Smoking Cessation

Key points

• Nicotine dependence rewires brain reward chemistry, so withdrawal, irritability, cravings and poor sleep typically peak in the first fortnight before easing.
• Dopamine release from each cigarette conditions the brain to expect it, which is why cravings make early quitting attempts so difficult.
• Varenicline blunts cravings by partly activating nicotine receptors, while bupropion, originally an antidepressant, eases withdrawal through a different route.

Why quitting is harder than willpower alone

Nicotine binds to receptors in the brain’s reward pathway, releasing dopamine with each cigarette. Over time, the brain expects this stimulus and under-produces dopamine without it. That is what makes the early weeks of quitting so uncomfortable, and why cold turkey has a low success rate.

Medicines that act on these same receptors change the equation significantly. Varenicline partially activates nicotine receptors to blunt cravings while blocking the rewarding effect of any cigarette smoked during a quit attempt. Bupropion, originally developed as an antidepressant (see antidepressants), also reduces cravings and eases withdrawal-related low mood through a different mechanism. Both approaches sit within the broader addiction recovery medicine toolkit.

Staying with a plan once you start

Quit attempts succeed far more often when a course of treatment is completed rather than stopped early, which makes continuity more important than the choice of product. If a move or a supply gap interrupts a course partway through, resuming the same medicine is usually better than starting a different one from scratch.

Further reading

• Join Freedom From Smoking | American Lung Association
• Quit smoking - Better Health - NHS