Smoking Cessation: An Overview and Treatment options

Smoking Cessation: Information and Available Treatment Options

Table of Contents

Smoking cessation has become a major goal for individuals and communities across the globe who find themselves contending with nicotine addiction. The short and long-term benefits of smoking cessation are numerous, and run the gamut of protecting against physical illness, greater mental health, and improved physical appearance. As with all matters concerning one’s health, gaining a better understanding of this issue can help those facing smoking addiction achieve a more in-depth look at the challenges this issue can entail, the dynamics that have caused this form of addiction to become a global concern, and the smoking cessation treatment options available to them. Read on to discover these as well as other aspects of this topic.


Nicotine Addiction: A Definition

Cigarette Smoking

Smoking dependency is defined as the compulsion to inhale nicotine, which is a stimulant found at a high percentage in products made from the tobacco plant, such as cigarettes and cigars.

By inhaling tobacco smoke, the nicotine within it binds to the brain’s nicotinic cholinergic receptors, causing the release of acetylcholine. A mood-elevating neurotransmitter, acetylcholine induces a pleasurable sensation upon its release. Over time, repeated smoking creates a physical dependency, where instead of elation, the now addicted neural system begins to demand larger and larger amounts of nicotine just to maintain the same level of relative calm. When nicotine is not readily available, a feeling of agitation settles in, as the smoker experiences disquieting anxiety until that dissipates after their next smoke.

Nicotine addiction also appears to have a genetic side to it. As a result, certain individuals are more likely to develop it due to their genetic makeup.

Many studies have additionally associated nicotine addiction with social factors, with group acceptance and social status playing a pivotal role in developing a smoking habit. Nearly nine out of ten smokers start smoking while still in adolescence, many of them while in the company of their peers. As such, their first associations with smoking are linked to a desire to fit in as part of a social group.

Recent decades have also shown larger rates of smokers belonging to a lower socioeconomic status, within high-income countries. A proposed theory seeking to explain this refers to the intimidating aura that smoking is thought to create: thus, in an apparent effort to gain greater deterrence, a larger number of individuals belonging to this sector adopt the habit of smoking.

Man Smoking

Taken together, these factors work to preserve and worsen smokers’ nicotine addiction. The resulting physical and psychological health issues can be quite detrimental.


Smoking Addiction Statistics and Health Risks

13.7% of the adult population are considered smokers, with men slightly more likely to smoke than women (15.6% vs. 12.0%, respectively). 45 million people in the US are smokers.

These staggering statistics are due to the highly addictive nature of tobacco, which causes about one-third of all individuals who have ever smoked to become addicted.

Adding to this, only 7% of those who attempt quitting manage to do so successfully. This is mainly due to the difficult withdrawal process, whose more common side effects include anxiety symptoms, irritable mood, an increase in appetite accompanied by weight gain and insomnia. Many of those who attempt to quit cite these and other side effects as too hard to stave off, admitting that while they were able to avoid smoking for a certain period of time, eventually they found themselves pushing aside what they knew about the health hazards of smoking to once again become regular cigarette smokers.

Due to its highly addictive nature, the difficult withdrawal process and its detrimental effects on smokers’ health, some 8 million deaths a year are attributed to smoking-related causes. Tobacco addiction has already been shown to play a decisive role in the development of cancer, diabetes, cardiovascular diseases, lung disorders, and other life-threatening health issues.

In developed countries, 85% of cancer deaths among men have been associated with smoking. An estimated 40–45% of all cancers, in addition to 90–95% of all lung cancers have some correlation with smoking. Tobacco smoking has also been associated with an increased likelihood of oral cancer, which accounts for more than one-third of all cancer cases. As a result of its detrimental effects on their populations, many governments have declared smoking addiction to be a national emergency, with programs aiming to educate children, teenagers, and adults of the health risks that tobacco use brings with it.


The History of Smoking Addiction

Tobacco was first discovered in the Americas, where it has been cultivated for some 8000 years. Around 2000 years ago, chewing and smoking tobacco became part of cultural and religious ceremonies.

Christopher Columbus is considered the first European to discover tobacco. In 1531, the plant was first cultivated on European soil, and by 1600, it had already spread across the continent, where it had begun to be used as a form of currency. By the 1700s, tobacco cultivation, trade, and use had grown so widespread as to have developed into its own, formidable industry.

The health hazards of tobacco consumption were first brought to public attention in 1602, when an anonymous essay focused on the effects that soot and tobacco exposure had on the health of English chimney sweepers was published. In 1795, pipe-smoking was linked to lip cancer, and shortly thereafter, another article highlighted the dangers that tobacco use has when regularly used.

