In this blog for people planning to stop smoking Robert Walton, a Senior Fellow in General Practice, and Nicola Lindson, a Cochrane editor and author, explore new Cochrane evidenceCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. on how cutting down on cigarettes before trying to stop compares with other ways of stopping smoking.
Page last updated: 14 January 2022. Page last checked 2 February 2023
It’s a great idea isn’t it? No need to stop smoking all at once – I’ll just cut down gradually and then it will be much easier to give up completely. But is it true?
Well there is some scientific evidence from addiction biology to back this idea up. People who smoke heavily take in more nicotine and since nicotine is a very highly addictive substance they tend to crave tobacco more and suffer more ill effects when they stop using cigarettes. It is clear that people who smoke fewer cigarettes experience fewer withdrawal symptoms when they try to stop.
Looking from a less ‘medical’ perspective, breaking down a goal that appears unachievable into small bite-sized chunks that seem within your grasp often seems to be a good strategy. About half of all smokers in the UK say that they would like to stop smoking by cutting down first, with the other half saying they would prefer to stop smoking all at once (West and Brown, 2012). The numbers are similar among smokers in the US (Shiffman et al, 2017).
However, abrupt quitting may be the only option offered by stop-smoking services, and this may push those who want to cut down first to go it alone. This is not ideal, as we know that providing people with support and medication nearly doubles the chance of success (Stead et al, 2016). Providing people with a choice between cutting down to quit and quitting all at once may encourage more people to get help to quit. But before you decide to give it a go, it’s important to know how effective this approach is likely to be.
Cutting down to quit: does it help people to stop smoking?
A new Cochrane ReviewCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. on cutting down to quit smoking, Smoking reduction interventions for smoking cessation (published September 2019), pulled together the evidence from 51 studies with 22,509 people . In all of the studies, some people were asked to cut down first before stopping (Lindson et al, 2019). Encouragingly, there was no evidence of a difference in quit rates in the 22 studies (9,219 participants) that directly compared ‘reducing to quit’ with abrupt quitting. This suggests that people could be given a choice of cutting down to quit or abrupt quitting without reducing their chances of successfully stopping smoking.
So, what is the best way to cut down in order to quit smoking?
The review also found some evidence that cutting down to quit was more successful when people received professional support to help them quit compared to self-help. Therefore, if you want to reduce your smoking, approaching a healthcare professional such as your GP or pharmacist could be a good way forward.
There was also some evidence that using fast-acting nicotine replacement therapy (e.g. nicotine gum or lozenge) or varenicline whilst reducing cigarettes smoked may be more effective in helping people to stop smoking than using nicotine patches, bupropion or no medication to cut down. A healthcare professional can advise on this and fast-acting nicotine replacement therapy is available to buy in pharmacies and supermarkets in the UK.
Deciding how to stop smoking – personal choice?
If both approaches to quitting are likely to have similar success rates then perhaps deciding between cutting down to quit and quitting all at once should be left to each individual to make up their mind. We are all different and what works for one may not work for another, and of course people who have tried many times to quit abruptly may want to try a new approach.
Whichever way you choose, the evidence suggests that seeking support and using stop smoking medications to help you will improve your chances of quitting and staying smoke-free in the long-term.
Good luck with your resolution to stop smoking!
Join in the conversation on Twitter with @rtwalton123 @CochraneUK @CochraneTAG or leave a comment on the blog.
Read more blogs about the evidence on quitting smoking.
Declarations of interest:
Robert Walton reports grants from NIHR Health Technology Asessment, grants from NIHR Programme Grants for Applied Research, personal fees and other from TTS Pharma, outside the submitted work; In addition, Dr. Walton has a patent WALTON R, MCKINNEY E, MARSHALL S, MURPHY M, WELSH K, others. GENETIC INDICATORS OF TOBACCO CONSUMPTION. Patent number: 2001038567. Filed date: 24 Nov 2000. Publication date: 01 Jun 2001 with royalties paid to gNostics, and a patent Tucker MR, Walton R, Matthews H, Miskin A. Method and Kit for Assessing a Patient’s Genetic Information, Lifestyle and Environment Conditions, and Providing a Tailored Therapeutic Regime. Patent number: US20110251243 A1. Application number: US 12/944,372. Filed date: 11 Nov 2010. Publication date: 13 Oct 2011 issued to None.
Nicola Lindson is the Managing Editor of the Cochrane Tobacco Addiction Group (TAG). Her salary is funded by an NIHR Infrastructure grant for the Cochrane TAG via the University of Oxford. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic ReviewsIn systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. Programme, NIHR, NHS, or the Department of Health and Social Care.
What are your thoughts on “cytisine”? Can it help you stop smoking?
I assume personality and disciple influences success rate as much as the approach.
I tried various approaches and was able to stop for up to eighteen months on one or two occasions. One day at a time can work. Even after one day free of cigarettes has benefits ( not smelling, being able to smell, saving money, feeling ” clean” and breathing more easily and having more energy). Counting the days until you are free for a weekend, a week, two weeks and a month can be motivating. After a week the craving is much reduced. If you have a relapse, start again when you feel ready. Don’t feel a failure as that could really be an excuse to carry on smoking. Instead, take credit for each smoke free day.
The subsequent attempts should be easier if you really do have a good reason to stop.
I stopped about six years ago after a serious accident. I needed to be free of nicotine and the noxious substances in preparation for major surgery. The severity of the accident encouraged me to think about whether I wanted better health or not. I felt a sense of responsibility to self and others and wanted to avoid long term dependence on others to live the independent life I had.
When I finally decided to quit, I did so without involvement of others. I felt it was time to take control over my health. Although there were and still are days when I crave a puff, the thought of feeling sick and smelling awful stops me. I know that just one puff would take me back to smoking every day. The idea disgusts me. I guess I have reprogrammed my thoughts or brainwashed myself in some way. I do love the idea of a quick lungful of nicotine and the other pollutants that make up these cancer sticks but will probably not indulge.
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I could live months without a cig, so I thought that I’m not a tru-smoker, but sometimes those caravings were crawling to me. When you start to feel this little buzz after first drink, and then this nicotine kick in your head, a little bit of dizziness. I love this! And also those are the reasons I had to quit. Everytime I was telling myself that it will be only one, maybe two smokes, and not more, because next day will be very awful… guess what… every time the next day was awful. For me a big help was reading this book – net-bossorg/the-easiest-way-to-quit-smoking-for-life – it really change my point of view.
what do you think about “cytisine”Can it help in quitting smoke?