Is it better to quit smoking cold turkey or gradually?

Key takeaways

• A 2019 Cochrane review found cutting down first and quitting abruptly give similar long-term quit rates (moderate-certainty evidence).
• A 697-person trial in England found 22.0% of abrupt quitters vs. 15.5% of gradual quitters were abstinent at 6 months.
• Cutting down may work better with medication such as fast-acting NRT or varenicline, but that evidence is low-certainty.
• Nicotine replacement therapy increases quit rates by 50% to 60%, according to a 2018 Cochrane review.
• Counseling and medication together can more than double your chance of quitting (WHO, CDC).

Is cold turkey or cutting down more effective?

The strongest summary of the evidence finds no clear winner. A 2019 Cochrane systematic review compared reduction-to-quit approaches, meaning cutting down before stopping completely, with quitting abruptly across 22 studies and 9,219 participants. It found moderate-certainty evidence that neither approach results in superior long-term quit rates.

Based on this review, people who prefer to cut down first are not choosing a clearly worse method, and neither are people who prefer to stop all at once.

Didn't a major study find cold turkey works better?

One large trial did. In a 2016 randomized trial published in Annals of Internal Medicine, 697 adult smokers at primary care clinics in England either quit abruptly or cut down by 75% over the 2 weeks before quitting. Both groups received behavioral support from nurses and used nicotine replacement before and after their quit day.

Abrupt quitting came out ahead, and the authors concluded that quitting abruptly is more likely to lead to lasting abstinence than cutting down first, even for people who initially preferred to cut down. The later Cochrane review, which pooled 22 studies, did not find a clear difference overall, so the evidence is best described as mixed.

• At 4 weeks: 49.0% of the abrupt-quitting group were abstinent vs. 39.2% of the gradual group.
• At 6 months: 22.0% of the abrupt-quitting group were abstinent vs. 15.5% of the gradual group.

Does cutting down work better with medication?

Possibly. The Cochrane review found low-certainty evidence that cutting down may be more effective when medication is used as an aid, particularly fast-acting nicotine replacement therapy (NRT) or varenicline.

NRT itself is well supported. A 2018 Cochrane review found high-quality evidence that all licensed forms of NRT, including gum, patches, nasal spray, inhalators, and tablets or lozenges, help people who try to quit, and that NRT increases the rate of quitting by 50% to 60%.

What improves your chances of quitting either way?

Support. The WHO says counselling and medication can more than double a tobacco user's chance of quitting successfully, and the CDC says that counseling and medication are each effective alone but together can more than double your chance of success. Options the CDC lists include nicotine patches, gum, and lozenges, and prescription pills such as varenicline and bupropion that you can discuss with your doctor.

Many people don't use this help. The CDC reports that in 2022, 53.3% of U.S. adults who smoked tried to quit in the past year, and 38.3% of those who tried to quit or recently quit used counseling or medication. In the U.S., you can reach a quitline coach at 1-800-QUIT-NOW.