Cochrane LibrarySmoking Cessation

Does it matter how you stop smoking?

e-cigThe typical way to stop smoking is to quit abruptly, but some smokers opt to reduce smoking before quitting as an alternative approach to cessation.

Researchers from the UK and Vermont reviewed the evidence in this Cochrane review.

First, the details.

  • 10 studies of 3760 participants were included in the meta-analysis.
    • 3 studies used pharmacotherapy as part of the treatment.
    • 5 studies included behavioral support.
    • 4 included self-help therapy.
    • 1 study included behavioral support and self-help therapy.
  • Comparisons were made between the success of reducing smoking to quit and abrupt quitting.
  • Adverse events were also compared.

And, the results.

  • Neither reduction nor abrupt quitting had superior abstinence rates when all the results from studies were combined.
  • Pharmacotherapy, behavioral support, or self-help therapy had no effect on the success of smoking cessation.
  • No conclusions about the difference in adverse events between treatments were possible.

The bottom line?

The authors concluded, “Reducing cigarettes smoked before quit day and quitting abruptly, with no prior reduction, produced comparable quit rates, therefore patients can be given the choice to quit in either of these ways.”

Successful smoking cessation is one of the most difficult things to accomplish. Under the best circumstances the rate of quitting successfully is less than 20% after 6 months — 17% after 12 months.

About 15 years ago I worked on a smoking cessation product that combined B vitamins with a self-help workbook. Back then we joked that you had to quit 5 times to quit once. Now, even with the addition of nicotine replacement therapy and other prescription drugs, the success rate hasn’t changed much.

Based on the 20% success rate, be prepared to quite 5 times in order to successfully quite once.

7/24/13 13:23 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.