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NCCIH Clinical Digest

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Complementary Health Approaches for Smoking Cessation: What the Science Says

January 2021

Clinical Guidelines, Scientific Literature, Info for Patients: 
Complementary Health Approaches for Smoking Cessation

smoking cessation hand flower
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Mind and Body Practices

Mindfulness Meditation

Several studies have compared mindfulness meditation-based quit-smoking programs with conventional counseling programs. In some studies, the mindfulness-based programs produced better results; in others, results with the two types of programs were similar.

What Does the Research Show?

  • A 2017 systematic review and meta-analysis of four randomized controlled trials involving a total of 474 smokers found that that 25.2 percent of participants in the mindfulness group remained abstinent for more than 4 months compared to 13.6 percent of those who received usual care therapy. However, another 2017 systematic review and meta-analysis of 10 randomized controlled trials of mindfulness meditation for smoking cessation found that overall, mindfulness meditation did not have significant effects on abstinence or cigarettes per day, relative to comparator groups.
  • Several studies have used functional magnetic resonance imaging to examine the effects of mindful attention on the anterior cingulate and prefrontal cortex in smokers, the areas of the brain associated with cravings and self-control. In a 2017 study of 23 participants who completed either mindfulness training or cognitive behavioral treatment for smoking cessation, the researchers found that stress reactivity in several brain regions including the amygdala and anterior/mid insula was related to reductions in smoking after treatment. These same regions also differentiated between treatment groups such that the mindfulness training group showed lower stress reactivity compared to the cognitive behavioral treatment group. The findings suggest that reduction in stress reactivity may be one of the underlying mechanisms of mindfulness-based treatments. In a 2013 study, participants’ self-reported results demonstrated that mindful attention reduced cravings. In addition, the brain imaging results indicated that mindful attention reduced neural activity in a craving-related region of the subgenual anterior cingulate cortex. In another 2013 study, a 2-week course of meditation (5 hours in total) produced a significant reduction in smoking, compared to a relaxation training control. Results of brain imaging showed increased activity for the meditation group in the anterior cingulate and prefrontal cortex.

Safety

  • Meditation is considered to be safe for healthy people.
  • There have been rare reports that meditation could cause or worsen symptoms in people who have certain psychiatric problems, but this question has not been fully researched.

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.

References

  • Barnes J, Dong CY, McRobbie H, et al. Hypnotherapy for smoking cessation. Cochrane Database Syst Rev. 2010;10:CD001008.
  • Bock B, Dunsiger SI, Rosen RK, et al. Yoga as a complementary therapy for smoking cessation: results from BreathEasy, a randomized clinical trial. Nicotine Tob Res. 2019;21(11):1517-1523.
  • Bock BC, Fava JL, Gaskins R, et al. Yoga as a complementary treatment for smoking cessation in women. J Womens Health (Larchmt). 2012;21(2):240-248.
  • Brewer JA, Mallik S, Babuscio TA, et al. Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug Alcohol Depend. 2011;119(1-2):72-80.
  • Cahill K, Lindson-Hawley N, Thomas KH, et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2016;5:CD006103.
  • Carim-Todd L, Mitchell SH, Oken BS. Mind-body practices: an alternative, drug-free treatment for smoking cessation? A systematic review of the literature. Drug Alcohol Depend. 2013;132(3):399-410.
  • Elibero A, Janse Van Rensburg K, Drobes DJ. Acute effects of aerobic exercise and Hatha yoga on craving to smoke. Nicotine Tob Res. 2011;13(11):1140-1148.
  • Hasan FM, Zagarins SE, Pischke KM, et al. Hypnotherapy is more effective than nicotine replacement therapy for smoking cessation: results of a randomized controlled trial. Complement Ther Med. 2014;22(1):1-8.
  • Kober H, Brewer JA, Height KL, et al. Neural stress reactivity relates to smoking outcomes and differentiates between mindfulness and cognitive-behavioral treatments. Neuroimage. 2017;151:4-13.
  • Maglione MA, Maher AR, Ewing B, et al. Efficacy of mindfulness meditation for smoking cessation: a systematic review and meta-analysis. Addict Behav. 2017;69:27-34.
  • Oikonomou MT, Arvanitis M, Sokolove RL. Mindfulness training for smoking cessation: a meta-analysis of randomized-controlled trials. J Health Psychol. 2017;22(14):1841-1850.
  • Rogers E, Sherman S. ACP Journal Club. Review: cytisine increases smoking abstinence. Ann Intern Med. 2013;159(4):JC11.
  • Tahiri M, Mottillo S, Joseph L, et al. Alternative smoking cessation aids: a meta-analysis of randomized trials. Am J Med. 2012;125(6):576-584.
  • Tang YY, Tang R, Posner MI. Brief meditation training induces smoking reduction. Proc Natl Acad Sci USA. 2013;110(34):13971-13975.
  • Tutka P, Vinnikov D, Courtney RJ, et al. Cytisine for nicotine addiction treatment: a review of pharmacology, therapeutics and an update of clinical trial evidence for smoking cessation. Addiction. 2019;114(11):1951-1969.
  • Walker N, Howe C, Glover M, et al. Cytisine versus nicotine for smoking cessation. N Engl J Med. 2014;371(25):2353-2362.
  • Westbrook C, Creswell JD, Tabibnia G, et al. Mindful attention reduces neural and self-reported cue-induced craving in smokers. Soc Cogn Affect Neurosci. 2013;8(1):73-84.
  • White AR, Rampes H, Liu J, Stead LF, Campbell J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev. 2014;1:CD000009.

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH’s Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH website at nccih.nih.gov. NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.

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