

Several plausible reasons. Cutting down gradually keeps attention on the cigarette, turns each one into an increasingly precious reward, and prolongs the period of discomfort. Stopping cleanly, by contrast, concentrates the difficulty into a few days, with a clear landmark.

What that does not mean

It does not mean that cutting down is useless. It keeps two legitimate places.

• As a step taken on as such, when stopping completely seems out of reach: cutting down with a date to review is better than an objective abandoned.
• With a treatment, when the doctor proposes starting a treatment several days or weeks before the quit date, which is a recognised strategy.

But cutting down is not, in itself, a health objective: cardiovascular risk remains high even at low consumption.

How to choose your date

• Within two weeks. Far enough away to prepare, close enough not to let motivation fade.
• Not the day before a major deadline: an exam, a house move, starting a job, an operation.
• Not in the middle of a personal or professional crisis, if you can avoid it.
• A day of the week when your day is structured, rather than an empty Sunday.
• Written down, and told to two people.

Should you wait for 'the right moment'?

No. The right moment does not exist, and waiting for it is one of the most effective forms of indefinite postponement. A suitable moment is more than enough.

And if an opportunity arises?

Some people stop without preparation, following an event — a test result, a birth, a bout of flu that stopped them smoking for three days. These unplanned stops exist and sometimes succeed very well. If it happens to you, do not let the opportunity pass: simply add a treatment and support as quickly as possible.

9. Preparing for the day

The week before

• Write down your date and tell two or three people, asking them for one precise thing: 'call me on Thursday evening', 'do not smoke in front of me for the first two weeks'.
• Get your treatment — see section 10 — and know how to use it before the day.
• Make an appointment with a doctor, a pharmacist or a stop-smoking clinic, or sign up with a support line.
• Identify your ten automatic situations and write, for each, what you will do instead.
• Plan the first three days hour by hour, especially the evenings.

The day before

• Throw everything away: cigarettes, lighters, ashtrays, papers, filters, the reserve hidden in the glove compartment and the one in the kitchen drawer. Everything, without exception and without 'just in case'.
• Clean: wash the clothes that smell, air the house and the car, have the seats cleaned if you can. Smell is a powerful trigger.
• Clear the smoking places: change the layout of the balcony, take away the chair where you used to smoke.
• Prepare a kit: sugar-free chewing gum, carrot sticks, water, something to fiddle with, an elastic band round your wrist, your card of reasons.

The day itself

• Change your morning routines. Have breakfast somewhere else, change your drink, go out earlier, take a different route.
• Drink plenty of water, eat at regular times.
• Move: a twenty-minute walk, even split up.
• Fill the risky moments: a call arranged for break time, an errand to run after lunch.
• Announce it to the people around you that day.
• Do not drink alcohol. It is the most useful precaution of the first weeks.

What helps from the very first day

Mark each tobacco-free day on a visible calendar, and put aside, physically or in a separate account, the money you are not spending. These two tiny acts give a visible return for an effort that otherwise does not show.

Telling people or not

Tell a few chosen people: it is a factor in success. You are not obliged to announce it to everyone, nor to justify yourself. If you fear how people will look at you if you start again, simply say: 'I am giving it a try, we will see.'

10. Treatments: nicotine replacement and medicines

This section explains what exists and what it does. It recommends no product, no dose and no duration: that is a matter for the doctor or the pharmacist.

Nicotine replacement products

They provide nicotine without combustion, and therefore without the toxic substances in smoke. Their objective is simple: to remove most of the physical craving while you undo the habits.

They come in two broad forms, and it is the combination of them that gives the best results:

• a continuous-release form, which covers the background need through the day;
• a fast-acting form, taken at the moment of a craving, which works within minutes.

The three most frequent mistakes

They explain most of the failures blamed on nicotine replacement.

1. Too low a dose. The dosage is chosen according to your consumption and the time between waking and the first cigarette. An under-dosed dependent smoker stays in withdrawal and concludes that 'it does not work'.
2. Too short a duration. They are used for several weeks, generally several months, with a gradual reduction decided with the professional — not ten days.
3. No fast-acting form combined with it. Occasional cravings need a rapid response; without one, the temptation to have a cigarette again is far stronger.

If you still feel withdrawal, the right reaction is not to grit your teeth: it is to go back to the professional to adjust the dose.

