How to Quit Smoking: Do Rewards and Medicines Work?
18 Oct 2026
Quitting is hard to do on willpower alone. Large reviews show that varenicline, cytisine and combination nicotine replacement roughly double the odds of staying quit at six months compared with no medicine [1], and structured rewards for staying smoke-free add a further benefit [2]. A new remote trial suggests combining rewards with a future-focused thinking exercise is workable, though it is too small to prove it works [3].
How to Quit Smoking at a glance
- Medicines: varenicline and cytisine each led to about 8 extra quitters per 100 people at six months or longer [1].
- Rewards: incentive programmes raised the chance of still being smoke-free at six months or more by about 50% [2].
- Short-lived gains: for people with other substance problems, rewards doubled quitting during treatment, but the advantage faded at long-term follow-up [4].
- New trial: a remote programme for 97 veterans was feasible, but it was a feasibility study, not proof of benefit [3].
Which medicines help you quit smoking?
The strongest comparison comes from a Cochrane network meta-analysis covering 319 trials and 157,179 participants. It found high-certainty evidence that varenicline (odds ratio 2.33), cytisine (2.21) and nicotine e-cigarettes (2.37) led to more quitting than control [1]. In absolute terms, that is roughly seven or eight extra quitters for every 100 people treated [1].
Combination nicotine replacement, a patch plus a fast-acting form such as gum, also performed well (odds ratio 1.93). The patch alone (1.37), fast-acting replacement alone (1.41) and bupropion (1.43) were each better than nothing, but by a smaller margin [1]. So if you are choosing a single option, the doctor's advice on varenicline, cytisine or combination replacement is worth hearing. The e-cigarette findings come from countries where they are sold legally; in India their sale is restricted, so this article does not suggest them.
Do rewards for staying smoke-free work?
Contingency management means you earn a reward each time a test shows you have not smoked. A Cochrane review of 48 studies and more than 21,900 people found that incentives raised the chance of being smoke-free at six months or longer, with a risk ratio of 1.52 and high-certainty evidence [2]. The benefit held even when rewards had stopped by follow-up [2].
In people already being treated for alcohol or drug problems, a meta-analysis of 22 articles found rewards more than doubled smoking abstinence by the end of treatment (risk ratio 2.56). At long-term follow-up the advantage disappeared (risk ratio 1.03) [4]. Quitting smoking was also linked with a higher likelihood of staying off alcohol or other drugs [4]. The lesson is that support needs to last longer than the reward does.
| Approach | What research shows | Limit |
|---|---|---|
| Varenicline or cytisine | About 8 extra quitters per 100 at 6+ months [1] | Needs a prescription and follow-up |
| Combination nicotine replacement | Better than a single form [1] | Smaller effect than varenicline |
| Rewards for staying smoke-free | Risk ratio 1.52 at 6+ months [2] | Programme must be well designed |
| Rewards in people with other substance use | Doubled quitting during treatment [4] | No clear gain by long-term follow-up |
| Remote rewards plus future thinking | Feasible in 97 veterans [3] | Small, not proof of benefit |
What each type of help offers, and where it falls short [1,2,3,4].
What did the new remote trial add?
A US team tested a programme delivered entirely at a distance for 97 military veterans over 16 weeks. Everyone got nicotine patches for 12 weeks. One group also did a daily "episodic future thinking" exercise, picturing and describing positive future events, and earned rewards for smoke-free breath samples in weeks 1 to 4 [3].
Feasibility looked good. About 88% of eligible people enrolled, around two-thirds completed the final assessment, and more than 80% submitted their daily breath samples and cues [3]. The combined group showed a higher share of smoke-free breath samples, but the study was built to test practicality, not to prove effectiveness [3]. It tells us the approach is workable. It does not yet tell us that it works.
What helps most in everyday care?
A scoping review of 30 primary care studies concluded that the strongest evidence supported combining behavioural counselling with medicines [5]. Systems that prompt the doctor to ask about smoking, and that make medicines easy to get, helped too. Evidence for vaping cessation was thin, with only two studies focused on e-cigarette users [5]. Most of those studies were from high-income countries. If you use bidis, chewing tobacco or hookah rather than cigarettes, ask your doctor how the advice applies, because these reviews mostly looked at cigarette smoking.
Why do so many people relapse?
Cravings, stress, alcohol, and being around other smokers are the usual triggers. Many people try several times before quitting for good. Planning for the first three months matters: who to call, what to do at the moment of craving, and what to do after a slip. A slip is not failure. Tell your doctor and restart the plan.
If low mood, anxiety or thoughts of self-harm appear while you are quitting, speak to a doctor promptly. Tele-MANAS (14416, free, 24 hours) offers mental health support, and 112 is the number for emergencies.
Getting help in Delhi
Tobacco dependence is a substance use problem, and the approach used at Brain Bridge Clinic in Safdarjung Enclave, New Delhi, for dependence generally applies: a full assessment of your use and health, a plan that can include medicines where appropriate and counselling, relapse-prevention planning and involving family where you want them. If you want help quitting, you can book an assessment and tell us what you smoke or chew and how long you have used it.
Related pages: De Addiction, De Addiction Rehab Programs, Relapse Prevention Programs.
Frequently asked questions
What is the most effective way to quit smoking?
Combining behavioural support with a medicine such as varenicline, cytisine or combination nicotine replacement is best supported by research [1,5].
Do rewards for not smoking really work?
A Cochrane review found they increased long-term quitting by about 50% (risk ratio 1.52) [2]. In people with other substance problems, the advantage faded after treatment ended [4].
Are nicotine patches enough on their own?
The patch alone helps (odds ratio 1.37) but less than varenicline or combination replacement [1].
Does quitting smoking hurt recovery from alcohol or drug use?
A meta-analysis found that smoking cessation treatment was linked with a higher likelihood of abstinence from alcohol or illicit drugs, not a lower one [4].
What if I relapse?
Many people need several attempts. Tell your doctor, review what triggered it, and restart with a plan.
References
- Lindson N, Theodoulou A, Ordóñez-Mena JM, et al. Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses. The Cochrane database of systematic reviews. 2023;9(9):CD015226. doi:10.1002/14651858.CD015226.pub2. PMID 37696529.
- Notley C, Gentry S, Livingstone-Banks J, et al. Incentives for smoking cessation. The Cochrane database of systematic reviews. 2025;1(1):CD004307. doi:10.1002/14651858.CD004307.pub7. PMID 39799985.
- Nist AN, Fontes RM, Tegge AN, et al. Remotely delivered episodic future thinking and contingency management for smoking cessation: A randomized feasibility trial among military veterans in the United States. Experimental and clinical psychopharmacology. 2026;34(5):498-510. doi:10.1037/pha0000879. PMID 42848037.
- Secades-Villa R, Aonso-Diego G, García-Pérez Á, et al. Effectiveness of contingency management for smoking cessation in substance users: A systematic review and meta-analysis. Journal of consulting and clinical psychology. 2020;88(10):951-964. doi:10.1037/ccp0000611. PMID 33048571.
- Wang S, Rojas I, Dean E, et al. Evidence for Embedding Smoking and Vaping Cessation Support in Primary Care: A Scoping Review. Journal of general internal medicine. 2026. doi:10.1007/s11606-026-10835-3. PMID 42902121.