Ready to quit smoking? Check out these new alternatives to make it last this time

It is never too late to quit tobacco. If you’ve tried but have not been successful, or returned to smoking, it’s worth exploring some new approaches that could be a better fit for you. For those who are able to succeed, whether on a first or fifth attempt, the rewards are great. Tobacco cessation is often the single most important thing a person can do to reduce cancer risk, improve cardiovascular health and avoid debilitating respiratory disease.

The truth is that most people know about the health risks of smoking like lung cancer and chronic obstructive pulmonary disease. Last month I saw one of my patients in the clinic after he had been hospitalized for the third or fourth time in 2023 with respiratory complications of smoking. We talked about how he was doing and how to adjust his medical therapy. Then I asked him about his smoking and what I could do to help him quit tobacco. We had talked about tobacco many times before. He knew the impact it was having on his health. He had even quit successfully for short periods in the past, but he felt powerless and discouraged to give it up for good. But different approaches work for different people, and we discussed other methods like focusing on different motivators with acceptance and commitment therapy (ACT).

It's true that quitting is challenging for many people, and it doesn’t always happen the first time, as many as half of those who try don’t quit or relapse on the first try. The challenges of stopping smoking are less of a testament to lack of individual will power as they are testament to the incredibly difficult task of changing one’s lifestyle, especially with a habit so addictive as smoking. If you’ve tried to quit but haven’t done so yet, give yourself some grace, and don’t shy away from trying again – perhaps with a different approach. So, what are the best ways to break the habit of smoking?

The standard approach

Currently, the standard tobacco cessation approach is to pair prescription medication with cognitive behavioral therapy (CBT). CBT for tobacco cessation, whether done as an individual or as part of a group, usually focuses on understanding why someone smokes and then avoiding, controlling or distracting from those triggers.

Understanding the 'why' behind your habits

The “why” of smoking can be complicated. Sometimes it has to do with managing stress or the comfort of a familiar routine. Sometimes it has to do with how a person grew up or the behaviors of co-workers or family members. In the CBT model, understanding someone’s “why” for smoking leads directly to identifying triggers that can be modified.

For example, if smoking is a way to relieve stress at work, then finding other ways to reduce stress at work might make it easier to quit. Perhaps moving into a less stressful role or reporting to a supervisor with a different management style can make attempts to quit more successful. If all else fails, distracting oneself with a different habit can lessen the desire to smoke – such as walking during the lunch hour, chewing gum or squeezing a stress ball.

CBT and prescription medications represent the conventional wisdom on how to quit tobacco and are still the first thing to try for those interested in quitting. However, it doesn’t work for everyone, at least not on the first attempt, and different people often need different approaches to quit tobacco. So, it is encouraging that recent evidence suggests an alternative to CBT has similar long-term results.

An alternative approach

Acceptance and commitment therapy (ACT) paired with prescription medications is emerging as an alternative to CBT. Rather than focusing on why someone smokes, ACT puts more emphasis on their why for quitting. Rather than control, avoid or distract from the things that trigger smoking, ACT encourages people to commit to a course of action consistent with their values then be mindful and acknowledge cravings without acting on them.

A new 'why' to strengthen motivation

Perhaps someone’s why for quitting is that they don’t want to pass a bad habit down to their children or that they want to be healthy to enjoy their later years with family. Identifying and returning to that motivation is important in ACT. Research shows that willpower can be strengthened or weakened through behavior. Contemplating your why can grow your resolve and prepare you for the challenge ahead.

Acknowledge cravings

Similarly, acknowledging a craving can be empowering. Avoiding triggers to smoke, controlling situations or distracting from cravings can work to a point. But eventually there will be a trigger you cannot avoid, a situation you cannot control or a craving from which you cannot distract yourself. Recognizing little successes facing one’s craving while maintaining one’s resolve can lead to bigger successes.

Imagine a person trying to deal with fear of public speaking and consider the different approaches. In the CBT approach you might avoid situations where you would be asked to speak, or you might try to control the situation by writing prepared remarks ahead of time, or you might distract from the fear by imagining everyone in the audience is actually a close friend. The approach with ACT is more akin to deciding that you want to get over your fear of public speaking and deciding to do so by gradually speaking in front of others more and more until it feels more comfortable.

In studies comparing ACT to CBT (participants also received prescription medication in both groups) tobacco cessation rates were similar in the two groups over the long-term.

I talk with my patients about tobacco. I talk with my family about it also. I encourage them to find the motivation and the courage to quit, and I let them know that when they are ready, I am here to help. A new year is a time for new resolutions, often relating to health, and it really is never too late to quit tobacco. If you currently smoke and would like to quit, speak with your clinician about how they can support you with prescriptions and referrals.

Peter Barkett, MD, practices internal medicine at Kaiser Permanente Silverdale and writes a regular column for the Kitsap Sun. He lives in Bremerton.