The other treatments

There are also prescription medicines whose effectiveness in helping people stop is established, working through mechanisms other than providing nicotine. They have contraindications, unwanted effects and precautions for use, and some are started before the quit date. This guide does not name them and recommends none: this is a conversation to have with your doctor, telling them about your history, your current treatments and your past attempts.

How to raise the subject

'I want to stop on the 12th. What help do you advise, and at what dose?'

'I have already tried patches and it did not work: was the dose right?'

'I have my first cigarette within five minutes of waking.'

What has not proved itself

Many methods are offered and sold. To date, the solid evidence concerns nicotine replacement products, certain prescription medicines, behavioural support, and nicotine-containing electronic cigarettes. Other approaches have been studied without their effectiveness being convincingly established. That does not mean that they suit nobody; it means that they must not be substituted for what works.

During pregnancy

Treatment is decided with the professional looking after the pregnancy, never alone. What is certain is that continuing to smoke is not the safer option, and that behavioural support is effective in this situation.

11. Support: clinics, helplines and apps

Why it changes everything

Because the data are unambiguous: support increases the chances of stopping, the effect grows with the number and the length of contacts, and combining a treatment with support does markedly better than either alone. Stopping alone, with nothing, is the least effective strategy of all.

What exists

• Your general practitioner, who can prescribe, set the dose, follow you up, and see you again.
• The pharmacist, who advises on forms and dosages and who is very accessible.
• Stop-smoking clinics, in hospitals or in the community, specialised and often inexpensive.
• Stop-smoking helplines, free in many countries. The data show that support in which the service calls you back is particularly effective.
• Apps and text-message programmes, whose effectiveness has been shown for certain formats.
• Groups, in person or online.
• Psychologists trained in cognitive behavioural approaches, particularly if anxiety or mood are involved.

What support brings in concrete terms

A plan suited to your situation, a correct dosage, someone to be accountable to without being judged, answers to difficulties as they arise, and above all a framework that holds beyond the first two weeks — that is, at the moment when the initial motivation drops.

How many contacts

The more, the better. In practice, one appointment before the quit date, one in the first week, one after a month, then at three months, is a reasonable minimum.

If you prefer to do it alone

That is possible, and many people manage it. Add at least two things: a correctly dosed treatment, and some form of follow-up, however minimal — a telephone line, an app, a friend who calls you every week.

12. The first days

What awaits you

The first three days are the most uncomfortable physically. Expect irritability, frequent cravings, difficulty concentrating, disturbed sleep and unusual hunger. It is expected, it is normal, and it then decreases quickly.

The rules for the first seventy-two hours

• No cigarette, under any pretext. Not a drag, not a puff of someone else's. It is the most important rule in this whole guide.
• No alcohol. It releases the brakes and triggers the vast majority of early returns to smoking.
• Treatment, at the right dose, and a fast-acting form to hand.
• Water, plenty of it, and meals at regular times.
• Move every day, even twenty minutes of walking.
• Fill the evenings.
• Sleep as soon as you can; if sleep is poor, a fixed getting-up time all the same.

Change the gestures, not only the substance

The morning coffee, the journey, the break, the phone: change hand, cup, route, place for your break. A gesture taken out of its usual setting is far less of a trigger.

The break companion

If your breaks were social, do not abolish them: go with your colleagues without smoking, or replace them with another ritual — a tea, a walk round the building, a call. Losing the cigarette and losing the breaks at the same time makes stopping needlessly hard.

What you can say to those around you

'I am stopping from Thursday. I am going to be unbearable for a week or two, it is not aimed at you. What helps me: not smoking in front of me, not asking me every day whether I am holding out, and suggesting we go out for a walk.'

The third day

Statistically it is the hardest, and it is useful to know that in advance. It is not a sign that you will not manage it: it is the peak, and after a peak, things come down.

13. Cravings: getting through a few minutes

The fact that changes everything

A craving to smoke is not a continuous state. It rises, peaks and comes down, most often in less than five minutes. It does not ask to be fought for hours: it asks to be ridden out for a few minutes. The whole strategy follows from this fact.

