Smoking cessation: Is abrupt quitting more effective than a gradual approach?

Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P. Gradual versus abrupt smoking cessation. A randomized, controlled noninferiority trial. Ann Intern Med 2016;164(9):585-592.

• Patients in the “abrupt cessation group” were asked to stop smoking on their quit day. Participants in the “gradual cessation group” were also given short-acting nicotine products (gum, lozenges, nasal spray, sublingual tablets, inhalator, or mouth spray) and asked to reduce smoking to half of the baseline amount by the end of the first week and to a quarter of the baseline amount at the end of the second week.
• At both 1 month and 6 months, validated abstinence rates were higher in the abrupt cessation group: 49.0% vs 39.2% at 1 month (relative risk [RR] 0.80; 95% CI 0.66 to 0.93) and 22.0% vs 15.5% (RR 0.71; 0.46 to 0.91) at 6 months.
• At 1 month, one additional patient will be successful for every 13 patients who abruptly stop instead of stopping gradually (number needed to treat [NNT] = 12.8; 7.5 – 38.4). At 6 months, the benefit is not quite as large (NNT = 22.2; 11.9 – 71.7).

A. For motivated patients, quitting abruptly on a set date, preceded by 2 weeks of nicotine replacement via a patch, is more effective than doing the same preparation but gradually cutting down before stopping, even when each omitted cigarette is replaced with a hit of nicotine.