For most people, quitting smoking is a real challenge. The more severe a nicotine addiction, the higher – one might assume – the risk of relapse. However, it seems that the approach taken to quit may have an even greater impact on the risk of relapse. A survey conducted by the Nicotine Institute has now examined how general practitioners assess the effectiveness of various methods and strategies, and where they observe the highest relapse rates. Surprisingly, although the general practitioner is often the first point of contact for smoking cessation, there also appear to be information gaps among professionals when it comes to alternative nicotine products, their significantly lower harm compared to cigarettes, and their potential to support a successful quit attempt.
Common Methods for Smoking Cessation
In practice with smokers willing to quit, there are several methods used, some of which can significantly facilitate the process. In addition to nicotine replacement therapy products, specially developed medications are considered common, which suppress the craving for cigarettes and the symptoms of nicotine withdrawal. In addition to these approaches, cold turkey and so-called alternative nicotine products are also options. The latter, like pharmacy nicotine replacement products, aim to alleviate withdrawal symptoms.
>> Learn here how the so-called biopsychosocial model enables a holistic treatment approach to nicotine abuse.
Nicotine Replacement Products for Smoking Cessation
Specifically, nicotine replacement therapy products include:
- Nicotine patches
- Nicotine chewing gums
- Nicotine lozenges
- Nicotine nasal sprays
In all these cases, nicotine is consumed or substituted in a form that is less harmful compared to smoking.
The most commonly prescribed medications include psychotropic drugs – particularly those from the group of antidepressants, such as bupropion and nortriptyline.
Smoking Cessation with Alternative Nicotine Products
Alternative nicotine products include:
- E-cigarettes
- Heated tobacco products
- Nicotine pouches and snus
Here too, nicotine is consumed or substituted via a source that is less risky compared to traditional tobacco cigarettes.
>> You might also be interested in: How much nicotine is in cigarettes, snus, and nicotine pouches?
Smoking Cessation via Cold Turkey
With cold turkey, smoking is stopped without the use of any aids. This method involves enduring possible withdrawal symptoms. Although some former smokers have succeeded using this strategy, cold turkey is certainly considered the most difficult approach to quit smoking.
Survey on Smoking Cessation
On the occasion of World No Tobacco Day on May 31, the Nicotine Institute Vienna provided insights into a self-funded survey of 254 Austrian general practitioners in the first quarter of 2025. On the one hand, the results aim to show which of the mentioned methods are most frequently recommended by general practitioners. On the other hand, they also aim to reveal how respondents assess the effectiveness of each method and the associated risk of relapse. Furthermore, it is evident that a majority of professionals call for more extensive education on alternative nicotine products.
The General Practitioner as a Key Contact for Smoking Cessation
The results of the survey show that general practitioners should be well-informed about the possibilities, effectiveness, and relapse risk of smoking cessation strategies: 54 of the surveyed GPs reportedly hold more than ten patient consultations per week on tobacco cessation. Another 200 address the topic in up to ten consultations per week.
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GP practices thus appear to be an important point of contact for smokers willing to quit. - © Image: AdobeStock |
Which Smoking Cessation Methods GPs Recommend
According to the survey, the majority of physicians (specifically 149) recommend pharmacy nicotine replacement products. Only 65 professionals appear to support cold turkey. And when it comes to alternative nicotine products, the recommendation rates are even lower: only 18 recommend nicotine pouches, 20 are in favor of e-cigarettes, and 2 respondents see potential in heated tobacco products.
Which Method Bears the Highest Relapse Risk
There seems to be consensus that cold turkey carries the highest risk of relapse. Even those who recommend this method consider it largely ineffective. Surprisingly, pharmacy nicotine replacement products are perceived as having a higher relapse risk than alternative nicotine products.
More Education for Evidence-Based Smoking Cessation Counseling
According to the survey, the majority of the doctors surveyed are calling for more intensive education about alternative nicotine products. A well-informed knowledge base is essential for evidence-based and personalized patient consultations.
Univ.-Doz. Dr. med. Ernest Groman, scientific director of the Nicotine Institute, notes:
“The survey clearly shows that general practitioners play a key role in smoking cessation. However, they need more knowledge about new, potentially less harmful products in order to effectively support their patients.”
Knowledge Gaps Hinder Smoking Cessation
If a lack of information about potentially less harmful cigarette alternatives persists and fewer professionals recommend them for smoking cessation, then such information gaps may indeed hinder successful cessation. Products like nicotine pouches may be effective for quitting and may even carry a lower relapse risk compared to other options.
Groman further comments:
“For people who cannot or do not want to stop smoking, alternative nicotine products such as e-cigarettes, heated tobacco, or tobacco-free nicotine pouches are potentially less harmful options. They can also play an important bridging role on the path to abstinence.”
It can also be assumed that a broader range of cessation aids is likely to appeal to more smokers wishing to quit – and might even motivate smokers who would not otherwise have considered quitting.
Smoking Cessation – What Really Helps?
According to German addiction researcher Prof. Dr. Heino Stöver, the situation is clear:
"The current debate around tobacco prevention remains shaped by outdated mindsets that demonstrably do not achieve results. Instead of focusing on evidence-based solutions, restrictive approaches and outdated narratives still dominate. The fixation on a pure abstinence paradigm – the 'quit or die' mentality – does not sustainably reduce smoking rates. Rather, it discourages many affected individuals and hinders realistic pathways to quitting."
Stöver therefore advocates for a paradigm shift that breaks away from rigid, obsolete approaches and acknowledges the so-called harm reduction approach for tobacco.
He further states that the public debate continues to be marked by misconceptions and incorrect risk assessments. There is an urgent need for fact-based education on actual risks and differentiated quitting options.
>> You might also be interested in: Addiction researcher supports EU-wide legalization of Swedish snus
Sweden as a Role Model for Risk-Reduced Strategies
Both experts agree that Sweden's achievements in recent years serve as a model. As Groman emphasizes, about 50 percent of male nicotine users there turned to smoke-free alternatives. As a result, the lung cancer rate among Swedish men is only half that of Austria. This is clear evidence that lower-risk alternatives can make a real difference—both individually and societally.
| According to Eurostat, the current smoking rate in Sweden is nearly 5 percent. A country falling below this threshold is generally considered smoke-free. - © Image: AdobeStock |
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Groman adds:
"Smokers have a right to easily understandable information about the risks of different products as well as access to affordable alternatives to cigarettes."
Low-threshold access to nicotine replacement products and risk-based taxation are welcomed in this regard.