The four-step method

1. Name it. 'This is a craving. It lasts a few minutes.'
2. Delay. Decide to do nothing for five minutes, watch in hand. Almost always, it will have passed.
3. Do something else, something physical. Drink a large glass of water, go outside, climb a flight of stairs, wash your hands, breathe slowly and deeply about ten times, chew something, use your fast-acting form of replacement.
4. Record it. Time, trigger, intensity, and what worked. After a week, you will have your own manual.

The four actions to keep in mind

A simple memory aid, used by many practitioners: delay, breathe, drink, move. None of these actions is spectacular; their value is that they fill exactly the time needed.

The thoughts that keep coming back, and the answers

• 'Just one.' One cigarette after stopping reactivates the whole circuit. It is not a test, it is a restart.
• 'I am too stressed today.' Tobacco raises the background level of nervousness; it does not lower it. The calm you feel is the end of a craving.
• 'I have managed three weeks, I can handle it.' This is the thought that precedes most of the returns to smoking in the second and third months.
• 'I am going to put on weight anyway.' The average weight gain is a few kilos, it can be limited, and the health benefit bears no comparison.
• 'I am missing out on a pleasure.' Read your table from section 6 again: most of your cigarettes were scored 2 or 3 out of 10.

Observing rather than fighting

An effective variant consists of describing the craving as an external phenomenon: where it sits in the body, how it changes, when it weakens. Observing it without responding to it weakens it, and provides concrete proof that you can choose not to obey.

Late cravings

They arise months after stopping, suddenly, prompted by a smell, a place, an emotion. They are normal, they are brief, and they do not mean that the dependence is coming back. Respond to them as you did to the first ones.

14. Trigger situations

Identifying them

Go back to the list drawn up in section 6. For most smokers, the triggers are the same: waking, coffee, the car, the end of a meal, the break at work, the phone, waiting, boredom, annoyance, the end of the day, alcohol, other smokers.

The rule: a written plan for each situation

For each of your five main triggers, write what you will do instead. Not 'I will resist', but a precise action.

Situation	What I do instead
Morning coffee	I change cup and drink it standing up, in another room
End of lunch	I get up and walk outside for five minutes
Car	I empty the ashtray, prepare a playlist, keep chewing gum
Break at work	I go with them without smoking, or I climb a flight of stairs
End of the day	I have a shower when I get in, before sitting down

Avoiding, at the start

During the first weeks, it is perfectly legitimate to skip certain evenings, not to sit on the smoking side of a terrace, not to go along to cigarette breaks. This is not running away: it is strategy, while you install other automatic habits. You will go back later, better equipped.

Other smokers at home

This is one of the most underestimated difficulties. If someone smokes in your home, the rate of going back to smoking increases markedly. A few precise requests help a great deal: not smoking indoors, not leaving a packet in sight, not offering you one, not smoking in front of you during the first month. And suggesting that you stop together, where that is possible, is what works best.

Emotions

Anger, sadness and boredom are three major triggers, because the cigarette served to mark a pause in the emotion. Replace the function, not only the gesture: go out, call someone, write two lines, take ten slow breaths.

Periods of life

A house move, a separation, a bereavement, a change of job: these periods increase the risk of going back to smoking. If one of them occurs, reinforce the arrangements — get back in touch with the person supporting you, increase the treatment if the professional thinks it useful — instead of relying on willpower alone.

15. Alcohol, nights out and relapse

The leading cause of going back to smoking

If only one thing were to be retained from this guide about relapse, it would be this: alcohol is by far the most frequent trigger of a return to smoking, particularly in the first three months. It releases the brakes, it alters judgement, it is almost always accompanied by smokers, and it turns 'I do not smoke any more' into 'just one, tonight'.

What to do about the first weeks

The recommendation is simple and effective: no alcohol for the first two to four weeks. If that seems excessive to you, compare it with the cost of going back to smoking completely.

After that, prepare each evening out

• Decide before you leave what you will drink and what time you will go home.
• Tell one person who will be there that you have stopped.
• Keep a fast-acting form of replacement in your pocket.
• Do not go outside for a cigarette 'just to keep someone company'.
• Have a way of getting home that does not depend on anyone else.
• Eat beforehand.

If your drinking is itself an issue

Many smokers discover, on stopping, that the two were linked. Dealing with both at the same time is difficult; dealing with them one after the other is often more realistic. Our programme Drinking less, or stopping offers a complete method — with one important safety point: if drinking is daily and heavy, stopping alcohol abruptly can be dangerous and requires prior medical advice.

