Set a quit day and stop all at once on that day, rather than cutting down gradually first

Cost

Free. You just pick a day on the calendar and tell your family and coworkers ahead of time.

What you get

In the UK, 697 smokers were randomly split into two groups. One group stopped all at once on the quit day. The other cut their smoking by 75% in the two weeks before the quit day. Both groups had behavioral support from nurses and used nicotine replacement before and after the quit day. At week 4, 49.0% of the stop-all-at-once group (95% CI 43.8–54.2, the plausible range) had not relapsed, against 39.2% (34.0–44.4) of the gradual group, a relative risk of 0.80 (0.66–0.93). At 6 months it was 22.0% (18.0–26.6) for the all-at-once group and 15.5% (12.0–19.7) for the gradual group, a relative risk of 0.71 (0.46–0.91). People who already preferred cutting down gradually also had a lower success rate at week 4 than people who preferred stopping at once (38.3% against 52.2%).

Notes

Disputed. Cochrane once had a review comparing exactly these two approaches, and concluded they were about the same (RR 0.94, 95% CI 0.79–1.13, 10 trials, 3760 people), but that review was withdrawn in 2019 and is no longer updated. So the best evidence now is the randomized trial above, which points toward stopping all at once. In that trial both groups started nicotine replacement before the quit day, and that practice has its own evidence: starting early rather than on the quit day itself raised success by about 25% (RR 1.25, 95% CI 1.08–1.44, 9 trials, 4395 people, moderate-certainty evidence). So a sensible order is to set the date first, start the patch two weeks ahead, and stop all at once on the day.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Lindson-Hawley N, Banting M, West R, Michie S, Shinkins B, Aveyard P (2016). Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial. Annals of Internal Medicine, 164(9), 585–592. https://doi.org/10.7326/M14-2805
2. Theodoulou A, Chepkin SC, Ye W, et al. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 6, CD013308（提前用尼古丁替代品那一段）. https://doi.org/10.1002/14651858.CD013308.pub2

Translated from the Chinese original. Original book, section 2, tip 4. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer