Professional Documents
Culture Documents
Smoking Cessation
Smoking Cessation
The Effectiveness of Quitting Cold Turkey vs. Other Smoking Cessation Techniques
Ariel Aiken, Alyssa Crump, Emmalee Rich, Michaela Huber, Andrew Edie, and Harlie
Silberman
Abstract
This research paper reviews how smoking cessation techniques help fight the addiction to
tobacco and nicotine that is contained in cigarettes. The paper also explains how effective each
smoking cessation technique is that is mentioned within the research done for smoking cessation
while explaining how smoking affects the body. The main research purpose of this paper is as
stated: the effectiveness of quitting cold turkey versus other smoking cessation techniques in
individuals over the age of twenty years old. It has been proven by many studies that quitting
cold turkey is not the most effective way to quit smoking. There is a higher chance of relapse
when choosing to do the cold turkey method over the others such as the nicotine patch,
medications, e-cigarettes, and vaping. It is explained within the paper of which cessation
A variety of studies have been conducted about smoking and the adverse impacts, both
mentally and physically, that the habit has on the smoker. Smoking is linked to many conditions
and disease processes such as cancer and decreased cognitive functioning. Despite decades of
warnings, including labels on the side of the product, approximately thirty-eight million
Americans still engage in smoking cigarettes on a regular and even daily basis. In addition to
respiratory problems from shortness of breath to cancer, smoking restricts blood flow to critical
organs, most significant of which is the brain. The brain directs every task that an individual
accomplishes. A decreased oxygen supply to the brain can cause ischemia to the extremities and
other vital organs. This may have short and long-term negative effects on the body. Many
smokers feel sluggish and irritable if they cannot have a cigarette and smokers are linked to
having a shorter life expectancy than non-smokers due to the various conditions related to the
addiction.
This research paper examines the effectiveness of quitting smoking cold turkey versus
other smoking cessation techniques in individuals over the age of twenty years old. The research
examined in this paper has demonstrated the cognitive compromise that smoking facilitates on
the body, particularly in individuals over the age of twenty years old. There was a remarkable
result noted when smokers had voluntarily participated in a cognitive screening test that
measured their neuropsychological capabilities. For example, the specific measurements in one
speed, and visual-spatial/constructional skills (Razani, Boone, Lesser, Weiss, 2008). There were
several scales and tests that the volunteers had partaken in, that resulted in lower overall scores
that demonstrated decreased cognitive functioning with smokers versus non-smokers. Some of
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 4
the dependent variables noted in this study were as followed: age, education, sex, and vascular
status (illness) (Razani, Boone, Lesser, Weiss). With this information given it has shown
individuals that smoking is not good for the body and mind.
The effectiveness of quitting depends on the individual and their method to help them
cope with continued desire that the body has for nicotine while not re-engaging in a habit that
will shorten the user’s life. Some of those smoking cessation techniques that will be noted in this
paper will be quitting cold turkey, E-cigarettes and vaping, medications, and the nicotine patch.
However, some cessation techniques have proven more effective/successful than others.
As society has become more aware of the dangers of smoking, multiple smoking
cessation methods and theories have been utilized by the smoker in an attempt not to become the
latest casualty to this most harmful of legal habits. These methods are said to be beneficial if a
smoker is able to cease smoking entirely or switch to a replacement product which may still feed
the body the nicotine it craves without the harmful side effects like heart disease, respiratory
problems, or cancer, of conventional cigarette smoking. E-cigarettes have emerged and gained
National Academies of Sciences, Engineering, and Medicine, e-cigarettes have lower levels of
toxicants than tobacco cigarettes. Multiple studies have been completed to determine the true
effectiveness of e-cigarette use versus other methods related to cessation of traditional cigarettes.