Coffee

It triggers fewer returns to smoking but a great many cravings, because the association is very strong. Two strategies: move it — drink it standing up, somewhere else, in a different cup — or reduce it temporarily. Note also: stopping smoking changes the way the body eliminates caffeine, and many people feel more on edge for the same amount. Cutting down on coffee after stopping is often a good idea.

16. Weight, and how to limit it

What actually happens

Two mechanisms combine: nicotine slightly increased energy expenditure and reduced appetite, and the return of taste and smell makes food more attractive. To that is added the replacement of the gesture by snacking.

The average weight gain is a few kilos in the first year, with very wide individual differences: some people put on nothing, others put on more. Most of it happens in the first three months.

The comparison that puts things in perspective

The health benefit of stopping smoking very greatly exceeds the risk associated with a few kilos. In other words: do not give up on stopping for fear of your weight, and do not start smoking again in order to lose weight.

What limits weight gain

• Do not diet at the same time. Two simultaneous deprivations almost always fail. Deal with weight afterwards, when stopping is consolidated.
• Eat at regular times, without skipping meals: disordered hunger is the leading cause of snacking.
• Prepare non-calorie substitutes for the gesture: sugar-free chewing gum, vegetable sticks, sparkling water, fruit.
• Drink water regularly: the feeling of craving is often confused with thirst.
• Move. Physical activity limits weight gain, reduces cravings in the moment and improves mood. The reviews devoted to exercise in stopping smoking show that it helps with cravings and withdrawal, even in short sessions.
• Be wary of alcohol, which is high in calories and disinhibiting.
• Weigh yourself rarely, once a week at most, so as not to turn every fluctuation into an argument for starting again.

Sugar

The craving for sweet things genuinely increases in the first weeks. Rather than fighting it head-on, have alternatives within reach and accept a slight temporary increase: it is a reasonable compromise compared with starting to smoke again.

After three months

This is the time to deal with weight, if necessary, when stopping is solid. Taking up regular physical activity is the best way in: it serves both objectives at once.

17. Mood, stress and sleep

The false idea to correct

Many smokers are convinced that the cigarette manages their stress and that stopping will make them anxious or depressed. The meta-analysis published by Gemma Taylor and her colleagues in 2014 concludes the opposite: after stopping, anxiety, depression and stress decrease, and quality of life improves — including in people with psychiatric disorders. The size of this improvement is comparable, in some analyses, to that of an antidepressant treatment.

The explanation is consistent with section 2: what the smoker calls 'stress' is in large part the craving between two cigarettes, which disappears once withdrawal is over.

The first weeks remain difficult

That does not prevent the irritability, nervousness and low mood of the first two to four weeks, which are real. You have to get through them knowing that they are temporary, and distinguish them from what follows.

What should lead you to seek help

A deep sadness that settles in and persists beyond a few weeks, a generalised loss of interest, dark thoughts: talk to your doctor, without waiting and without starting to smoke again to relieve it. If you are being treated for a psychiatric disorder, mention your plan to stop before you begin: some treatments have to be monitored, because stopping smoking changes the way the body metabolises certain medicines.

Sleep

It is often disturbed in the first weeks: taking longer to fall asleep, waking, more vivid dreams. It improves. The useful rules are the usual ones: fixed getting-up time, no long naps, light in the morning, physical activity during the day, less caffeine. Our programme Getting your sleep back: the Psychotip® programme sets out the method in detail if the problem persists.

Handling tension differently

If the cigarette was your only strategy in the face of tension, you need to find replacements for it before you need them: walking, breathing slowly, calling someone, writing, taking a real break with no screen. Our programmes Emotion regulation: the toolkit and Mindfulness: the eight-week programme offer structured tools.

18. The electronic cigarette

This section gives the state of knowledge as it is, with no campaigning in either direction.

What is established

Electronic cigarettes containing nicotine help people to stop smoking. The Cochrane review devoted to this question concludes that they increase the chances of stopping compared with nicotine replacement products, and the trial published by Peter Hajek and his colleagues in 2019, which compared them directly with replacement products with the same support in both groups, pointed the same way.

