Quit Smoking or just Reduce?
As long as the number of long-term smokers remains relatively high, ‘quit smoking’ will be common healthcare advice. But when smokers fail in their attempts to quit or their addiction makes it next to impossible, cutting down by using nicotine replacement therapy, or NRTs, – such as gum, inhalers or ‘vaping’ devices – is a recommendable alternative. Or is it?
Does reduction help?
In the British Medical Journal, practitioners Paul Aveyard and Nicola Lindson-Hawley recently wrote that reduction is a positive step towards cessation and tends to be taken by smokers who later quit. Cutting down works, they say, in that it
“may weaken the conditioned response created by smoking, making relapse less likely to be triggered by exposure to cues to smoke after quitting.” 
But what of the health benefits of quitting and cutting down?
Interestingly, while most smokers have been made aware of the positive effects their bodies experience after quitting – beginning with a drop in heart rate after only 20 minutes  – Professor Mike Kelly of NICE Public Health Centre (the world’s first institute to state that nicotine replacement therapy can help hardened smokers quit) couldn’t say the same for reducing cigarettes smoked, admitting that although smokers who cut down usually go on to quit,
“existing evidence is not clear about the health benefits of reducing smoking.” 
It seems that the great advantage of reduction (especially when combined with an NRT), is its attractiveness to smokers. In this method, not only is less willpower is involved, but the obligation to ‘go it alone’ is removed.
Interestingly, when success rates come into the picture, specific results are debatable. Considering the cold turkey approach, the NHS website states that
“only 4% who try to give up without help are successful for a year or longer […] going cold turkey has a very low success rate.” 
However, Professor Simon Chapman, director of research at the Sydney Medical School’s School of Public Health, says that
“(Going cold turkey is) overwhelmingly the most popular successful way that most people quit smoking. […] If you take 100 ex-smokers and ask them how they quit, about 66 to 75 of them will have quit smoking without any assistance at all.” 
How to advise patients to quit smoking?
So when patients ask you for advice, with such diverse options and contradicting success rates blinking on your radar, how should you proceed?
According to Professor Chapman, it’s worth considering that far from lining up to buy inhalers and gum, smokers often want to achieve their own success
“[people] don't, in the main, want to engage with public health professionals to try to quit smoking,” he says, “They want to do it themselves.” 
Of course, the double-edged sword of smoking addiction is well known, affecting users both physically and psychologically. Therefore, those who chose to go cold turkey – without NRT to alleviate the physical effects of nicotine withdrawal – must understand the psychological elements to their addiction.
Health care professionals might consider supporting their patients by giving tips to calm the psychological discomfort of quitting, such as choosing and sticking to a pre-determined quitting date; ridding the home of all smoking-related objects (ashtrays, lighters etc); composing a list of your motivations for quitting and constructing (healthy) habits for when cravings hit, like reading through your motivations list, calling a friend or drinking a glass of water. 
Whatever route smokers choose, ignoring and fostering smoking addiction in patients cannot be an option. While the road to quitting may include several false-starts, for smokers who wish to quit, the numerous positive health benefits of quitting far outweigh the potential temporary discomfort experienced while quitting.
Author - Erin Walton
 Should smokers be advised to cut down as well as quit? BMJ 2014;348:g2787
 Within 20 Minutes of Quitting - poster
 NICE publishes guidance on cutting down smoking
 Is going 'cold turkey' the most effective way to quit smoking?
 Smoking: cutting down or quitting