Smoking Cessation: Quitting Cold Turkey vs.

Other Smoking Cessation Techniques 1

The Effectiveness of Quitting Cold Turkey vs. Other Smoking Cessation Techniques

Ariel Aiken, Alyssa Crump, Emmalee Rich, Michaela Huber, Andrew Edie, and Harlie

Silberman

Youngstown State University

Abstract
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 2

This research paper reviews how smoking cessation techniques help fight the addiction to

tobacco and nicotine that is contained in cigarettes. The paper also explains how effective each

smoking cessation technique is that is mentioned within the research done for smoking cessation

while explaining how smoking affects the body. The main research purpose of this paper is as

stated: the effectiveness of quitting cold turkey versus other smoking cessation techniques in

individuals over the age of twenty years old. It has been proven by many studies that quitting

cold turkey is not the most effective way to quit smoking. There is a higher chance of relapse

when choosing to do the cold turkey method over the others such as the nicotine patch,

medications, e-cigarettes, and vaping. It is explained within the paper of which cessation

technique was the most effective.

A variety of studies have been conducted about smoking and the adverse impacts, both

mentally and physically, that the habit has on the smoker. Smoking is linked to many conditions
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 3

and disease processes such as cancer and decreased cognitive functioning. Despite decades of

warnings, including labels on the side of the product, approximately thirty-eight million

Americans still engage in smoking cigarettes on a regular and even daily basis. In addition to

respiratory problems from shortness of breath to cancer, smoking restricts blood flow to critical

organs, most significant of which is the brain. The brain directs every task that an individual

accomplishes. A decreased oxygen supply to the brain can cause ischemia to the extremities and

other vital organs. This may have short and long-term negative effects on the body. Many

smokers feel sluggish and irritable if they cannot have a cigarette and smokers are linked to

having a shorter life expectancy than non-smokers due to the various conditions related to the

addiction.

This research paper examines the effectiveness of quitting smoking cold turkey versus

other smoking cessation techniques in individuals over the age of twenty years old. The research

examined in this paper has demonstrated the cognitive compromise that smoking facilitates on

the body, particularly in individuals over the age of twenty years old. There was a remarkable

result noted when smokers had voluntarily participated in a cognitive screening test that

measured their neuropsychological capabilities. For example, the specific measurements in one

study were as followed: intelligence, language, memory, attention and information-processing

speed, and visual-spatial/constructional skills (Razani, Boone, Lesser, Weiss, 2008). There were

several scales and tests that the volunteers had partaken in, that resulted in lower overall scores

that demonstrated decreased cognitive functioning with smokers versus non-smokers. Some of

the dependent variables noted in this study were as followed: age, education, sex, and vascular

status (illness) (Razani, Boone, Lesser, Weiss). With this information given it has shown

individuals that smoking is not good for the body and mind.
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 4

The effectiveness of quitting depends on the individual and their method to help them

cope with continued desire that the body has for nicotine while not re-engaging in a habit that

will shorten the user’s life. Some of those smoking cessation techniques that will be noted in this

paper will be quitting cold turkey, E-cigarettes and vaping, medications, and the nicotine patch.

However, some cessation techniques have proven more effective/successful than others.

As society has become more aware of the dangers of smoking, multiple smoking

cessation methods and theories have been utilized by the smoker in an attempt not to become the

latest casualty to this most harmful of legal habits. These methods are said to be beneficial if a

smoker is able to cease smoking entirely or switch to a replacement product which may still feed

the body the nicotine it craves without the harmful side effects like heart disease, respiratory

problems, or cancer, of conventional cigarette smoking. E-cigarettes have emerged and gained

popularity as a possible safer alternative to conventional cigarette smoking. According to the

National Academies of Sciences, Engineering, and Medicine, e-cigarettes have lower levels of

toxicants than tobacco cigarettes. Multiple studies have been completed to determine the true

effectiveness of e-cigarette use versus other methods related to cessation of traditional cigarettes.

The researchers in the study: “Can E-Cigarettes and Pharmaceutical Aids Increase

Smoking Cessation and Reduce Cigarette Consumption? Findings From a Nationally

Representative Cohort of American Smokers” examined 3,093 quit attempts nationwide who

used the electronic nicotine delivery systems (ENDS). These researchers evaluated the

effectiveness these electronic products have on long-term tobacco termination (greater than thirty

days) in adults below the age of thirty-five. To conduct this analysis, the researchers used the

federally funded PATH study which warrant self-interviews in both English and Spanish. The

researchers gathered samples from thousands of subjects. They split the interviews into two years
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 5

labeled Wave 1 and Wave 2. Wave 1 had 10,851 subjects who reported that they smoked

regularly. About a year after this interview was conducted, Wave 2 questioned 8,861 (81.7%)

subjects from Wave 1 on whether they still smoked regularly or not. From Wave 1, 5,172

(64.5%) subjects reported no attempt at quitting in the past year and 56 people did not report

details on their attempted cessation of smoking. This left 3,093 subjects remaining for the

researchers’ study (Benmarhnia, Pierce, Leas, White, Strong, Noble, Trinidad, 2018).