What is probable

For a smoker, switching entirely to the electronic cigarette very greatly reduces exposure to the toxic substances of combustion. That is not an opinion: it is the direct consequence of the fact that there is no combustion.

What is not established

The long-term effects, over several decades, are not known, for the simple reason that these products are recent. It would be dishonest to pretend otherwise. 'Far less harmful than smoked tobacco' is not the same thing as 'without risk'.

The three rules that follow from all this

1. If you do not smoke, do not start. The product is not harmless, it creates dependence, and there is no reason to take it up if you do not smoke.
2. If you smoke and you switch to vaping, switch completely. Mixed use — a few cigarettes plus vaping — retains most of the risk and does not amount to stopping.
3. Aim for the exit. The objective remains to free yourself from nicotine as well, in time, with a gradual reduction of the dosages.

The precautions

Use products that comply with the regulations in your country, bought through identified channels. Never add substances that are not intended to be inhaled. Keep the liquids out of reach of children: poisoning by swallowing is a real risk. And report any new respiratory symptom to your doctor.

During pregnancy

The question arises differently and the data are more limited: it is discussed with the professional looking after the pregnancy, never alone.

What to remember if you are hesitating

If nicotine replacement and support have failed several times, the electronic cigarette is an option whose effectiveness is now documented. It is best used with support, like any other form of help, and not instead of it.

19. Particular situations

Pregnancy

Stopping smoking during pregnancy is one of the most beneficial interventions there is, for the mother and for the child: smoking is associated with an increased risk of complications, of growth restriction and of prematurity. Structured psychosocial interventions have shown their effectiveness in this situation, as the Cochrane review conducted by Catherine Chamberlain and her colleagues concludes. Any treatment is decided with the professional looking after the pregnancy. And if complete stopping is not achieved immediately, every tobacco-free week counts.

After the birth, starting again is frequent: anticipate it, and ask for follow-up that continues beyond the delivery.

The people around you and children

Passive smoking is harmful, particularly for children — respiratory infections, ear infections, asthma. If you are not ready to stop, three immediate measures greatly reduce exposure: never smoke indoors, never in the car, and never in the presence of a child. Residues deposited on clothes and surfaces count too.

Young adults

Dependence becomes established quickly and early. Two messages: the earlier you stop, the more complete the benefit, and the products presented as alternatives — flavoured vaping, heated tobacco, nicotine pouches — also create dependence.

Other forms of tobacco

Roll-ups, the water pipe, cigars, heated tobacco, smokeless tobacco: none is a safe option. The water pipe in particular exposes you to large quantities of smoke during a session, contrary to a widespread idea.

Where illness is already present

After a heart attack, a stroke, a cancer diagnosis, or in the case of chronic respiratory disease, diabetes or peripheral arterial disease, stopping remains the most effective measure available, and its benefit is rapid. It is never 'too late', and it is exactly the moment when professional help is most accessible.

Before an operation

Stopping several weeks before surgery improves wound healing and reduces complications. Hospital teams often offer support on that occasion: it is a good opportunity to take.

During a hospital stay

A stay in hospital amounts to a forced stop that can become a lasting one, provided it is supported — treatment during the stay, and above all organised follow-up after discharge, which is the critical moment.

When other substance use is involved

Alcohol, cannabis, other substances: dealing with everything at the same time is rarely realistic. Establish an order with a professional, and do not give up on stopping smoking on the pretext that you should 'sort out the rest first'.

20. When it does not shift

First, check the dose

This is the number one cause of failure on treatment. If you still feel marked withdrawal — irritability, permanent cravings, difficulty concentrating — while on replacement, the dose is probably insufficient or the fast-acting form is missing. Go back to the professional to adjust it, instead of concluding that treatments do not work on you.

Then, check the duration

A treatment stopped after ten days has not been used properly. The usual durations are counted in weeks and months, with a gradual reduction decided with the professional.

Then, look at what triggers it

Go back to your record. A return to smoking almost always has an identifiable cause: alcohol, an evening out, a smoker at home, a period of tension, the boredom of a Sunday, an untreated emotion. You do not correct 'a lack of willpower'; you correct a precise situation.

