How to quit smoking with a plan: abrupt or gradual?

What was tested?

In the 2016 trial by Lindson-Hawley and colleagues, 697 people were split into two groups. Both had nicotine replacement and support. The gradual group cut their smoking by 75% in the two weeks before the quit day; the other group smoked as usual until then. At week 4, 39.2% of the gradual group had quit, against 49.0% of the abrupt group. At 6 months the figures were 15.5% and 22.0%.

The 2019 Cochrane review by Lindson and colleagues pooled 51 studies and 22,509 people. It found no difference between cutting down to quit and quitting abruptly (RR 1.01; 95% CI 0.87 to 1.17), with moderate certainty. The authors add that cutting down with fast-acting NRT or varenicline may do better.

All of these trials had a quit date. We found no support for the idea that open-ended cutting down, with no date, ends in quitting.

Is a few cigarettes a day safe?

Hackshaw and colleagues reviewed 141 cohorts in BMJ in 2018. Smoking one cigarette a day carried about 46% of the excess risk of coronary heart disease seen at twenty a day in men, and 31% in women. The authors write that there is no safe level of smoking for cardiovascular disease. Cutting down may help, but the goal should stay quitting completely.

Nicotine replacement

In the 2018 Cochrane review by Hartmann-Boyce and colleagues (133 studies, 64,640 people), NRT raised the chance of quitting with RR 1.55 (95% CI 1.49 to 1.61). The product and dose depend on the person, so this is a conversation for a doctor or pharmacist.

How to build the plan

• Pick a quit day and put it in your calendar.
• Write down three or four moments when you smoke: morning coffee, a break, after a meal. Next to each, write what you will do instead (see the if-then guide).
• Ask a pharmacist or doctor about NRT or other support.
• When a craving comes, wait one minute, then decide again.

In Purrpose you can set up either quitting or cutting down. For smoking, we suggest a plan with a quit date.