A detailed interview composed of amount tobacco used, smoking history, and

sociodemographic characteristics were gathered from these 3,093 participants. These questions

gathered essential research answers from both waves which included the number of cigarettes

they smoked in the past thirty days, how many per day, and how old they were when they began

smoking consistently. They were also asked about any quit attempts. If they admitted to making

a quit attempt, they were then asked if they used e-cigarettes, nicotine patches, nasal spray, etc.

(Benmarhnia, Pierce, Leas, White, Strong, Noble, Trinidad, 2018).

As for the subjects who attempted to quit smoking, 25.2% used ENDS and 23.5% used

one or more approved pharmaceutical product. Overall, 84.5% of this group who attempted to

quit failed and began smoking again by the time Wave 2 interviews came around. The use of

ENDS for quitting tobacco made no difference in the Wave 1 group. When Wave 2 was

conducted, those who used electronic products, such as e-cigarettes, were among the lowest

group to maintain cessation for more than thirty days (Benmarhnia, Pierce, Leas, White, Strong,

Noble, Trinidad, 2018).

Overall, there was no substantial data that proved differences when it came to ENDS

users versus other methods to quit smoking. Most subjects who attempted to quit in this analysis

relapsed and began smoking again. Those subjects who used ENDS to quit were also smoking
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 6

cigarettes while using these electronic products (Benmarhnia, Pierce, Leas, White, Strong,

Noble, Trinidad, 2018). These researchers discovered that ENDS are a more effective cessation

method than most pharmaceutical options, but these electronic products did not appear to remove

or reduce the intake of tobacco cigarettes of these subjects (Benmarhnia, Pierce, Leas, White,

Strong, Noble, Trinidad, 2018).

In addition to electronic based cessation therapies, pharmaceutically recommended drugs

have been studied in their effectiveness to elicit cessation from traditional tobacco cigarettes.

Chantix, otherwise known as varenicline, is a prescription drug that is used to aide in the

cessation of smoking. When smoking, nicotine is attached to the nicotine receptors in the brain

and releases a chemical called dopamine. Dopamine leaves a person with a sense of feeling

good. However, when a person runs out of dopamine, it leaves them with wanting another

cigarette. Thus, the addiction to cigarettes is born. Chantix is believed to work by attaching itself

to the nicotine receptors in the brain therefore disabling the nicotine transfer (Ebbert, Wyatt,

Hays, Klee, & Hurt, 2014). While Chantix allows for the receptors to release some dopamine,

there is not as much released. This allows the person to slowly wean off of cigarettes due to the

diminished reward from not having as much dopamine released. Chantix can be used if the

person is still smoking or if the person completely cuts out smoking and is only using Chantix.

Either way, the drug will do its job (Ebbert, Wyatt, Hays, Klee, & Hurt, 2014).

A research study done entitled: “Unassisted Quitting and Smoking Cessation Methods

Used in the United States” discusses the effectiveness of assisted cessation of smoking using

nonpharmacologic and pharmacologic methods. The study follows assisted methods of cessation

such as Chantix. It also examines completely stopping the use of cigarettes unassisted, i.e.

quitting cold turkey. This study was an analytic sample that was consisting of former smokers
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 7

which included “long-term quitters” and “recent quitters”. The “long-term quitters” were those

who had quit one to three years prior to this survey. The “recent quitters” were adults who have

quit within one year of the study. This study was based on U.S. adult smokers who had quit

smoking already. It was a survey that gathered information to see what methods were used to

quit smoking. Whether it would have been nicotine gum/patches, a phone system to stay in touch

with people trying to quit or people who had used no methods, the people were asked what they

had done to help them to quit (Soulakova & Crockett, 2016).

In this study, 5,788 former U.S. adult smokers were considered to address the first

question they had. The first question was, the prevalence of assisted and unassisted smoking

cessation. Out of the 5,788 people, 2,922 (53.3%) were male and 2,866 (46.7%) were female.

Out of the total people surveyed, only 1,703 (26.3%) used a pharmacologic method (Soulakova

& Crockett, 2016). Also, out of the total 5,788 people only 745 (11.0%) used Chantix as one of

their resources to assisted them in quitting. This study had shown that majority of former

smokers quit unassisted (3,960, 71.6%). Whereas, 1,396 (21.9%) people only used

pharmacologic methods (ie Chantix), 307 (4.4%) used pharmacologic and nonpharmacologic

methods and 125 (2.1%) used only nonpharmacologic methods (Soulakova & Crockett, 2016).

