Podcast: Can people stop smoking by cutting down the amount they smoke first?

There are more than 50 Cochrane Reviews of the effects of interventions to help people quit smoking; one of which investigates whether reducing smoking before quitting might be an alternative to stopping suddenly. It was updated in September 2019 and we asked lead author, Nicola Lindson, from the Cochrane Tobacco Addiction Group based in the University of Oxford in the UK to tell us about their latest findings.

The standard way that people are told to quit smoking is to smoke as normal until a quit day, and then stop using all cigarettes. However, this is daunting for many, and those who have tried it without success might like to try another way. Cutting down on cigarettes smoked before quitting may provide such an alternative, and so it’s important to know whether it is as effective as quitting abruptly.

Our review investigates this and we’ve found that there is moderate quality evidence that people who were asked to stop smoking all of their cigarettes at once were not more likely to quit than people who were asked to cut down their smoking before quitting. We had also wanted to explore whether cutting down to quit resulted in any adverse effects, such as cigarette cravings, difficulty sleeping, low mood or irritability; but very few studies provided this information, so it remains unclear.

We included 51 randomised studies in the review, involving more than 22,000 people who smoked tobacco. Most were adults, and they typically smoked at least 23 cigarettes a day at the start of the research. The studies compared people who were asked to cut down their smoking and then quit tobacco smoking altogether with either a group who did not receive any treatment to stop smoking, a group who were asked to stop smoking all at once, or a group who were asked to cut down their smoking in a different way. 

Reduction methods tested varied greatly across studies; with some simply asking participants to reduce the amount they smoked, while others provided detailed instructions or suggestions of how to go about it; some of which was face to face.

Looking deeper into the evidence, we found that people who cut down their smoking while using varenicline or a fast-acting form of nicotine replacement therapy (NRT), such as gum or lozenge, may be more likely to quit than those who cut down their smoking using a different medicine, or no medicine. We also found that giving people face-to-face support to cut down may help more to quit than if they are simply provided with self-help materials.

The take home message, therefore, is that asking people to cut down their smoking first may be a useful way to help people to stop smoking. Cutting down to quit whilst using fast-acting NRT or varenicline, and whilst receiving behavioural support may maximise people’s chances of success. Future well-conducted studies should focus on investigating whether cutting-down-to-quit may be more helpful for particular populations, and which ways of cutting-down-to-quit result in the highest quit rates.