Smoking Cessation: Find Information & a Smoking Cessation Clinic

Many former smokers swear by it: After the last cigarette, it’s over! For some smokers, this works, and they don’t need any further help to quit smoking. For many others, however, there are still many “last cigarettes” before they admit to themselves that they need professional help.

There is a wide range of methods for quitting smoking. However, many of these approaches have not been proven effective. In some cases, you may even experience problematic side effects.

Be sure to choose a scientifically proven treatment method. The clinic or specialist in smoking cessation must demonstrate that patients remain smoke-free even after six—or better yet, twelve—months.

A combination of medication and behavioral/psychotherapy is recommended for smoking cessation. This approach addresses both physical and psychological dependence.

The most promising approach is nicotine replacement therapy combined with professionally guided individual or group therapy.

It is not smoking itself that is addictive, but rather the nicotine ingested during the process. However, the burnt additives in cigarettes and cigars are responsible for the development of diseases. Nicotine replacement therapy therefore aims to supply the body with nicotine without burning tobacco. In addition, there are

• nicotine patches,
• nicotine gum, and
• nicotine nasal spray

are also options.

Nicotine replacement therapy and psychological therapy can also be used independently of one another. They are still effective in such cases.

One thing is always true: Strong willpower is essential when quitting smoking! You must be firmly resolved to quit smoking immediately.

Quitting smoking is unfortunately not entirely easy, but it is definitely doable © mbruxelle | AdobeStock

In medically supervised smoking cessation, the doctor or therapist first takes a medical history. They will ask you about your smoking history and your current smoking habits.

The Fagerström Test can be used to assess the degree of nicotine dependence. The extent of nicotine dependence provides guidance for the dosage and duration of medication and psychological therapies.

Concurrent mental health conditions, such as depression, may worsen during nicotine withdrawal. Therefore, you should discuss these comorbidities with your doctor before quitting smoking. 

Make a list of the negative consequences of smoking as well as your personal reasons for quitting. This will help you quickly boost your motivation at any time.

The first seven to ten days of quitting smoking are the hardest. After that, withdrawal symptoms improve significantly. In fact, the peak of withdrawal symptoms is already over after the first two days.

Possible withdrawal symptoms when quitting smoking include

• depressed mood,
• sleep disturbances,
• irritability,
• aggressiveness,
• nervousness,
• restlessness,
• impaired concentration,
• slowed heart rate,
• increased appetite, or
• weight gain.

The primary goal of smoking cessation should be permanent abstinence. This means you stop smoking entirely.

While your exposure to harmful substances does decrease even if you simply smoke less, such a reduction in cigarette consumption is not very promising because the risk of eventually smoking more again is very high. Reducing smoking can only be an alternative in exceptional cases—when complete abstinence is definitely unattainable (e.g., after several therapeutic attempts).

Methodologically, quitting smoking from one day to the next is recommended. You should remove any remaining cigarettes and ashtrays from sight beforehand. Only after this radical method has failed should a gradual approach to quitting be considered as an alternative.

The goal of temporarily using nicotine replacement is to suppress or alleviate withdrawal symptoms.

However, taking medication does not help smokers overcome their old smoking habits. Nevertheless, nicotine replacement therapy significantly increases the likelihood of long-term smoking cessation.

In addition to reduced withdrawal symptoms, cardiovascular risks are also reduced. Nicotine replacement products can therefore be used for an extended period.

It is recommended, however, to discontinue nicotine replacement therapy no later than twelve weeks after quitting smoking.

All forms of administration are well tolerated when used as directed. The risk of developing dependence is low.

Available Nicotine Replacement Medications

Over-the-counter smoking cessation medications include

• nicotine gum (2 and 4 mg),
• nicotine patches (in three strengths, for 16 or 24 hours),
• nicotine sublingual tablets, and
• nicotine lozenges

are available. Prescription-only options include

• the nicotine nasal spray and
• the nicotine inhaler.

The nicotine patch and the nicotine nasal spray are considered the most effective.

The various forms of these medications work in different ways. Their suitability depends on your current smoking habits.

Below are the characteristics of the three most recommended nicotine replacement products:

Nicotine patches

Nicotine patches maintain a steady level of nicotine in the blood. They are applied once a day. Nicotine patches are particularly suitable for moderate to severe nicotine dependence and for those who smoke regularly throughout the day. 

After a few weeks, you should switch to a patch with a lower dosage. This way, you can phase out the nicotine patch within two to three months.

Possible side effects of nicotine patches include skin irritation and patch allergies.

Nicotine Gum

Nicotine gum is particularly suitable for mild to moderate nicotine dependence or for moderate and/or irregular cigarette consumption throughout the day.

You can use up to 16 pieces of gum per day. Nicotine gum can also be helpful in situations where a rapid nicotine intake is needed. This way, you may be able to prevent a relapse by using nicotine gum.

Over the course of several weeks, you should gradually reduce the number of pieces of gum you use. Nicotine gum is the best alternative if you are allergic to nicotine patches.

Nicotine gum and lozenges can

• irritate the oral mucosa, tongue, throat, and esophagus and
• lead to problems with dentures.

Nicotine nasal spray

Nicotine nasal spray is particularly suitable for smokers with a strong nicotine dependence and a high daily cigarette consumption.

After using the nicotine nasal spray, the body absorbs the nicotine very quickly. The maximum nicotine level is reached within ten minutes. This is why the spray is also effective in situations of intense craving.

However, there is a risk of developing dependence on nicotine nasal spray. It should be used regularly, but for no longer than six months and under medical supervision.

A combination of nicotine patches and nicotine gum, or nicotine patches and the nasal spray, is possible and recommended for severe dependence. However, you should discuss this with your doctor first.

Other Smoking Cessation Medications

In general, it is not recommended to use other smoking cessation medications in addition to these nicotine replacement products. While the antidepressant bupropion can help with smoking cessation, it may cause more serious side effects.

Nicotine replacement therapy can help counteract physical withdrawal symptoms. However, as part of the smoking cessation process, it’s also important to

• break old habits,
• practice new behaviors (e.g., in stressful situations), and
• learn self-control mechanisms.

Behavioral and psychotherapeutic interventions can help with this. They can be part of structured treatment programs or carried out independently.

Resources include, for example,

• the online smoking cessation program of the Federal Center for Health Education (BZgA)
• the smoking helpline of the German Cancer Research Center (DKFZ) (06221 42 42 00).

The positive effect of social support on smoking cessation has been scientifically proven. This can come from a doctor, but support from your personal circle is even better. So, if possible, involve someone close to you in your smoking cessation efforts.

In contrast,

• the introduction of “contracts” involving rewards for achieving goals and/or penalties for failing to do so,
• relaxation techniques/breathing exercises, and
• hypnosis

do not, according to current scientific knowledge, (permanently) increase the success rate.

Acupuncture does not appear to be any more effective for smoking cessation than a placebo treatment. There is also no scientific evidence of efficacy for smoking cessation treatments based on homeopathy and herbal medicine.