These statistics conclude that quitting smoking unassisted (cold turkey) remains the majority

method of action. However, when we look into the study more, we can see the most used

pharmacologic methods. Out of the 5,788 people, 26.3% used pharmacologic methods to quit.

This being that they either used only pharmacologic or combined with other methods. Among

the former smokers, the most commonly used pharmacologic methods were, a nicotine patch

(45.9%), Chantix (41.8%), and nicotine gum/lozenge (31.1%). This concludes that Chantix is not

the most used pharmacological method. The nicotine gum was the most used pharmacological
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 8

method. However, all of the pharmacologic methods are fairly close in percentages leading that

they are all about the same amount used (Soulakova & Crockett, 2016).

Along with Chantix, Bupropion (Zyban) is a selective serotonin reuptake inhibitor also

used for smoking cessation. This drug increases levels of dopamine and norepinephrine tricking

the body to thinking it is getting the euphoria type feeling nicotine causes. Ultimately, decreasing

cravings usually experienced from lack of nicotine. Often treatment is started while the patient is

still smoking to allowing serum bupropion levels to give full therapeutic effect . Within two

weeks, a date is set to quit while continuing medication (Bornemann, P., Eissa, A., & Strayer, S.

M., 2016). Many are prescribed to start on 150 mg for 3 days and then increase to 150 mg twice

a day (Bornemann, P., Eissa, A., & Strayer, S. M., 2016). The length of treatment is dependent

on individual patient factors such as previous smoking frequency and other possible

comorbidities.

A research study named, “Comparative Effectiveness of Smoking Cessation

Medications: A National Prospective Cohort from Taiwan” discusses comparison of different

pharmacological methods used. A national smoking agency in Taiwan conducted a study

comparing varenicline, bupropion, and nicotine replacement therapy comparing all modalities to

which has better outcome in achieving abstinence among recent quitters. A cohort of 11,968

participants received Varenicline (n=5,052), Bupropion (n=823), NRT gum (n=1944), and NRT

patch (n=4,149) (Chang, P.-Y., Lo, P.-C., Chang, H.-C., Hsueh, K.-C., & Tsai, Y.-W., 2016). All

participants were over the age of 18, wanted to quit smoking, and received a single smoking

pharmacotherapy with up to two treatment courses per year. No more than 8 refills were allowed

for the same cessation medication from the same clinic only a 90 day supply. The results were

based on self-reported interviews of participants recalling a 7-day, 1 month and 6 month timeline
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 9

of there cessation (Chang, P.-Y., Lo, P.-C., Chang, H.-C., Hsueh, K.-C., & Tsai, Y.-W., 2016).

Predominantly, varenicline users were more likely than NRT patch users to achieve abstinence

by the 6-month interview (P<0.001). NRT gum seemed to more effective in specifically the

females at the 6-month mark compared to the NRT patch (OR = 1.76, P = 0.013). Just

varenicline was found to work better than the NRT patch in specifically recent quitters who were

females and moderate nicotine dependent users. After 6 months of use, varenicline cessation

rates were 6% higher than bupropion (Chang, P.-Y., Lo, P.-C., Chang, H.-C., Hsueh, K.-C., &

Tsai, Y.-W., 2016).

Nicotine Transdermal patches have been a supplement used to achieve abstinence from

smoking. These patches can be easily purchased from a drugstore without prescriptions and

decrease withdrawal symptoms. They are applied directly to the skin daily and have varying

doses. Doses of Transdermal Nicotine patches can range from 7 mg to 21 mg depending on

average amount of cigarettes smoked per day and the amount of time since the client has last

smoked a cigarette. Since the patch is placed transdermal, the nicotine in the patch passes

through the skin to reach the bloodstream. Once in the bloodstream, the patch stops nicotine

cravings. The amount of nicotine replaced in the body through the patch is less nicotine than a

cigarette, allowing the body to wean itself off of nicotine. These patches, if used properly, have

been proven to be effective.

Previous clinical trials have proven the effectiveness of Transdermal Nicotine Patches.