Smoking began being linked to the development of lung cancer during the 1920s. Such reports were initially rejected by many news editors, who were reluctant to have these findings cut into the profits of the tobacco companies who bought ad space in their newspapers. Despite these conflicting motivations, by the 1960s it was made clear that tobacco smoking was at the root of a number of serious health conditions.

Mass cigarette production, via cigarette machines, was first developed in the second half of the 1800s. The original cigarette machines made about 200 cigarettes per minute; contemporary machines make about 9000 per minute. The mass production of cigarettes in the 1800s coincided with an advertising boom that together made cigarettes more widely promoted, desired, and available than ever before.

Traditional, western cigarette markets also experienced major changes during the 20th century. First, during the mid-20th century, a surge in cigarette advertisements brought tobacco to wider swaths of the general population. As the industry’s profits grew, so did its ability to sway politics and legislation, making it easier to sell under lax regulation. Cigarettes were also provided to allied soldiers during both world wars as a means to boost their morale. All these factors worked in tandem to make cigarette smoking more popular in the traditional western market.

However, as more and more research was conducted on the harmful effects of smoking, tobacco use became stigmatized among the west, and stricter rules were passed and enforced to mitigate the damage caused by both active and passive smoking. This change in attitude was also due to the first successful lawsuits that were brought against the tobacco industry during the late 20th Century.

Focusing instead on developing countries, the tobacco industry turned (some) of its attention away from the shrinking western market and toward Asia, Africa, the Middle East, the Former Soviet Union, and Latin America. It is in these markets, which still offer less strict regulations, that tobacco products are still allowed to be sold without much oversight.


The Physical Health Effects of Nicotine Addiction

The toxic substances found in tobacco and tobacco smoke affect almost every type of cell in a number of different ways:

  • Firstly, due to the myriad of harmful effects of tobacco on one’s health, scientists have linked its consumption to the “three Ds”: death, disease, and disability.
  • Tobacco contains 2550 known compounds, with tobacco smoke containing more than 4000 compounds. The primary, biohazardous compounds in tobacco include at least 43 carcinogens, (e.g., nicotine and nitrosamines), as well as alpha-emitting radionuclides (e.g., polonium 210).
  • Tobacco smoke, on the other hand, contains carbon monoxide, herbicide, fungicide and pesticide residues, tars, and other disease-promoting substances that can impair the body’s defense mechanism and functions.
  • Several of the active ingredients found in tobacco, such as tar, nicotine, and nitrosamine, have been potentially linked to oral cancer.
  • Smoking tobacco has an immunosuppressive effect, which adversely affects the body’s ability to manage and fight harmful parasitic elements.
  • If current tobacco use trends will continue, the tobacco industry is due to kill about ten million individuals per year. 70% of these deaths are estimated to occur in developing and emerging countries, and not in the west, which for a long time had been considered the traditional tobacco market.

Women Breaking Cigarette

Smoking Cessation: Definition and Timeline

Smoking cessation is defined as the sustained ability to avoid tobacco and tobacco products consumption. Though the smoking cessation process is greatly beneficial to one’s health, it is also reportedly quite difficult to withstand, due to an adverse withdrawal reaction.

The following timeline depicts the overall progression of this process, including the estimated times when certain symptoms and reactions are likely to arise. It should also be stated that according to research, the longer one refrains from smoking, the greater their chance of maintaining their smoking cessation over time. 


1 Hour

Within the very first hour after an individual quits smoking, their heart rate (the number of heartbeats per minute) can decrease back to normal. Their blood pressure may also drop down to normal, appearing together with signs of improved circulation.

3 Hours

Withdrawal symptoms normally arise by the three-hour mark, with signs of sadness, anxiety, and a difficulty concentrating becoming apparent.

12 Hours

After 12 hours, one’s blood pressure (i.e., the level of pressure within the heart between heartbeats) also drops down to normal. The blood’s carbon monoxide levels also decrease, which causes an increase in the amount of oxygen received by their internal organs.

24 Hours

Those who manage to make it a day without smoking decrease their chances of experiencing a myocardial infarction (also known as a heart attack).

48 Hours

After two days, one’s senses of smell and taste begin to recover, enhancing experiences in their everyday life.

3 Days

After three days of smoking cessation, nicotine withdrawal symptoms will become harder to tolerate. Significant moodiness and irritability, as well as headaches and cravings are all likely to become much more prominent at this point.

1 Week

Individuals who make it a week without smoking are nine times likelier to reach and maintain long-term cessation.

2 Weeks

At two weeks, the physical smoking withdrawal symptoms start to weaken, allowing individuals to turn their attention to the benefits of the cessation process. Namely, due to improved lung functions, increased circulation, and better oxygenation, they are now able to breathe, walk and run much more easily.

