How to Quit Smoking: What Works, Ranked by Evidence

If you want to know how to quit smoking, the most useful fact is this: the methods that work best are not the ones most men try. Most smokers quit cold turkey, with no medicine and no support, and most of those attempts fail within weeks. The approaches with the strongest evidence, such as varenicline, combination nicotine replacement and structured support, can double or more your chance of success.

This guide ranks the main options by the strength of the evidence behind them, using large reviews from Cochrane and the US Preventive Services Task Force. It explains what each one involves, how to build a quit plan around it, how to handle cravings and slips, and what happens to your body after you stop. It does not recommend any brand or product.

What quitting does for you, at any age

Quitting is the single most effective change a smoker can make for his health, and the benefits start sooner than most men expect.

For a stage-by-stage look at the recovery, from the first 20 minutes to 15 years, see what happens when you quit smoking.

A large study published in the New England Journal of Medicine in 2013 by Jha and colleagues followed US adults and found that smokers lost at least ten years of life compared with people who had never smoked. Quitting before age 40 cut the extra risk of death linked to continued smoking by about 90%. Men who quit between 25 and 34 gained about ten years of life, those who quit between 35 and 44 gained about nine, and those who quit between 45 and 54 gained about six. Stopping at any age helps.

According to the American Cancer Society and the US Surgeon General, the body starts to recover on a predictable timeline:

Smoking also affects things men care about day to day. It damages blood vessels, including the ones involved in erections, and it is one of the established causes covered in our guide to erectile dysfunction causes. It raises blood pressure and harms the heart, which is why stopping sits near the top of our complete guide to heart health for men.

Why quitting is hard

Nicotine is addictive. It reaches the brain within seconds of a puff and triggers a release of dopamine, which the brain quickly learns to expect. When nicotine levels fall, the brain signals for more. That is withdrawal, and it is why the first days and weeks after stopping are the toughest.

The habit side is just as strong. Most smokers link cigarettes to particular moments: the first coffee, the drive to work, a break with colleagues, a drink in the evening. Those cues trigger cravings long after the physical withdrawal has passed.

That is why the most effective quit plans tackle both sides. Medicine reduces the withdrawal and cravings driven by nicotine. Support and planning deal with the habits and triggers. Willpower alone has to fight both at once, which is why it so often fails.

How to quit smoking: the options, ranked

The US Preventive Services Task Force gives its highest grade (A) to offering adults who smoke both behavioral support and FDA-approved medicine, alone or together. Its 2021 recommendation found with high certainty that the benefit is substantial.

The ranking below shows how to quit smoking with the best odds, based on the strength and size of the effect in randomised trials. Combining a medicine with support beats either one alone.

Two caveats. First, the best method is the one you will use properly; an effective medicine taken for a week and abandoned will not help much. Second, your doctor may steer you towards or away from particular options depending on your health and other medicines.

Quit smoking medicines in detail

Varenicline

Varenicline is a prescription tablet that partly stimulates the brain’s nicotine receptors while blocking nicotine from cigarettes. In practice, it eases cravings and makes smoking less rewarding if you slip.

A 2023 Cochrane review by Livingstone-Banks and colleagues, covering 75 trials and more than 45,000 people, found high-certainty evidence that varenicline helped more people quit than placebo or no medicine, with more than twice the quit rate (risk ratio 2.32). Put another way, for about every eight people treated, one extra person quit who otherwise would not have.

The same review found no clear difference between varenicline and combination nicotine replacement. Both are top-tier options.

Varenicline is usually started one to two weeks before your quit date, and the dose is increased gradually. The most common side effect is nausea, which is often eased by taking it with food and water.

Was varenicline linked to mental health problems?

For years, concerns about mood changes made some men and doctors wary. The EAGLES trial, published in the Lancet in 2016, was designed to answer that question. It enrolled 8,144 smokers, about half of them with a stable psychiatric condition, and compared varenicline, bupropion, a nicotine patch and placebo.

Neither varenicline nor bupropion significantly increased moderate to severe neuropsychiatric side effects compared with placebo or the patch, in people with or without a psychiatric history. Varenicline also produced the highest quit rates, with odds of quitting 3.6 times those on placebo and about 1.7 times those on the patch or bupropion. If you have a history of depression or other mental health conditions, tell your doctor, who can monitor you, but it does not usually rule these medicines out.