The researchers in the study: “Can E-Cigarettes and Pharmaceutical Aids Increase
Representative Cohort of American Smokers” examined 3,093 quit attempts nationwide who
used the electronic nicotine delivery systems (ENDS). These researchers evaluated the
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 5
effectiveness these electronic products have on long-term tobacco termination (greater than thirty
days) in adults below the age of thirty-five. To conduct this analysis, the researchers used the
federally funded PATH study which warrant self-interviews in both English and Spanish. The
researchers gathered samples from thousands of subjects. They split the interviews into two years
labeled Wave 1 and Wave 2. Wave 1 had 10,851 subjects who reported that they smoked
regularly. About a year after this interview was conducted, Wave 2 questioned 8,861 (81.7%)
subjects from Wave 1 on whether they still smoked regularly or not. From Wave 1, 5,172
(64.5%) subjects reported no attempt at quitting in the past year and 56 people did not report
details on their attempted cessation of smoking. This left 3,093 subjects remaining for the
researchers’ study (Benmarhnia, Pierce, Leas, White, Strong, Noble, Trinidad, 2018).
sociodemographic characteristics were gathered from these 3,093 participants. These questions
gathered essential research answers from both waves which included the number of cigarettes
they smoked in the past thirty days, how many per day, and how old they were when they began
smoking consistently. They were also asked about any quit attempts. If they admitted to making
a quit attempt, they were then asked if they used e-cigarettes, nicotine patches, nasal spray, etc.
As for the subjects who attempted to quit smoking, 25.2% used ENDS and 23.5% used
one or more approved pharmaceutical product. Overall, 84.5% of this group who attempted to
quit failed and began smoking again by the time Wave 2 interviews came around. The use of
ENDS for quitting tobacco made no difference in the Wave 1 group. When Wave 2 was
conducted, those who used electronic products, such as e-cigarettes, were among the lowest
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 6
group to maintain cessation for more than thirty days (Benmarhnia, Pierce, Leas, White, Strong,
Overall, there was no substantial data that proved differences when it came to ENDS
users versus other methods to quit smoking. Most subjects who attempted to quit in this analysis
relapsed and began smoking again. Those subjects who used ENDS to quit were also smoking
cigarettes while using these electronic products (Benmarhnia, Pierce, Leas, White, Strong,
Noble, Trinidad, 2018). These researchers discovered that ENDS are a more effective cessation
method than most pharmaceutical options, but these electronic products did not appear to remove
or reduce the intake of tobacco cigarettes of these subjects (Benmarhnia, Pierce, Leas, White,
have been studied in their effectiveness to elicit cessation from traditional tobacco cigarettes.
Chantix, otherwise known as varenicline, is a prescription drug that is used to aide in the
cessation of smoking. When smoking, nicotine is attached to the nicotine receptors in the brain
and releases a chemical called dopamine. Dopamine leaves a person with a sense of feeling
good. However, when a person runs out of dopamine, it leaves them with wanting another
cigarette. Thus, the addiction to cigarettes is born. Chantix is believed to work by attaching itself
to the nicotine receptors in the brain therefore disabling the nicotine transfer (Ebbert, Wyatt,
Hays, Klee, & Hurt, 2014). While Chantix allows for the receptors to release some dopamine,
there is not as much released. This allows the person to slowly wean off of cigarettes due to the
diminished reward from not having as much dopamine released. Chantix can be used if the
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 7
person is still smoking or if the person completely cuts out smoking and is only using Chantix.
Either way, the drug will do its job (Ebbert, Wyatt, Hays, Klee, & Hurt, 2014).
A research study done entitled: “Unassisted Quitting and Smoking Cessation Methods
Used in the United States” discusses the effectiveness of assisted cessation of smoking using
nonpharmacologic and pharmacologic methods. The study follows assisted methods of cessation
such as Chantix. It also examines completely stopping the use of cigarettes unassisted, i.e.
quitting cold turkey. This study was an analytic sample that was consisting of former smokers
which included “long-term quitters” and “recent quitters”. The “long-term quitters” were those
who had quit one to three years prior to this survey. The “recent quitters” were adults who have
quit within one year of the study. This study was based on U.S. adult smokers who had quit
smoking already. It was a survey that gathered information to see what methods were used to
quit smoking. Whether it would have been nicotine gum/patches, a phone system to stay in touch
with people trying to quit or people who had used no methods, the people were asked what they
In this study, 5,788 former U.S. adult smokers were considered to address the first
question they had. The first question was, the prevalence of assisted and unassisted smoking
cessation. Out of the 5,788 people, 2,922 (53.3%) were male and 2,866 (46.7%) were female.
