To cut down or quit all at once?

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Most specialist smoking cessation services advise patients to select a quit date and quit smoking completely on that day (usually along with medication), but many smokers prefer the idea of cutting down gradually. What are the pros and cons?

I theory, cutting down gradually might provide a “softer landing” in that it might spread out the nicotine withdrawal over a longer period, rather than giving the nicotine receptors an abrupt shock of no nicotine. It also seems to fit with common sense that it might be easier to change the behavior gradually rather than all at once.

Smoking cessation services got into the habit of advising on abrupt cessation partly because they typically use nicotine replacement therapy and the labeling on the product has always advised on abrupt cessation. However, after decades of experience with nicotine replacement therapy (NRT) we now know that not only is there no real extra danger in smoking while using NRT, there is now some fairly consistent evidence that wearing the nicotine patch for 2 weeks prior to quitting smoking results in higher long-term quit rates. So some of our original reasons for preferring an abrupt quit no longer hold much water.

But when considering cutting down gradually there are a few things to bare in mind. The first one is that when smokers reduce their cigarette consumption by 50% they typically do not reduce their smoke (or nicotine) intake by 50%. Instead they tend to increase the amount they inhale from each cigarette. So it is important not to be fooled into thinking that by cutting down from 20 per day to 5 per day you have made a big difference to your health. In fact you may be sucking down 3 times as much smoke per cigarette and so have reduced your toxin intake only slightly.

The other thing to beware of is a very gradual reduction plan, lasting more than 6 weeks. Unfortunately, the longer your reduction timescale, the greater the chance that sometime in that time frame some life stress will come along and cause you to abandon the whole plan.

But these are not major problems for gradual reduction, so long as you have a clear plan to get down to zero cigarettes per day by a specific date, in the near future (like 3 weeks after you start reducing), and you stick to it.

The advantage of having an abrupt quit date with no gradual reduction is that it enables you to get on with it when you are feeling ready, and it means that the withdrawal phase will be over sooner. Some people liken it to the difference between pulling off a sticking plaster all at once versus pulling it off gradually.

Personally I think it is reasonable to leave the choice down to personal preference. But I would advise all smokers to consider using a smoking cessation medicine from the day they start reducing. This will make it less likely that they increase the amount they inhale from each cigarette, will make the reduction process feel easier, and will prevent the smoker becoming obsessed by thoughts of the next cigarette by the time they get down to less than 5 per day.

The key is to select a quit day, whether it’s right at the start of the process or a few weeks later, and stick to your plan.
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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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