Nicotine replacement therapy (NRT)

Nicotine replacement gives your body nicotine without the smoke, which contains most of the harmful chemicals. It comes as patches, gum, lozenges, inhalers, mouth sprays and nasal sprays. Many forms are available without a prescription.

A 2018 Cochrane review by Hartmann-Boyce and colleagues pooled 133 trials with more than 64,000 people and found that any form of NRT increased quit rates by about 55% compared with no NRT or placebo (risk ratio 1.55).

How you use it matters a great deal:

• Combine two forms. A 2023 Cochrane review found that using a patch together with a fast-acting form, such as gum or a lozenge, led to higher long-term quit rates than using one form (risk ratio 1.27). The patch gives a steady background level; the fast-acting form handles sudden cravings.
• Use enough. Heavier smokers usually need a higher-strength patch. Underdosing is one of the most common reasons NRT seems not to work.
• Use it for long enough. Most courses last at least 8 to 12 weeks, stepping down gradually.

Cytisine

Cytisine is a plant-based medicine that works in a similar way to varenicline. The 2023 Cochrane review found moderate-certainty evidence that it helps more people quit than placebo (risk ratio 1.30). In head-to-head trials, its effect was close to varenicline’s, though the evidence could not rule out a small difference either way. It is licensed in some countries but not all, so ask your doctor or pharmacist whether it is an option where you live.

Bupropion

Bupropion is a prescription tablet originally developed as an antidepressant. It reduces cravings and withdrawal symptoms. In the EAGLES trial it worked better than placebo, but varenicline beat it in direct comparison. It can be a useful option for men who cannot take varenicline or would prefer a different approach.

Vaping as a way to quit

Nicotine e-cigarettes are the most debated option, and the evidence has moved quickly.

The Cochrane living review of e-cigarettes for smoking cessation, updated in 2025, found high-certainty evidence that nicotine e-cigarettes help more people stop smoking than nicotine replacement therapy (risk ratio 1.55). The review included more than 100 studies and is updated as new trials are published.

There are important limits:

• US guidance is more cautious. The US Preventive Services Task Force concluded in 2021 that the evidence was insufficient to recommend e-cigarettes for quitting, and advised clinicians to point people towards methods with established effectiveness and safety. E-cigarettes are not FDA-approved quit aids.
• They are not risk-free. Vaping is far less studied over the long term than smoking, and its long-term effects are still unknown.
• The goal is to stop smoking completely. Using e-cigarettes alongside cigarettes, often called dual use, does not deliver the same benefit.
• Plan to stop vaping too. If you switch, treat it as a step, and aim to come off nicotine entirely over time.

If you have never smoked, none of this is a reason to start vaping. For the full picture on toxins, heart and lung risk and dual use, see our guide to vaping vs smoking.

Support: the part most men skip

Many men treat working out how to quit smoking as a private test of willpower. The evidence says otherwise: behavioral support adds to the effect of medicine, and the USPSTF gives it the same top grade.

Support can take several forms, and you do not have to sit in a group circle:

• Quitlines. Free telephone coaching. In the US, call 1-800-QUIT-NOW. In the UK, local NHS Stop Smoking Services offer free support and can supply medicines.
• Your doctor or pharmacist. They can prescribe or recommend medicines, set doses and check in with you.
• Text and app programmes. Many health services offer free text-message or app support that sends tips at the times you are most likely to crave.
• People around you. Telling a partner, friend or colleague raises the stakes and gives you someone to call when it gets hard.

Stress is one of the most common triggers for relapse. Building other ways to deal with it, covered in our guide on how to manage stress, makes the cigarette less tempting as the default response.

Your quit plan, step by step

This is how to quit smoking in practice. The plan below combines the strongest evidence into steps you can follow.

1. Set a quit date within the next two weeks. Close enough to keep momentum, far enough to prepare. If you choose varenicline, you will usually start it one to two weeks before this date.
2. Choose your medicine. Talk to your doctor or pharmacist about varenicline or combination NRT, the two strongest options. Get it in hand before quit day.
3. Line up support. Register with a quitline or stop smoking service, download a support app, or tell the people you see most.
4. Map your triggers. For a few days before quitting, note when and why you smoke. Pick a plan for each trigger, such as a short walk after meals or chewing gum on the drive.
5. Clear your space. On the night before, remove cigarettes, lighters and ashtrays from your home, car and bags.
6. Quit completely on the day. Not a single puff. The evidence favours stopping on a set day, ideally with medicine already in your system.
7. Take your medicine as directed for the full course. Stopping early is one of the main reasons people relapse.
8. Plan for alcohol. Drinking is a powerful trigger and lowers your guard. Consider cutting back for the first few weeks; our guide to alcohol and belly fat covers why cutting back helps in other ways too.

Stop all at once, or cut down first?

A 2016 trial in the Annals of Internal Medicine by Lindson-Hawley and colleagues randomised 697 smokers in English GP practices to quit abruptly on a set day or to cut down gradually over two weeks first. Both groups got support and nicotine replacement. At six months, 22% of the abrupt group were still not smoking, compared with 15.5% of the gradual group. Much of the difference came from people in the gradual group being less likely to make a quit attempt on the day.

The practical lesson: if you can, pick a date and stop completely. If you are not ready for that, cutting down with nicotine replacement is still a reasonable route towards quitting, and better than not trying.

Handling cravings and withdrawal

Withdrawal symptoms are usually strongest in the first few days after quitting and ease over the following weeks. Common ones include cravings, irritability, restlessness, trouble concentrating, low mood, increased appetite and disturbed sleep. They are uncomfortable but temporary, and the right medicine makes them much milder.

Individual cravings usually pass within minutes. A few tactics help you ride them out:

• Delay. Tell yourself you will wait ten minutes. Most cravings fade in that time.
• Use your fast-acting NRT, if you are on combination therapy. That is what it is for.
• Move. A brisk walk, a few push-ups or climbing the stairs can blunt a craving.
• Change the setting. If a place or routine triggers you, change it for the first few weeks.
• Keep your hands and mouth busy. Sugar-free gum, a drink of water or a toothpick can stand in for the ritual.

If you slip

A single cigarette is not a failure, and it does not mean you are back to smoking. Treat it as information: what triggered it, and what will you do differently next time? Keep taking your medicine and get straight back to not smoking. Many people who succeed have made several attempts first.

Other approaches you may hear about

Hypnosis, acupuncture, laser therapy and similar treatments are widely advertised. Cochrane reviews have not shown clear long-term benefit from acupuncture and related treatments, and the evidence for hypnotherapy is too limited to say whether it helps. If you want to try one of these, use it alongside a proven method rather than instead of one.

Willpower apps, rewards and money-back pledges can help some people stay motivated, but they are add-ons. The core of a strong plan is still medicine plus support.

What to expect in the first weeks

Knowing what is coming makes it easier to hold your nerve.

The first few days

This is usually the hardest stretch. Cravings are frequent and you may feel irritable, restless or low. Some men notice they cough more for a while as the lungs begin to clear. Keep your quit medicine going, use your fast-acting NRT if you have it, and keep busy.

Weeks one to four

Withdrawal symptoms usually ease steadily. Cravings come less often, though triggers such as alcohol, stress or a particular routine can still set them off. This is when many relapses happen, often because people feel they have beaten it and lower their guard. Stick with the plan.

After the first month

Most of the physical withdrawal has passed. Occasional cravings tied to old habits can still appear for months, but they become weaker and further apart. Keep taking your medicine for the full course your doctor or pharmacist recommends, even if you feel fine.

If you smoked for years: lung cancer screening

Quitting lowers your risk of lung cancer over time, but it does not erase years of smoking straight away. The US Preventive Services Task Force recommends a yearly low-dose CT scan for adults aged 50 to 80 who have a 20 pack-year smoking history and either still smoke or quit within the past 15 years.

A pack-year means smoking one pack a day for a year, so 20 pack-years could be a pack a day for 20 years or two packs a day for 10. If that describes you, ask your doctor about screening. Also see a doctor promptly about a cough that will not go away, coughing up blood, or unexplained weight loss; our guide to symptoms men should not ignore lists other warning signs.

Common worries about quitting

“I’ll put on weight”

Many people do gain some weight after quitting, often a few kilograms, partly because nicotine suppresses appetite and partly because food replaces the cigarette. The health gain from stopping smoking far outweighs the risk from modest weight gain. Regular activity, filling snacks and keeping an eye on alcohol all help.