The three questions

• Am I trying alone when it does not work alone? Combining treatment and support is what multiplies the chances.
• Is there something else underneath? Anxiety, depression, alcohol use, long-standing insomnia. Treating what is underneath sometimes changes the picture completely.
• Does my environment make stopping impossible? A partner who smokes indoors, a job where every break is a cigarette break. That is negotiated, not endured.

Change the strategy, not the objective

If three identical attempts have failed, do not try again identically. Change something: add support, increase the dose, change treatment in agreement with the doctor, try another form of help, or deal with another difficulty first.

What is not a good strategy

Promising yourself to stop 'when things are calmer', waiting for a moment of revelation, or relying on fear alone. None of these three approaches has shown any effectiveness, and the first two are polite ways of postponing indefinitely.

21. The slip, the relapse and the new attempt

A slip is not a relapse

A drag or a cigarette after stopping is a slip. Returning to your previous consumption is a relapse. Between the two there are a few hours and above all a series of thoughts: 'it is all over', 'I am incapable of it', 'I may as well buy another packet'. That reasoning does more damage than the cigarette itself.

What to do in the hour that follows

• Do not carry on. One cigarette, not an evening.
• Throw away what is left, immediately.
• Carry on with the treatment normally, without skipping it 'since I have smoked'.
• Start again the next morning as planned, with no transition day.
• Tell someone the same day.
• Record the exact situation: time, place, people, emotion, alcohol or not.

What a slip teaches

It points to a precise flaw in the plan. Almost always one of these: a drinking evening, a smoker at home, an unanticipated tension, an insufficient treatment dose, or excessive confidence after a few weeks. That flaw can be repaired.

If a relapse has become established

It is neither a catastrophe nor a verdict. Do three things: set a new date within two weeks, write down what you will do differently this time, and add one form of help that you did not have last time.

What the data say about multiple attempts

Most people who have stopped for good made several attempts before managing it. Each attempt increases the chances of the next, because it provides information about what makes you relapse. Counting your failures is pointless; counting what they have taught you is not.

The third month

It is a particular moment: physical withdrawal is over, vigilance drops, and confidence rises. Many returns to smoking take place then, often on a festive occasion. Keep some arrangement active — follow-up, a notebook, a contact — beyond the point when you think you no longer need it.

22. Those close to you

What really helps

Smokers who stop almost always mention the same kinds of support: that people do not smoke in front of them, that they are not asked every day whether they are holding out, that their mood is not commented on, and that they are offered concrete activities rather than encouragement.

What does not help

Keeping watch, counting the days out loud, pointing out that they are being unpleasant, recalling past failures, or saying 'I knew you would never manage it' after a slip. That last point is the most destructive: it turns a repairable incident into giving up.

What you can ask for

Be precise, and ask for few things at a time.

• 'Do not smoke indoors or in the car.'
• 'Do not offer me a cigarette, even as a joke.'
• 'Do not ask me every evening whether I have held out.'
• 'Suggest we go for a walk after dinner.'
• 'If I give in, tell me once, calmly, and do not bring it up again.'

If your partner smokes too

This is one of the best-identified relapse factors. The best option is to stop together, with the same date and the same support. If that is not possible, negotiate clear rules: not indoors, not in front of you, no packet in sight.

For children

Smoking in front of children exposes them and increases the probability that they will smoke themselves. Conversely, a parent who stops is a powerful example, and it is often the most motivating reason when all the others have failed.

If you are the one close to the smoker

Do not act as the police. Offer to go with them to an appointment, remove the tobacco from the house, suggest outings, and say that you are there in case of a slip rather than announcing consequences. Concrete support works; pressure does not.

23. When to seek help, and what to ask for

Without waiting

• A cough that lasts more than three weeks, persistent hoarseness, blood-stained sputum.
• Breathlessness that is new or getting worse.
• Chest pain, pain in the calves when walking.
• Any cardiac or neurological warning sign: call the emergency services.

To prepare for stopping

Make an appointment before your date, not after. A professional can assess your dependence, offer a suitable treatment at the right dose, arrange follow-up, and anticipate interactions with your current treatments.

Who to turn to

Your general practitioner, first of all.

Your pharmacist, very accessible, for the forms and dosages of replacement products.

A stop-smoking clinic, when stopping is difficult or several attempts have failed.

A stop-smoking helpline, free in many countries, with scheduled call-backs.