Out of the total people surveyed, only 1,703 (26.3%) used a pharmacologic method (Soulakova
& Crockett, 2016). Also, out of the total 5,788 people only 745 (11.0%) used Chantix as one of
their resources to assisted them in quitting. This study had shown that majority of former
smokers quit unassisted (3,960, 71.6%). Whereas, 1,396 (21.9%) people only used
pharmacologic methods (ie Chantix), 307 (4.4%) used pharmacologic and nonpharmacologic
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 8
methods and 125 (2.1%) used only nonpharmacologic methods (Soulakova & Crockett, 2016).
These statistics conclude that quitting smoking unassisted (cold turkey) remains the majority
method of action. However, when we look into the study more, we can see the most used
pharmacologic methods. Out of the 5,788 people, 26.3% used pharmacologic methods to quit.
This being that they either used only pharmacologic or combined with other methods. Among
the former smokers, the most commonly used pharmacologic methods were, a nicotine patch
(45.9%), Chantix (41.8%), and nicotine gum/lozenge (31.1%). This concludes that Chantix is not
the most used pharmacological method. The nicotine gum was the most used pharmacological
method. However, all of the pharmacologic methods are fairly close in percentages leading that
they are all about the same amount used (Soulakova & Crockett, 2016).
Along with Chantix, Bupropion (Zyban) is a selective serotonin reuptake inhibitor also
used for smoking cessation. This drug increases levels of dopamine and norepinephrine tricking
the body to thinking it is getting the euphoria type feeling nicotine causes. Ultimately, decreasing
cravings usually experienced from lack of nicotine. Often treatment is started while the patient is
still smoking to allowing serum bupropion levels to give full therapeutic effect . Within two
weeks, a date is set to quit while continuing medication (Bornemann, P., Eissa, A., & Strayer, S.
M., 2016). Many are prescribed to start on 150 mg for 3 days and then increase to 150 mg twice
a day (Bornemann, P., Eissa, A., & Strayer, S. M., 2016). The length of treatment is dependent
on individual patient factors such as previous smoking frequency and other possible
comorbidities.
comparing varenicline, bupropion, and nicotine replacement therapy comparing all modalities to
which has better outcome in achieving abstinence among recent quitters. A cohort of 11,968
participants received Varenicline (n=5,052), Bupropion (n=823), NRT gum (n=1944), and NRT
patch (n=4,149) (Chang, P.-Y., Lo, P.-C., Chang, H.-C., Hsueh, K.-C., & Tsai, Y.-W., 2016). All
participants were over the age of 18, wanted to quit smoking, and received a single smoking
pharmacotherapy with up to two treatment courses per year. No more than 8 refills were allowed
for the same cessation medication from the same clinic only a 90 day supply. The results were
based on self-reported interviews of participants recalling a 7-day, 1 month and 6 month timeline
of there cessation (Chang, P.-Y., Lo, P.-C., Chang, H.-C., Hsueh, K.-C., & Tsai, Y.-W., 2016).
Predominantly, varenicline users were more likely than NRT patch users to achieve abstinence
by the 6-month interview (P<0.001). NRT gum seemed to more effective in specifically the
females at the 6-month mark compared to the NRT patch (OR = 1.76, P = 0.013). Just
varenicline was found to work better than the NRT patch in specifically recent quitters who were
females and moderate nicotine dependent users. After 6 months of use, varenicline cessation
rates were 6% higher than bupropion (Chang, P.-Y., Lo, P.-C., Chang, H.-C., Hsueh, K.-C., &
Nicotine Transdermal patches have been a supplement used to achieve abstinence from
smoking. These patches can be easily purchased from a drugstore without prescriptions and
decrease withdrawal symptoms. They are applied directly to the skin daily and have varying
average amount of cigarettes smoked per day and the amount of time since the client has last
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 10
smoked a cigarette. Since the patch is placed transdermal, the nicotine in the patch passes
through the skin to reach the bloodstream. Once in the bloodstream, the patch stops nicotine
cravings. The amount of nicotine replaced in the body through the patch is less nicotine than a
cigarette, allowing the body to wean itself off of nicotine. These patches, if used properly, have
Previous clinical trials have proven the effectiveness of Transdermal Nicotine Patches.