“Smoking helps me cope with stress”

It feels that way because each cigarette relieves the withdrawal that built up since the last one. A 2021 Cochrane review of 102 studies found that people who stopped smoking for at least six weeks had less depression, anxiety and stress than those who kept smoking, and found no sign that quitting made mental health worse. If you notice signs of ongoing stress, our guide to chronic stress symptoms in men can help you spot them.

“I’ve tried before and failed”

Previous attempts are normal, and each one teaches you something about your triggers. If you tried cold turkey last time, switching to medicine plus support changes the odds substantially.

“I only smoke a few a day, so it doesn’t matter”

Even light smoking carries significant risk to the heart and blood vessels. Cutting down is a reasonable step towards quitting, but stopping completely delivers the full benefit. Our guide to smoking and heart disease shows why even one cigarette a day matters.

“It’s too late for me”

It is not. The Jha study found life-expectancy gains from quitting at every age it measured, and the heart benefits begin within a year or two. Quitting also improves the results of many other health checks; our men’s health checklist by age shows what to keep an eye on.

Questions to ask your doctor or pharmacist

A short appointment is enough to set you up with the right medicine. These questions help you get the most from it:

• Is varenicline or combination nicotine replacement the better fit for me, given my health and other medicines?
• What dose should I start on, and when should I start it relative to my quit date?
• How long should I take it, and how do I come off it?
• What side effects should I watch for, and what should I do if I get them?
• Is there a local stop smoking service or quitline you can refer me to?
• Do I qualify for lung cancer screening, or any other checks, given my smoking history?

If cost is a concern, ask about that too. Many health systems and insurers cover quit smoking medicines and support, and some stop smoking services supply them free.

Frequently asked questions

What is the best way to quit smoking?

The strongest evidence supports combining a medicine, such as varenicline or combination nicotine replacement, with behavioral support such as a quitline or stop smoking service. Together they work better than either one alone, and far better than willpower alone.

Is quitting cold turkey better than cutting down?

Choosing a quit date and stopping completely on that day, ideally with medicine already started, tends to work well. If you are not ready to stop outright, cutting down with nicotine replacement can be a step towards quitting.

How long do nicotine cravings last?

Withdrawal is usually worst in the first few days and fades over the following weeks. Individual cravings usually pass within minutes. Triggers linked to habits can return occasionally for longer, but they become weaker and less frequent.

Is varenicline safe?

For most people, yes. The large EAGLES trial found no significant increase in serious mental health side effects compared with placebo, including in people with stable psychiatric conditions. Nausea is the most common side effect. Your doctor will check whether it suits you.

Can vaping help me quit smoking?

Trials summarised by Cochrane show nicotine e-cigarettes help more people quit than nicotine replacement therapy. They are not risk-free, their long-term effects are not yet known, and US guidance remains cautious. If you use them, switch completely and plan to stop vaping later.

How soon do the health benefits start?

Some changes begin within days, and your risk of heart attack drops sharply within one to two years. After about ten years, your risk of dying from lung cancer is about half that of someone who still smokes.

The bottom line

Learning how to quit smoking comes down to using the methods with the strongest evidence instead of relying on willpower alone. Varenicline or combination nicotine replacement, paired with support from a quitline, stop smoking service or your doctor, gives you the best odds. Set a date, plan for your triggers, take your medicine for the full course and treat slips as lessons, not failures. Quitting at any age adds years to your life, and the benefits to your heart start within months.

This article is for general information and is not medical advice. Talk to your doctor or pharmacist before starting any quit smoking medicine, especially if you have a heart condition, a mental health condition or take other medicines.

Sources

1. US Preventive Services Task Force: Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons (2021)
2. Livingstone-Banks J et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews, 2023
3. Hartmann-Boyce J et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews, 2018
4. Cochrane review: Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation (2023)
5. Lindson N et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, 2025
6. Anthenelli RM et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES). Lancet, 2016
7. Jha P et al. 21st-Century Hazards of Smoking and Benefits of Cessation in the United States. N Engl J Med, 2013
8. American Cancer Society: Health Benefits of Quitting Smoking Over Time
9. Cochrane: Stopping smoking is linked to improved mental health (Taylor G et al., 2021)
10. Lindson-Hawley N et al. Gradual versus abrupt smoking cessation: a randomized, controlled noninferiority trial. Ann Intern Med, 2016
11. US Preventive Services Task Force. Screening for Lung Cancer: Recommendation Statement. JAMA, 2021