1 Month

Less congestion and shortness of breath, in addition to a rise in energy levels, are often reported around the one-month mark. Additionally, the growth of young, healthy lung fiber at this stage helps their body fight against bacterial infection.

6 Months

At six months, many former smokers begin noticing the mental health benefits of smoking cessation. Specifically, they find they are able to manage their stress more easily and do not become as overwhelmed with life’s trials and tribulations. They also report significantly less coughing, due to their lungs and airways no longer being inflamed and constantly irritated.

1 Year

After an entire year of refraining from smoking, individuals will find they have a much easier time breathing. They will also have cut their chances of developing heart disease by half, which will become even less likely the longer they go without smoking.


Mental Health Symptoms that Arise During the Cessation Process

The physical symptoms that are triggered when an individual first quits smoking, such as headaches and cravings, can greatly hinder their ability to stick with the overall cessation process. But it is the mental health responses to this process that are reported to cause the greatest amount of distress, and push those trying to quit back toward their addiction. So, what are these mental health symptoms, and how do they impact the overall smoking cessation process?

Some of the more common smoking cessation mental health symptoms are irritability, sadness, and moodiness, all of which tend to push the individual experiencing them to resume smoking as a way to alleviate them.

Symptoms of anxiety and depression can also be triggered as one undergoes smoking cessation. Such symptoms can include low mood and a difficulty concentrating (relating to depression), or increased tenseness (relating to anxiety). Anxiety and depression symptoms normally pass after a few weeks.

Another smoking cessation mental health issue is body image. As individuals experience cravings and increase their food consumption, many begin to gain weight. This can in turn affect how they view their body (in addition to a number of other physical health concerns), which can cause them to develop a negative self-image about the way they look. Incorporating regular exercise into their routine, switching over to healthier food, and remembering that cessation-related cravings will soon pass, can all help those trying to quit smoking manage during this process.


The Mental Health Benefits of the Smoking Cessation Process

Once the first month or so passes, individuals who manage to stick with the smoking cessation process begin to experience a decrease in side effect severity. Simultaneously, the benefits of quitting become more apparent, providing them with more immediate and tangible motivation to stay on course.

Symptoms of anxiety and depression, also experienced during the initial stage of the smoking cessation process, similarly begin to decrease. This allows those refraining from smoking to enjoy greater physical and mental health while not relying on smoking to maintain the same level of calm.

With these benefits taking effects, some individuals who use antidepressant or anxiolytic medications are able—under the supervision of their doctor—to decrease the dosage of their medications. This process can contribute to less severe pharmacological side effects, and to a better overall quality of life.


Smoking Cessation Treatments

The multiple health hazards that have been associated with smoking addiction have raised the need for safe and effective treatments able to facilitate smoking cessation. Here are some of the options available on the market:


Deep Transcranial Magnetic Stimulation

Deep Transcranial Magnetic Stimulation (Deep TMS for short) has been FDA-cleared since August 2020 as a smoking cessation treatment, due to its proven safety and efficacy. Deep TMS is a non-invasive medical device treatment that works by sending out electromagnetic pulses that help regulate the neural activity of brain structures found to play a key role in smoking addiction. Over time and with repeated treatment sessions, Deep TMS has been shown to reduce the craving sensation associated with the smoking withdrawal process. This helps the patient undergoing treatment to face their smoking addiction and better withstand its withdrawal process without succumbing to a smoking relapse.

Deep TMS does not require the use of anesthesia, allowing the patient to incorporate its treatment sessions into their regular routine. It also does not cause any long-term or severe side effects and can be combined with other forms of treatment.

In addition to treating smoking addiction, Deep TMS has been FDA-cleared to treat major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). It has also been CE-marked in Europe as a safe treatment option for these and several other mental health and neurological issues.

TMS treatment for smoking cessation

Behavior-Focused Therapy

According to research, forms of psychotherapy that emphasize behavioral change are more likely to successfully facilitate smoking cessation. As such, therapy branches such as cognitive-behavioral therapy (CBT) are considered the most optimal types of psychotherapy when looking to help quit smoking.

Compared to more traditional forms of psychotherapy, which delve into the hidden connections between the patient’s present life and their formative years, CBT takes a more goal-oriented approach. Rather, its emphasis is on the thoughts, feelings, physical sensations, and behaviors the patient has learned to associate with the condition they are battling. Together, patient and therapist discuss the various symptoms that arise as a result of said condition, as they consider more beneficial ways to respond to introduced stressors.

With smoking, CBT usually looks at the patient’s motivation to quit, any concerns they may have about the cessation process, and how they might best manage any hard-to-tolerate withdrawal symptoms. This shared examination allows the patient to acknowledge the diverse aspects of their addiction and face them in a more direct manner.


