Should I Quit Smoking Cold Turkey?

Let's be clear about a few things before we begin. Most smokers try to quit smoking cold turkey (CT = without taking medication to manage detox symptoms). It's true. Also true? I quit smoking CT myself (from a 3-pack-per-day habit). And finally, I usually suggest that smokers try CT first, for the same reasons that most people do  -- it's the quickest, easiest way to go for someone who wants to quit. No extra $$ spent, no waiting for NRT to arrive in the mail, no "Am I doing this right?"

There's only one problem. Decades of research repeatedly demonstrate that, for most smokers during most quit attempts, cold turkey offers the lowest odds of a successful quit. The conventional wisdom of pro-CT advocates (who often ignore the conclusions and summaries of the very studies they cite) focuses on the numbers of people who quit CT, not the % of quitters who succeed. If you're planning your quit now, be wary of three common myths about cold turkey quitting.

Myth #1. Cold Turkey is the most effective way to quit.

Only 3-6 CT quitters, out of every 100, will succeed during any given quit attempt. This makes cold turkey the least effective of all treatments, even less so than medication placebos. CT successes are so low because the physical, mental and behavioral components of withdrawal can prove too much to handle, and negatively impact quitters' work and personal lives -- especially for those who aren't that motivated to quit in the first place.

This doesn't necessarily mean that you won't be able to quit using CT. Any smoker who can make their quit their top priority, and do whatever it takes to not smoke one day at a time, can quit cold turkey like I did. But in the real world of randomized, controlled studies, most quit-medications demonstrate better quit-rates than CT. (See some references below the Join button)

Myth #2. Cold Turkey is the fastest way through withdrawal.

The longest, most intense detoxifications are usually suffered by CT quitters, depending on their level of addiction. Three days is commonly referred to as make-or-break time for CT withdrawal, but CT quitters can experience mild-to-severe detox symptoms, off and on, for weeks after quitting. I know this from personal experience; each of the three times I quit CT, I went through extended detoxes, what we called the Quit Flu in those days, lasting a week to a month.

Again, this is not to say you will suffer such withdrawal if you quit cold-turkey -- that's largely determined by your current addiction/smoking level and metabolism -- only that you're more likely to. And withdrawal symptoms are the top-reported reasons for relapse.

Myth #3. The intensity of a cold turkey quit inhibits relapse. 

Though many CT quitters claim that their quit is/was so horrific that they never want to go through it again, there's no solid research demonstrating that past withdrawal experiences influence current quit-success, or that a bad past experience helps us keep the quit this time. What we often find instead is an increased resistance to the idea of quitting this time because of past difficulties, and higher rates of slips and relapses during intense detoxes.

All that being said...

Cold turkey quitting may still best the way for you to quit. If you're a middle-aged man or post-menopausal woman motivated to quit, have successfully quit before without medicinal intervention, and/or aren't being treated for depression or a bi-polar condition, your odds of quitting CT are better than average. If you're pregnant or breastfeeding, or smoke less than half a pack a day, you probably should quit smoking cold turkey (discuss this with your doctor).

However, don't assume that cold turkey means no assistance at all -- research consistently shows that behavioral support and/or assistance from healthcare professionals and other ex-smokers can make the difference between losing or keeping your quit.

But if you know or fear that severe withdrawal will negatively impact your life, or if you haven't been able to get through detox unaided in the past, don't worry. You don't have to quit cold turkey. There are more effective treatment methods available to you!

No matter how you quit, staying quit is your real priority. Good luck, visit QuitNet for help, and KTQ!

Alan Peters, CTTS-M

Note: This blog is about CT quitting for individual smokers. Public health officials sometimes promote CT treatment to large populations, because they feel that's more cost-effective than paying for, distributing, and supporting compliance with quit-medicines on a large scale.

Note: No QuitNet staff, authors, or treatment specialists receive research funding or other remuneration from pharmaceutical companies or quit-smoking medication manufacturers. Our recommendations are always based on science and evidence, and best practices.

Pharmacological interventions for smoking cessation: an overview and network meta-analysis. 
AUTHORS' CONCLUSIONS: "Higher rates of smoking cessation were associated with NRT (17.6%) and bupropion (19.1%) compared with placebo (10.6%). Varenicline (27.6%) and combination NRT (31.5%) (eg, patch plus inhaler) were most effective for achieving smoking cessation."

Nicotine replacement therapy for smoking cessation.  
AUTHORS' CONCLUSIONS: "All of the commercially available forms of NRT increase the rate of quitting by 50 to 70%, regardless of setting.  The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual."

Usage Patterns of Stop Smoking Medications in Australia, Canada, the United Kingdom, and the United States.  
AUTHORS' CONCLUSIONS: "Approximately 3–5% of smokers who make an unaided quit attempt report remaining smoke free one year following their quit attempt [1]. In the UK, an evaluation of the NHS indicated that smokers who attempted to quit using stop smoking medication and behavioral support were nearly 4 times more likely to be quit at 52 weeks than smokers who attempted to quit with no assistance [6]."

Meta-analysis of the efficacy of nicotine replacement therapy for smoking cessation: differences between men and women.
AUTHORS' CONCLUSIONS: "NRT was more effective for men than placebo at 3-month, 6-month, and 12-month follow-ups. The benefits of NRT for women were clearly evident only at the 3- and 6-month follow-ups. Giving NRT in conjunction with high-intensity non-pharmacological support was more important for women than men."

Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guidelines. 
U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality
AUTHORS' CONCLUSIONS: "Numerous effective medications are available for tobacco dependence, and cllinicians should encourage their use by all patients attempting to quit smoking—except when medically contraindicated or with specific populations for which there is insufficient evidence of effectiveness (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents)... Clinicians also should consider the use of certain combinations of medications identified as effective in this Guideline."

Center for Disease Control Quit Smoking Fact Sheet
AUTHORS' CONCLUSIONS: "Medications for quitting that have been found to be effective include the following: Nicotine replacement products: Over-the-counter (nicotine patch [which is also available by prescription], gum, lozenge); Prescription (nicotine patch, inhaler, nasal spray); Prescription non-nicotine medications: bupropion SR (Zyban®),6 varenicline tartrate (Chantix®)."