How to quit smoking and manage tobacco withdrawal: what really works

• Every year 6,362 people die in the Dominican Republic from illnesses linked to tobacco; quitting means treating both the physical addiction and the habit.

Quitting smoking is not just a question of willpower; it means recognising that this is a physical addiction and also a habit deeply rooted in daily life. In the Dominican Republic, the impact of smoking remains significant. Every year, 6,362 people die from illnesses related to tobacco use, according to the report Global State of Tobacco Harm Reduction.

The problem is that, although many people want to quit, few manage it without support. Nicotine dependence and the habits that go with it make the process more complex than it looks. “Cigarette smoking is the leading preventable cause of death, and people who smoke can lose up to 10 years of life,” warns Dr Nancy Rigotti, a primary care physician at Mass General Brigham.

What happens in the body when you stop smoking

To understand how to quit smoking, you first have to understand what happens in the body. Nicotine produces chemical changes in the brain that create a momentary sense of wellbeing. Over time, the body adapts and needs more and more to feel the same, which creates dependence.

But the addiction is not only physical. Smoking also becomes a habit tied to specific moments: after eating, during stress or on work breaks. When a person stops smoking, tobacco withdrawal sets in. The process usually begins a few hours after the last cigarette and peaks between the second and third day.

“Symptoms improve gradually over a couple of weeks and almost disappear within a month,” explains Dr Rigotti. The most common symptoms include:

• Intense craving to smoke
• Irritability and anxiety
• Trouble sleeping
• Difficulty concentrating
• Increased appetite

Why quitting cigarettes is so hard

One of the greatest challenges for those looking to quit smoking cold turkey is that it is not only about giving up nicotine. “People believe smoking relieves discomfort, but what they are really doing is treating withdrawal symptoms,” says the specialist.

Everyday cues (such as drinking coffee or spending time with other smokers) can also trigger the urge to smoke even weeks after quitting. That explains why many people relapse, even after several attempts.

In Mexico, the Ministry of Health estimates that around 70% of smokers want to give up tobacco, but only 10% manage it without additional support.

Treatment to quit smoking effectively

The evidence shows that the best way to quit smoking is not to do it “cold turkey” but with a comprehensive approach. “Only 7% of people who quit smoking without support manage to stay that way for a year,” warns the specialist.

Effective treatment to quit smoking usually combines:

1. Medication. There are three main options: nicotine replacements (patches, gum, lozenges); bupropion; and varenicline. These help reduce withdrawal symptoms and the craving to smoke. “Combining therapies can be more effective than using only one,” explains the specialist.

2. Behavioural support. Breaking the habit matters as much as treating the addiction. “Behavioural therapy helps break the connection between the urge to smoke and the act of lighting a cigarette,” says Dr Rigotti.  Some strategies include identifying and avoiding triggers, changing routines, staying active, and seeking support from family or professionals.

What benefits does quitting smoking bring

Giving up tobacco has positive effects from the very first days. As well as improving breathing and energy, it reduces the risk of serious illness. In Mexico, health authorities warn that tobacco smoke is linked to cardiovascular conditions, Chronic Obstructive Pulmonary Disease (COPD), diabetes and various types of cancer.

“Quitting smoking quickly reduces cardiovascular risk, even in people who have smoked for years,” says Dr Rigotti.

How to quit smoking “for good”: what really makes the difference

There is no single formula, but there are factors that raise the chances of success. Preparing, understanding the process and seeking professional support are key steps. Because quitting smoking is not only about dropping a habit, it is about breaking a physical and emotional dependence built over years. And although the process can be hard, the benefits begin sooner than many imagine.

About Mass General Brigham

Mass General Brigham is a healthcare system that brings together the best minds in medicine to improve the lives of patients around the world. The system is made up of 16 hospitals, including 5 ranked among the best in the country by US News & World Report: Massachusetts General Hospital, Brigham and Women’s Hospital, Mass Eye and Ear, McLean Hospital and Spaulding Rehabilitation; along with community and specialist care centres, health insurance plans, physician networks, home care and long-term care services.

Mass General Brigham is a non-profit organisation committed to patient care, teaching and research. With an annual budget of almost 2 billion dollars, Mass General Brigham’s research programme is one of the largest in the United States, funding more than 2,700 clinical trials. It is also one of the country’s leading biomedical research organisations and the principal teaching affiliate of Harvard Medical School.

For more information about Mass General Brigham, visit massgeneralbrigham.org/international