The clinical study “Relationship Between Adherence to Daily Nicotine Patch Use and Treatment

Efficacy” examined whether adherence with a daily nicotine patch was related to increased rate

of smoking abstinence. The trial hypothesized an increase of adherence with the nicotine patch

due to easy use and a simple regimen. This was done through a 10-week randomized, double-
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 10

blind, placebo- controlled trial. This study stimulated “over the counter” conditions, allowing the

subjects to have little interference from the clinicians. The subjects were randomized to receive

either a 6-week placebo or a 6-week nicotine patch. Like over the counter stores, subjects

received patches and instructions on their use. They also received other supplementation such as

an audiotape, which included general smoking-cessation advice, and a relaxation regiment. Since

this study was over the counter conditions, no further instructions or interventions were given

throughout the trial. This included the subjects having no contact with the staff. The goal of this

trial was to parallel smokers buying nicotine patches on their own in hopes of quitting. Subjects

returned to be assessed at 6 weeks and 10 weeks. During the assessment, the clients turned in a

smoking diary and received an expired-air CO test. Subjects were only considered abstinence if

they reported no smoking within 7 days and their expired-air CO levels were <10ppm. The

populations had an average age of 42.8, weight of 77.3kg, length of smoking being 24.4 years,

35.2 cigarettes a day. Of 371 subjects, 253 remained adherent while 118 became nonadherent.

Subjects who were adherent by 3 weeks of application had improved chances of smoking

cessation. In conclusion, with a Transdermal Nicotine patch and over the counter conditions,

rates of adherence increased as opposed to a Placebo patch (Shiffman, S., Sweeney, C. T.,

Ferguson, S. G., Sembower, M. A., & Gitchell, J. G., 2010).

This study is directly related to our topic because it discerns results of a Nicotine patch

versus quitting without supplementation (Placebo). Because the body is still receiving a small

amount of Nicotine within the bloodstream, craving and withdrawal symptoms are minimal. This

allows the treatment to be effective creating an easier transition to smoking abstinence. In

opposition, quitting cold turkey creates difficult withdrawal symptoms and a problematic

situation. People who quit without a treatment have a challenging time and a higher chance of
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 11

returning to smoking habits. With the proper use and correct dose, the transdermal nicotine patch

is very effective.

The survey that was found involved viewing smoking rates in the United States

comparing young adult and older smokers. The survey was done nationally in order to determine

the smoking cessation rates between the two specific groups. The age groups used in this

research were ages 18-64 which is a very wide range to compare. The results of the survey

showed that younger adults which ranged from 18-24 were more likely to have quit for 6 months

or longer. The research also showed that younger adults were less likely to use pharmaceutical

aids. The research conducted by the group involved the ages over 20 years of age. This survey

found was important to include because it focuses on why older adults are the better focus when

it comes to quitting smoking.

The group compared older adults above the age of 20 quitting smoking cold turkey versus

using other techniques. The information conducted by the survey showed older adults needing

the use of pharmacological aids compared to those younger. Therefore, the study of the research

is necessary to compare so that there is evidence of older adults being the more appropriate age

group to evaluate. The article states, “The use of any pharmaceutical aid during the most recent

quit attempt was 19.4% overall and 6.3% for nicotine gum, 11.8% for a patch, less than 1.0% for

a nasal spray, 1.2% for lozenges, 1.3% for an inhaler, 1.4% for tablets, and 6.2% for an

antidepressant prescription since Nicotine is the addictive chemical in smoking tobacco, as

Zyban, bupropion, or Wellbutrin. Use of any pharmaceutical aid during the most recent quit

attempt increased significantly with each higher age” (Messer, Trinidad, Al-Delaimy, Pierce,

2008,p. 2). This is showing that this use of pharmaceutical aids is useful and helpful when it

come to quitting smoking versus cold turkey, especially in older adults. The article also claims,
Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 12

“25.5% (95% CI=24.2%, 26.9%) among 50- to 64-year-olds, representing a 2.6- times increase.”

(Messer, Trinidad, Al-Delaimy, Pierce, 2008, p. 2). These numbers are showing that there is a

higher percentage of pharmaceutical aids used among older adults and that is more successful

among that age group than quitting cold turkey.

In conclusion, the study have shown that quitting smoking cold turkey was the least

effective method. The smokers in the study all showed a need of some alternative method in

order to quit smoking. The research studies conducted showed that more smokers could not

completely quit smoking even with the other alternative methods like nicotine patch or the e-

cigarettes. This has shown how quitting cold turkey is harder on the participants when they have

smoked for multiple years. They are more likely to revert back to their old smoking habits when

trying to quit abruptly by themselves.

All of the statistics have shown a conclusive argument that favors pharmacologic and

other cessation methods over quitting cold turkey. They have shown that when using alternative

methods, smokers are more likely to not have a relapse and completely cut smoking out of their

lives, versus the other method of quitting cold turkey which they tend to pick up smoking again

in as little as three months. Therefore, the research study has been deemed as successful due to

the studies all related to the fact that using other alternatives are more successful than the method

of quitting cold turkey.

Smoking Cessation: Quitting Cold Turkey vs. Other Smoking Cessation Techniques 13

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