Complementary Health Approaches for Smoking Cessation: What the Science Says

Hypnotherapy

There is some evidence to suggest that hypnotherapy may improve smoking cessation, but data are not definitive.

What Does the Research Show?

• A 2014 randomized controlled trial of 164 patients hospitalized with cardiac or pulmonary illness compared the efficacy of hypnotherapy alone, as well as hypnotherapy with nicotine replacement therapy, to conventional nicotine replacement therapy alone. The study found that hypnotherapy patients were more likely than nicotine replacement therapy patients to be nonsmokers at 12 weeks and 26 weeks after hospitalization.
• A 2010 Cochrane review of 11 studies compared hypnotherapy with 18 different control interventions. The authors found that hypnotherapy did not have a greater effect on 6-month quit rates than other interventions or no treatment. They concluded that there is not enough evidence to show whether hypnotherapy could be as effective as counseling treatment.
• A 2012 meta-analysis of randomized controlled trials found that acupuncture, hypnotherapy, and aversive smoking increased smoking abstinence, but the patient population in the analysis was small and reports of smoking cessation were not validated by bio-chemical means.

Safety

• Hypnosis is considered safe when performed by a health professional trained in hypnotherapy.
• Self-hypnosis also appears to be safe for most people. There are no reported cases of injury resulting from self-hypnosis.

Yoga

Only a few studies have been conducted on the effects of yoga for smoking cessation. Although preliminary results have been positive, larger, high-quality studies are needed to determine rigorously if yoga is an effective treatment.

What Does the Research Show?

• A 2018 randomized controlled trial involving 227 adult smokers concluded that yoga appears to increase the odds of successful smoking abstinence, particularly among light smokers. However, the study, which randomly assigned participants to 8 weeks of either yoga classes or general wellness classes in addition to conventional counseling, found no difference between the groups in the percentage of people who were still not smoking 3 and 6 months after the program ended.
• A 2013 systematic review of 14 clinical trials concluded that yoga and meditation-based therapies hold promise in assisting with smoking cessation; however, larger, high-quality studies are needed to determine rigorously if yoga and meditation are effective treatments.

Safety

• Yoga is generally low-impact and safe for healthy people when practiced appropriately under the guidance of a well-trained instructor.
• Overall, those who practice yoga have a low rate of side effects, and the risk of serious injury from yoga is quite low. However, certain types of stroke as well as pain from nerve damage are among the rare possible side effects of practicing yoga.
• Women who are pregnant and people with certain medical conditions, such as high blood pressure, glaucoma, and sciatica, should modify or avoid some yoga poses.

Acupuncture

Only a few high-quality studies on acupuncture for smoking cessation have been conducted, so firm conclusions about its effectiveness cannot be drawn.

What Does the Research Show?

• A 2014 Cochrane review of 38 randomized trials concluded that although pooled estimates suggest possible short-term effects there is no consistent, bias-free evidence that acupuncture, acupressure, or laser therapy have a sustained benefit on smoking cessation for 6 months or more. However, lack of evidence and methodological problems mean that no firm conclusions can be drawn.

Safety 

• Relatively few complications from the use of acupuncture have been reported to the U.S. Food and Drug Administration (FDA), in light of the millions of people treated each year and the number of acupuncture needles used. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments.
• When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.

​​​​​​​Natural Products

Cytisine

The natural product cytisine (also known as cytisinicline) is used as a smoking cessation aid in some central and eastern European countries. Several studies have indicated that it can help people quit smoking. NCCIH is involved in a public/private partnership with a company that seeks to bring cytisine to market in the United States and is supporting a series of nonclinical studies on cytisine as part of its development as a smoking cessation treatment. In August 2017, the FDA accepted the Investigational New Drug application for cytisine, authorizing the company to proceed with clinical development of the product. If the FDA approves cytisine after further clinical testing, it will provide a new option for smoking cessation treatment in the United States.

What Does the Research Show?

• A 2019 meta-analysis of eight studies found that cytisine increases the likelihood of smoking cessation.
• A 2016 Cochrane review concluded that cytisine increases the chances of quitting smoking, although absolute quit rates were modest in two recent trials.
• A 2014 pragmatic trial published in The New England Journal of Medicine involving 1,310 participants in New Zealand found that when combined with brief behavioral support, cytisine was superior to nicotine-replacement therapy in helping with smoking cessation; however, cytisine was associated with a higher frequency of self-reported adverse events.
• A 2013 systematic review and meta-analysis of 7 trials involving 4,020 participants found that cytisine increases rates of smoking abstinence compared with placebo or other control.

Safety

• When taken at the recommended dosage, cytisine is associated with no significant increase in adverse events compared with placebo, although gastrointestinal symptoms are more common. In a 2014 pragmatic trial, the most frequent self-reported adverse events in the cytisine group were nausea and vomiting and sleep disorders.

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