The clinical study “Relationship Between Adherence to Daily Nicotine Patch Use and Treatment
Efficacy” examined whether adherence with a daily nicotine patch was related to increased rate
of smoking abstinence. The trial hypothesized an increase of adherence with the nicotine patch
due to easy use and a simple regimen. This was done through a 10-week randomized, double-
blind, placebo- controlled trial. This study stimulated “over the counter” conditions, allowing the
subjects to have little interference from the clinicians. The subjects were randomized to receive
either a 6-week placebo or a 6-week nicotine patch. Like over the counter stores, subjects
received patches and instructions on their use. They also received other supplementation such as
an audiotape, which included general smoking-cessation advice, and a relaxation regiment. Since
this study was over the counter conditions, no further instructions or interventions were given
throughout the trial. This included the subjects having no contact with the staff. The goal of this
trial was to parallel smokers buying nicotine patches on their own in hopes of quitting. Subjects
returned to be assessed at 6 weeks and 10 weeks. During the assessment, the clients turned in a
smoking diary and received an expired-air CO test. Subjects were only considered abstinence if
they reported no smoking within 7 days and their expired-air CO levels were <10ppm. The
populations had an average age of 42.8, weight of 77.3kg, length of smoking being 24.4 years,
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 11
35.2 cigarettes a day. Of 371 subjects, 253 remained adherent while 118 became nonadherent.
Subjects who were adherent by 3 weeks of application had improved chances of smoking
cessation. In conclusion, with a Transdermal Nicotine patch and over the counter conditions,
rates of adherence increased as opposed to a Placebo patch (Shiffman, S., Sweeney, C. T.,
This study is directly related to our topic because it discerns results of a Nicotine patch
versus quitting without supplementation (Placebo). Because the body is still receiving a small
amount of Nicotine within the bloodstream, craving and withdrawal symptoms are minimal. This
opposition, quitting cold turkey creates difficult withdrawal symptoms and a problematic
situation. People who quit without a treatment have a challenging time and a higher chance of
returning to smoking habits. With the proper use and correct dose, the transdermal nicotine patch
is very effective.
The survey that was found involved viewing smoking rates in the United States
comparing young adult and older smokers. The survey was done nationally in order to determine
the smoking cessation rates between the two specific groups. The age groups used in this
research were ages 18-64 which is a very wide range to compare. The results of the survey
showed that younger adults which ranged from 18-24 were more likely to have quit for 6 months
or longer. The research also showed that younger adults were less likely to use pharmaceutical
aids. The research conducted by the group involved the ages over 20 years of age. This survey
found was important to include because it focuses on why older adults are the better focus when
The group compared older adults above the age of 20 quitting smoking cold turkey versus
using other techniques. The information conducted by the survey showed older adults needing
the use of pharmacological aids compared to those younger. Therefore, the study of the research
is necessary to compare so that there is evidence of older adults being the more appropriate age
group to evaluate. The article states, “The use of any pharmaceutical aid during the most recent
quit attempt was 19.4% overall and 6.3% for nicotine gum, 11.8% for a patch, less than 1.0% for
a nasal spray, 1.2% for lozenges, 1.3% for an inhaler, 1.4% for tablets, and 6.2% for an
Zyban, bupropion, or Wellbutrin. Use of any pharmaceutical aid during the most recent quit
attempt increased significantly with each higher age” (Messer, Trinidad, Al-Delaimy, Pierce,
2008,p. 2). This is showing that this use of pharmaceutical aids is useful and helpful when it
come to quitting smoking versus cold turkey, especially in older adults. The article also claims,
“25.5% (95% CI=24.2%, 26.9%) among 50- to 64-year-olds, representing a 2.6- times increase.”
(Messer, Trinidad, Al-Delaimy, Pierce, 2008, p. 2). These numbers are showing that there is a
higher percentage of pharmaceutical aids used among older adults and that is more successful
In conclusion, the study have shown that quitting smoking cold turkey was the least
effective method. The smokers in the study all showed a need of some alternative method in
order to quit smoking. The research studies conducted showed that more smokers could not
completely quit smoking even with the other alternative methods like nicotine patch or the e-
cigarettes. This has shown how quitting cold turkey is harder on the participants when they have
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 13
smoked for multiple years. They are more likely to revert back to their old smoking habits when
All of the statistics have shown a conclusive argument that favors pharmacologic and
other cessation methods over quitting cold turkey. They have shown that when using alternative
methods, smokers are more likely to not have a relapse and completely cut smoking out of their
lives, versus the other method of quitting cold turkey which they tend to pick up smoking again
in as little as three months. Therefore, the research study has been deemed as successful due to
the studies all related to the fact that using other alternatives are more successful than the method
References
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