Hypnosis Therapy

Hypnosis has also been shown to assist with smoking cessation. During the hypnosis process, the patient (who remains conscious and in control throughout the treatment session) is gradually eased into a state of trance. This allows them to focus on the ideas introduced by the therapist, who is then able to connect between cigarette smell and an unpleasant smell, such as exhaust fumes. As a result, patients may then begin to experience repulsive sensations when around cigarettes, causing them to refrain from such situations.


Nicotine Replacement Products

In an effort to protect against the adverse effects of smoking, Nicotine replacement products offer small doses of nicotine, so as to satiate the adverse effects of the withdrawal process, while avoiding the harmful effects of smoking. Products such as nicotine patches, gum, lozenges, inhalers, and sprays all offer an alternative to tobacco smoking.


Nicotine-Free Medication that Facilitates Smoking Cessation

A number of prescription medications have been empirically proven to mitigate the nicotine withdrawal process. One such drug, Bupropion, which is sold under the brand name Wellbutrin, is also used to treat depression. A second drug, called Varenicline and sold under Chantix or Champix, can help against smoking dependence by blocking the brain’s nicotine receptors.


How to Continue Adhering to a Smoking-Free Lifestyle

As difficult as reaching smoking cessation can be, maintaining it can be a challenging task all of its own. Craving a cigarette, due to biological addiction, as a self-soothing mechanism or social pressure can all lead to constant triggers for an individual attempting to stay away from nicotine. To counter this, several forms of encouragement are recommended, when aiming to achieve a continuous smoking cessation process:

Noting How Life has Improved Without Smoking

Reminding oneself of the benefits they are able to enjoy in thanks to quitting smoking can help maintain their self-control in the face of “just one cigarette.” They can include:

  • Noticing how they are able to reach greater levels of calm without relying on smoking to do it for them.
  • Thinking of how their breathing has improved, compared to how out of breath they used to be.
  • Checking on their heart rate and oxygen levels at the doctor’s office and seeing how much better they are.
  • Going over the long-term effects of smoking cessation, such as avoiding cancer and other potentially deadly diseases, preventing infertility and sexual dysfunction, and enjoying a longer lifespan that will grant them more time with their loved ones.

An individual’s triggers for smoking can be very personal, from a one-time, stressful situation to a recurring one. Whatever the type of trigger, though, going over all the ways one’s life has improved due to quitting smoking can help contextualize a momentary desire to smoke, and show how what they have to gain by sticking with their non-smoking lifestyle is greater than the relatively minor satisfaction a cigarette would provide.

Introducing Small Changes to Your Routine

Taking pleasure in activities one has learned to associate with smoking, such as drinking their morning coffee or meeting up with friends who smoke, could potentially push them to begin smoking again. Simple changes in one’s routine can help avoid having these activities serve as a trigger: changing where you sit with your coffee in the morning, meeting at a new pub, or finding new activities that have not been linked to smoking can all act as small steps toward a nicotine-free life.


Exercising is great for one’s health in general and can negate some of the weight gain that can occur during the smoking cessation process. Though at first, physical activity might cause them to quickly run out of breath, building up one’s stamina and seeing results through increased ability and a more toned physique can act as a positive reinforcement when trying to refrain from smoking.

Finding Empathy for Yourself

For many individuals trying to quit smoking, the incredibly addictive nature of nicotine makes having even one cigarette the first step down the short road back to regular smoking. This can cause those who do succumb to nicotine to become very self-critical after they slip up.

But though the health risks with smoking are indeed very serious, chastising oneself when cigarettes prove too tempting does little to keep them away from them. Rather, it can keep them in a state of frustration that can eventually drive them to smoke more and more, while decreasing their motivation to get back on track.

Smoking a cigarette after one has taken the trouble to quit is far from ideal. But it is understandable to sometimes find yourself taking a step back, as you try to keep yourself, on the whole, moving toward a better quality of life. It is this empathy for oneself or a loved one that can prove to be the necessary factor when one does momentarily return to smoking, as they try to once again overcome their addiction.


Smoking Cessation and COVID-19

Research conducted by the World Health Organization (WHO) has established a connection between having a history of tobacco smoking and developing the more serious symptoms of COVID-19, also known as the coronavirus. The association is largely due to the disease causing severe respiratory problems by attacking the patient’s lungs.

Acknowledging this link between the pandemic and nicotine dependence, many smokers have decided to quit in the face of COVID-19. In the UK, for example, over 300,000 smokers quit due to COVID-19, in addition to more than 2.4 million smokers who have reduced their smoking intake for the same reason. Smoking cessation numbers are the highest they have been in a decade, with many of those who quit attributing this to COVID-19-related concerns.