A psychologist trained in cognitive behavioural approaches, if anxiety, mood or alcohol are involved.

What to bring

Your record from section 6: number of cigarettes a day, the time between waking and the first one, past attempts and what made them fail, current treatments. Ten lines are enough.

Useful ways of putting it

'I want to stop on the 12th. What help do you advise, and at what dose?'

'I have already tried replacement products and I stayed in withdrawal: was the dose sufficient?'

'I am on this treatment; does stopping smoking change anything?'

'I started again after two months. What do we do differently this time?'

What you have the right to ask for

A written plan, a date to be seen again, what to do in the case of a slip, and a contact between appointments. A trained professional will offer you all of that spontaneously.

24. Eight weeks, step by step

Week 1 — Observe

Change nothing. Record every cigarette: time, context, trigger, craving beforehand, actual satisfaction. At the end of the week, count them, work out the annual cost, and note your two key figures.

Week 2 — Decide and equip yourself

Fill in the four boxes and write your three reasons on a card. Set your quit date, within two weeks. Make an appointment with a doctor or a pharmacist to choose a treatment and its dose. Tell two people.

Week 3 — Prepare and stop

Write your plan for your five risky situations. The day before: throw everything away, clean everything, prepare the kit. On the day: change your morning routines, move, fill the risky moments, no alcohol. Then apply the seventy-two-hour rule.

Week 4 — Getting through

Use the craving method every time, and record the cravings. Check that your treatment dose is sufficient: if you are in withdrawal, call the professional. Walk twenty minutes a day. Still no alcohol. Mark each day on the calendar.

Week 5 — Social situations

Prepare a first evening out: arrival and leaving times, drink, refusal sentence, fast-acting replacement in your pocket, one person who knows. Make it an experiment and note what happened.

Week 6 — The body

Set up regular physical activity, three times a week. Settle meals at fixed times. Deal with sleep if the nights are bad. Do not start any diet.

Week 7 — Consolidate

Take stock with your professional: dose, duration, possible reduction. Count the money saved and do something visible with it. List the benefits you have seen — they will be useful to you in the third month.

Week 8 — Prepare for what comes next

Write your anti-relapse plan: the three situations that would put you in danger, what you will do, who you will call, and exactly what you will do in the case of a slip. Arrange a follow-up appointment at three months. Keep a fast-acting replacement within reach, even if you think you no longer need it.

If you have started again

Go back to week 2: a new date, what you are changing, one more form of help. This is not starting from zero — you now know what makes you relapse.

25. Frequently asked questions

How long does withdrawal last? The physical features begin within the first hours, peak over the first three days, and ease markedly over two to four weeks. What lasts longer are the cravings linked to situations — coffee, alcohol, an emotion — and they last only a few minutes each time.

Is it better to stop all at once or to cut down gradually? All at once, on a set date. The trial that directly compared the two strategies, in people who were equally supported, found better results with stopping cleanly. Cutting down keeps its place as a step taken on as such when stopping seems out of reach, but it is not the best route.

Do patches and gum really work? Yes, it is one of the best-established findings. When they fail, it is most often because the dose was too low, the duration too short, or because no fast-acting form was combined with the continuous one. If you are still in withdrawal, the dose needs reviewing.

Am I going to put on weight? On average a few kilos in the first year, with large differences from one person to another. It can be limited: do not diet at the same time, eat at regular times, prepare non-calorie substitutes for the gesture, and move. The health benefit of stopping very greatly exceeds the risk linked to those kilos.

Will I become anxious or depressed if I stop? The first weeks are irritable, that is true. But in the medium term the data show the opposite: anxiety, depression and stress decrease after stopping, including in people being treated for a psychiatric disorder. What is taken for stress managed by the cigarette is in large part the craving between two cigarettes.

The electronic cigarette: good idea or bad idea? For a smoker who wants to stop, it is a form of help whose effectiveness is now documented, at least comparable to that of replacement products. Three rules: do not start if you do not smoke, switch completely to vaping rather than alternating, and aim in time to come off nicotine. The very long-term effects are not known.

Are a few cigarettes a day acceptable? For health, no: cardiovascular risk stays high even at low consumption, and there is no risk-free threshold. How long you have smoked in fact counts for more than the daily number. Smoking little is better than smoking a lot, and markedly worse than stopping.

