Ready to Quit Smoking This New Year?
Expert Advice to Help Make Your Attempt Stick
Cigarette cameos appeared in more than half of the top box-office films produced in 2024. A “CigInfluencers” Instagram account claims smoking is cool again. Is cigarette smoking making a comeback?
Taghrid Asfar, M.D., M.S.P.H, professor of Public Health Sciences at the University of Miami Miller School of Medicine, doesn’t think so. “At the national level, reducing smoking has been one of the most successful stories for public health,” she says.
In 1965, shortly after the first major national survey of smoking, 42% of U.S. adults over 18 were smokers. In 2022, that rate dropped to less than 12%.
Over the last 60 years, dramatically reducing smoking at the population level has been an accumulative effect of increasing the age limit for legal smoking, raising prices and public awareness campaigns. Smoking bans in most public spaces helped make the habit taboo.
It doesn’t help when more celebrities are smoking today, but Dr. Asfar doesn’t anticipate cigarettes making a big comeback anytime soon. Instead, she’s focused on hard-to-reach populations where smoking rates remain high, such as underserved populations, HIV patients, cancer survivors and some occupational groups, like construction workers.
For these folks, and for anyone else addicted to nicotine and hoping to quit this New Year, Dr. Asfar shares research and advice on what it takes to extinguish your cigs once and for all.
Why is it so hard to quit smoking?
Smoking isn’t a result of weak willpower. Nicotine cravings are the result of real, measurable changes in the brain’s reward, learning and stress systems. “Part of why it’s tough to quit smoking is because nicotine reaches your brain 10 seconds after you light your cigarette and have the first inhale, making it very addictive,” says Dr. Asfar.
Over time, the craving grows.
Here’s how the smoking craving works in your brain:
- Nicotine binds to receptors on neurons in your brain that give you a dopamine spike.
- Over time, nicotine receptors become desensitized, so your brain creates more receptors to compensate. You’ll need more nicotine to feel the same effect.
- Your brain triggers craving cues as you pair smoking with activities, like driving, drinking coffee or taking work breaks.
Does vaping help you quit cigarette smoking?
Many people mistakenly think vaping helps with smoking cessation. This is by design.
When vaping arrived in the United States in 2010, it was marketed as less harmful than cigarettes. “A lot of people started using vaping to quit smoking,” says Dr. Asfar.
In practice, it doesn’t necessarily work.
An umbrella review of electronic nicotine delivery systems (ENDS) showed vaping can improve smoking cessation in very controlled clinical trials, but this doesn’t apply at the population level.
“The evidence is still not clear comprehensively if vaping has any benefit over smoking,” says Dr. Asfar.
Meanwhile, many others started vaping without ever smoking cigarettes before.
“There’s a disagreement in the tobacco control community. One group is very worried that vaping is normalizing smoking and unraveling decades of work. Others think vaping is good for smoking cessation,” says Dr. Asfar.
Smoking cessation treatment
To quit smoking, what works is a combination of medication, nicotine patches, and behavioral change.
“The best strategies are the combined behavioral and pharmacological intervention because smoking is not only about nicotine addiction, it’s also a coping method,” says Dr. Asfar.
Medication to quit smoking
The most effective smoking cessation medication on the market now is Chantix, which should be prescribed and closely monitored by a healthcare provider. “Chantix works on the nicotine receptor in the brain, blocking nicotine from entering the brain and reducing craving, withdrawal symptoms, irritation and nervousness when you’re trying to quit smoking,” says Dr. Asfar.
Nicotine patches
Meanwhile, over-the-counter nicotine patches feed the body nicotine in slow, small amounts to reduce the craving.
Behavior modification
Several evidence-based smoking cessation apps are designed to make behavior change easier. Some even provide live phone or app support.
If you fail to quit smoking the first few times, that doesn’t mean you’ll never succeed.
“Based on our experience, most people don’t quit on their first attempt. It takes at least 2 to 4 attempts to quit smoking,” says Dr. Asfar.
How to rewire your brain to quit smoking
Once you consistently remove nicotine from your system, your number of nicotine receptors eventually returns to normal — often within several weeks. Your cravings become less frequent and intense as those reward and stress circuits normalize. Behavioral strategies, medications, and nicotine-replacement therapy can all help stabilize these circuits during the transition.
Reduction is also helpful.
In one study, Dr. Asfar and her team reduced participants’ daily cigarettes by 30% over 2-3 weeks.
“Gradual nicotine reduction helped their body cope with the smoker’s addiction slowly,” she says. The good news, says Dr. Asfar, is that through smoking cessation efforts and discouraging people from starting in the first place, the rate continues to decrease overall. “I was in a state meeting for the Tobacco Advisory Committee just recently, and smoking is declining across all groups — youth, young adults and adults.”
Written by Wendy Margolin. Medically reviewed by Taghrid Asfar, M.D., M.S.P.H.
Tags: Coping with cravings, Dr. Alberto Caban Martinez, Dr. Taghrid Asfar, Nicotine withdrawal tips, Smoking triggers, Tobacco harm reduction
