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If there is anything that is self-evident about smoking, it is that quitting is hard. Lower-nicotine cigarettes, however, seem to make the urge to smoke easier to fight.

Most doctors in North America consider tobacco use to be the number one remediable health problem. If patients are just told how horrible smoking is for them, the reasoning usually goes, surely they will quit tobacco on their own. As almost any smoker can tell you, this approach almost never works.

However, many smokers do want to quit for various reasons. Maybe it is concern about health. It may be something one does for a spouse, a lover, or a child who is concerned about health. Some people stop smoking simply because it costs so much. 

However, all methods of smoking cessation are not equal.

  • About 90 percent of smokers who decide to quit use the "cold turkey" method. They simply stop smoking cigarettes. This method is occasionally (but not very often) successful.
  • Some smokers try professional counseling, acupuncture, or hypnosis. These methods work about 60 percent of the time for at least one month, and about 20 percent of the time for a full year. In other words, a year later, 80 percent of people will be smoking again even if they do get professional intervention.
  • Antidepressant therapy, nicotine patches, behavioral therapy, and group therapy on the lines of "Smokers Anonymous" also work about 20 percent of the time.
Some people are so hooked on smoking that they can be diagnosed with a psychiatric disorder, tobacco use disorder, defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These are people who smoke more and more despite multiple attempts at quitting, or who continue to smoke even when they have end-stage lung disease, or who smoke despite the fact it ends relationships, or who smoke even when it is physically hazardous, for example, smoking in bed. Most people who suffer tobacco use disorder are also addicted to nicotine. 
Reliable indicators that someone is addicted to nicotine are a need to smoke as soon as one gets up in the morning, and smoking more than two packs a day.
There are smokers who don't feel better when they quit. These include people who have a history of major depression, especially women smokers who have a history of major depression, and smokers of either sex who are overweight. Antidepressants such as Prozac and Paxil may help people who feel extremely depressed when they don't smoke, but these medications take about six weeks to kick in, even when they are appropriately prescribed. Many people go back to smoking rather than face depression. Medications such as bupropion, nicotine replacement therapy (NRT), and varenicline help overweight smokers keep from gaining even more weight when they quit, but the pounds come on quickly when the medications are discontinued.
One intervention that hasn't been tried very often is switching smokers to low-nicotine cigarettes. 
These are not reduced-nicotine cigarettes you can buy over the counter. These are medically prescribed cigarettes with 85 to 97 percent of the nicotine removed. In this method of treatment, no attempt is made to force smokers to quit. They are allowed to smoke as many low-nicotine cigarettes as they like. When they return to their regular brands, however, their habits often change drastically.
Continue reading after recommendations

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  • Bergen AW, Michel M, Nishita D, Krasnow R, Javitz HS, Conneely KN, Lessov-Schlaggar CN, Hops H, Zhu AZ, Baurley JW, McClure JB, Hall SM, Baker TB, Conti DV, Benowitz NL, Lerman C, Tyndale RF, Swan GE
  • Transdisciplinary Research in Cancer of the Lung Research Team. Drug Metabolizing Enzyme and Transporter Gene Variation, Nicotine Metabolism, Prospective Abstinence, and Cigarette Consumption. PLoS One. 2015 Jul 1. 10(7):e0126113. doi: 10.1371/journal.pone.0126113. eCollection 2015. PMID: 26132489.
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