I am 60 and I have smoked for forty years. Is there still any point? Yes. Large follow-up studies show a benefit at any age, with a rapid fall in cardiovascular risk and a gain in life expectancy that is still measurable after sixty. The benefits for breathing, cough and energy appear within a few weeks.

Does one single cigarette count? Yes. One cigarette after stopping reactivates the whole circuit and precedes most complete returns to smoking. If it happens, do not finish the packet, throw away what is left, keep up your treatment and start again the very next morning.

Can I drink alcohol while I am stopping? Avoid it completely for the first two to four weeks: it is by far the leading trigger of returns to smoking. After that, prepare each evening out — leaving time, drink, fast-acting replacement in your pocket, one person who knows.

My partner smokes. Can I still manage it? Yes, but it is harder, and it is negotiated rather than endured. Ask for precise rules: not indoors, not in the car, not in front of you for the first month, no packet in sight. And suggest stopping together: that is what gives the best results.

I have already failed four times. What is the point of trying again? Because that is exactly the usual course of events: most people who have stopped for good made several attempts. Each attempt provides information about what makes you relapse. The only thing to change is not to try again identically: add one form of help that you did not have before.

26. Key points

• Stopping is not a matter of willpower: it is dependence on a substance, doubled by thousands of habits, and it is treated with tools.
• The cigarette does not relax you: it relieves a craving it created itself. The background level of nervousness falls after stopping.
• A clean quit date gives better results than cutting down gradually.
• Nicotine replacement works; combine a continuous form and a fast-acting form, at the right dose and for long enough.
• Behavioural support increases the chances, and combining it with a treatment does markedly better than either alone.
• A craving lasts a few minutes: delay, breathe, drink, move.
• Alcohol is the leading trigger of a return to smoking: avoid it in the first weeks, then prepare each evening out.
• Weight gain averages a few kilos and it can be limited; do not diet at the same time.
• Anxiety and mood improve after stopping, including in people being treated for a psychiatric disorder.
• The nicotine-containing electronic cigarette helps people stop; it is not harmless, you do not start if you do not smoke, and mixed use is not stopping.
• It is never too late: the benefit exists at any age and begins within the first few hours.
• Starting again is not a final failure: set a new date, change one thing, and add one form of help you did not have.

27. Sources and foundations

This guide is an original text written for Psychotip. It draws on published work, without reproducing the material of any proprietary programme. It neither names nor recommends any medicine.

• R. Doll and R. Peto (1954, 2004), British doctors study: tobacco-related mortality and the benefits of stopping over fifty years of observation.
• P. Jha et al. (2013) and K. Pirie et al. (2013), risks of smoking in the twenty-first century and gain in life expectancy according to age at stopping.
• United States Surgeon General (1988), nicotine and dependence; (1990), benefits of stopping; (2014 and 2020), health consequences and help with stopping.
• N. Benowitz (2010), pharmacology of nicotine and the mechanisms of dependence.
• J. Hughes (2007), features of tobacco withdrawal and their course over time.
• J. Hartmann-Boyce et al. (2018, 2023), Cochrane reviews of nicotine replacement products and their combinations.
• L. Stead et al. (2012, 2016), Cochrane reviews of combining drug treatment with behavioural support; T. Lancaster and L. Stead, individual behavioural counselling.
• L. Stead et al. (2013), Cochrane review of stop-smoking telephone helplines; R. Whittaker et al. (2019), mobile phone interventions.
• N. Lindson-Hawley et al. (2016), trial comparing abrupt stopping with gradual reduction.
• P. Hajek et al. (2019), trial comparing the electronic cigarette with nicotine replacement products; J. Hartmann-Boyce et al. (2022), Cochrane review of electronic cigarettes for stopping smoking.
• H. Aubin et al. (2012), weight gain after stopping smoking.
• G. Taylor et al. (2014), meta-analysis: stopping smoking and mental health.
• C. Chamberlain et al. (2017), Cochrane review of psychosocial interventions for stopping smoking during pregnancy.
• M. Ussher et al. (2019), Cochrane review of physical exercise as an aid to stopping.
• M. Fiore et al. (2008), American clinical guidelines on the treatment of tobacco dependence.
• World Health Organization, reports on the global tobacco epidemic.

Content last reviewed: 2026.