Quitting smoking: The path to this is difficult for many.

Nicotine patches, a strong will, and social support – what are the key factors in helping people quit smoking? Experts say several attempts are often necessary, along with support from others. Statistically speaking, a combination of nicotine replacement therapy and support – in special groups or through other means – is the most promising, says Marina Hinßen of the Charité Hospital in Berlin.

The Frankfurt Institute for Addiction Research surveyed nearly 6,200 smokers and ex-smokers in 2022. When asked what helped them quit, over 2,000 participants cited willpower. Support from their social environment came in second. Nicotine replacement therapy was a game changer for just over 1,000 respondents.

According to the survey, those who quit smoking needed an average of about four serious attempts to quit. The turning point was often an illness or, in women, pregnancy. Some also quit for the sake of their children, grandchildren, or partners. A frequently cited motivation was "bad smell."

The first step is a smoking cessation date, says Gertraud Stadler of the Charité Hospital in Berlin. Conditions such as an upcoming vacation with a change of location are helpful. "Anything that helps break habits."

The first few days can be characterized by severe withdrawal symptoms. Social support, encouragement, and praise are important during this time, explains Stadler. It's not an easy time for the partner either; the smoker is very irritable and may also exhibit physical symptoms such as sweating.

Distraction and walks are helpful. Nicotine patches and gum can help decouple the habit from the behavior and help you taper off nicotine, Stadler says.

Many participants in the Frankfurt study found substitute behaviors helpful: In addition to eating and exercising, for example, “five push-ups when I feel like smoking” and “smelling the ashtray” were mentioned.

Smoking together is difficult to replace. Study participants frequently cited rituals associated with reaching for a cigarette: smoking breaks at work or meeting other smokers at a bar, for example.

The Frankfurt analysis states that “behavioral aspects, especially long-standing habits and situations with a trigger function, are significantly more important for maintaining smoking habits than manifest symptoms of addiction.”

No, as Hinßen says: Almost everyone manages to quit smoking at some point. "If I truly want to be mentally free and independent, then that will naturally work by replacing everything with something positive and by truly changing my structures and habits." Behavioral approaches are more important than focusing on nicotine addiction.

Official regulations also play a role. In Australia, for example, smoking is prohibited in many public places, and people must maintain a safe distance from entrances. "These social measures are actually the most effective," says Stadler. They make it easier for smokers to smoke less in public spaces and become smoke-free.

There's no clear answer to this question, says Hinßen, team leader of the "nachvorn" smoking prevention project. While statistically speaking, the chances of success are somewhat higher if someone quits smoking tobacco cigarettes using a nicotine-containing e-cigarette than without, a large proportion then stick with e-cigarettes and have essentially just shifted their addiction: their nicotine dependence persists. And, according to initial study results, e-cigarettes also have health consequences.

Although the overall levels of harmful substances in e-cigarettes are lower than in tobacco cigarettes, they still impair the respiratory system and place a strain on the cardiovascular system, says Hinßen. Furthermore, there are substances released during the vaporization process whose health effects are still little known – due to a lack of long-term studies.

Stadler adds that vaping causes less environmental pollution. It's also expected that the lower levels of carcinogenic substances will result in fewer lung cancers and other types of cancer, as well as less cardiovascular stress. At the same time, however, it's unknown whether other substances also increase the risks. "The trivialization of e-cigarettes should be a very serious question mark."