Nicotine dependence treatment

The addictive substance in cigarettes is nicotine. Nicotine dependence is also called nicotine addiction. As described in a review published in the New England Journal of Medicine, nicotine stimulates nicotinic receptors in the brain and increases the release of dopamine, a substance linked to feelings of pleasure. With regular smoking, the brain gets used to a steady supply of nicotine, so when the nicotine level drops after a cigarette, irritability, anxiety and cravings set in, and the next cigarette relieves them for a while. The WHO classifies this condition as a disease: in ICD-10 as tobacco dependence syndrome (F17.2) and in ICD-11 as nicotine dependence (6C4A.2), regardless of whether the nicotine comes from a cigarette or an e-cigarette.

Tobacco-related diseases are caused mainly by the smoke. According to the WHO description in ICD-11, nicotine plays only a partial role in these diseases, and most of the damage is done by the carcinogens and other harmful compounds inhaled with the smoke. Nicotine replacement therapy is built on this distinction: a patch or gum supplies nicotine, which eases withdrawal symptoms, and the patient does not inhale smoke. According to a 2025 report by Poland's National Institute of Public Health (PZH), 28.8 percent of men and 20.3 percent of women in Poland smoke tobacco every day, and according to the Chief Sanitary Inspectorate about 70,000 people die of tobacco-related diseases every year.

Why do levels of some medicines rise after quitting smoking?

Components of tobacco smoke speed up the breakdown of some medicines in the liver. Nicotine itself does not have this effect, so after quitting smoking the levels of these medicines rise even in someone who has switched to a nicotine patch or an e-cigarette. Once smoking stops, the effect of smoke on liver enzymes gradually fades. According to the UK Specialist Pharmacy Service, the first changes may be seen within 3 days, and it may take 2 to 4 weeks for the effect to wear off completely. For most of these medicines the dose does not need to change, but a few of them need monitoring:

• clozapine: before quitting, the patient should tell their psychiatrist without delay, and the psychiatrist orders a blood level test, reduces the dose if needed and repeats the test a week later;
• olanzapine and haloperidol: if the patient has marked drowsiness, dizziness or other side effects, the doctor reduces the dose by 25 percent;
• theophylline: the doctor considers gradually reducing the dose by 25 to 33 percent over a week and checks the level of the medicine in the blood;
• warfarin: the risk of bleeding goes up, so at follow-up visits the doctor checks the INR, a measure of how quickly blood clots.

Anyone who starts smoking again should tell their doctor, because the doses usually need to go back to what they were before quitting.

The sooner someone reaches for a cigarette after waking up, the more strongly dependent they are. The Fagerström test is based on this link: a person who lights their first cigarette within 5 minutes of waking up gets 3 of the possible 10 points, the same as for smoking more than 30 cigarettes a day. The whole test has six questions:

1. How soon after waking up do you smoke your first cigarette? Within 5 minutes scores 3 points, 6 to 30 minutes 2 points, 31 to 60 minutes 1 point, later 0.
2. Do you find it hard not to smoke in places where smoking is banned, such as a cinema? If yes, 1 point.
3. Which cigarette would be hardest to give up? The first one in the morning scores 1 point, any other 0.
4. How many cigarettes do you smoke a day? Up to 10 scores 0 points, 11 to 20 scores 1 point, 21 to 30 scores 2 points, 31 or more scores 3 points.
5. Do you smoke more often in the first hour after waking up than during the rest of the day? If yes, 1 point.
6. Do you smoke when you are so ill that you spend most of the day in bed? If yes, 1 point.

A score of 6 points or more means strong dependence and affects the dose of medicine: according to the Summary of Product Characteristics for nicotine gum, a person with this score, or one who smokes more than 20 cigarettes a day, starts with 4 mg gum instead of 2 mg. The Summary of Product Characteristics for 4 mg lozenges considers a person strongly dependent as soon as they light their first cigarette within 30 minutes of waking up. In a study of 5,934 cancer patients, the test score was a poor predictor of who would manage to quit.

Nicotine withdrawal symptoms usually start 6 to 24 hours after the last cigarette. According to the WHO description in the ICD-11 classification, they include low mood, insomnia, irritability, anger, anxiety, difficulty concentrating, restlessness, a slower heart rate, increased appetite and cravings, as well as a worse cough and mouth ulcers. The cough and mouth ulcers can last 2 to 3 weeks.

A review of research on tobacco withdrawal shows that anger, anxiety, low mood, difficulty concentrating and insomnia are strongest in the first week and last 2 to 4 weeks. According to a review of studies of people who quit without help, most relapses also happen within the first 8 days.

Cravings come back in situations in which the patient used to smoke. The National Cancer Institute lists stress, driving, drinking coffee or tea, meals, drinking alcohol, boredom and spending time with smokers. It advises reminding yourself that the urge to smoke will pass in a few minutes, waiting it out with a short walk, and taking a different route to work than usual.

Can quitting smoking cause anger or aggression?

Yes, anger and impatience are typical symptoms of nicotine withdrawal. American researchers measured this in a laboratory experiment in 1991. Heavily dependent smokers played a computer game in which a fictitious opponent took points from them every so often, and they could take points from the opponent in return. On a day without cigarettes they did this more often than on a day when they smoked. After chewing nicotine gum, their reactions went back to the level of the smoking day, but after gum without nicotine they did not.

According to a review of studies on gum and other oral forms of nicotine, 9 well-designed studies assessed irritability in the first week without cigarettes. All of them showed that nicotine in this form reduces irritability. Irritability usually eases after 2 to 4 weeks, so someone who is quitting can warn family and colleagues that they may lose their temper more easily during that time. Anyone who is losing self-control or thinking about harming themselves or someone else needs urgent medical help.

Does a short walk help you get through a craving?

Yes, for a while. In an analysis of data from experiments in which smokers either exercised or rested after a break from smoking, the urge to smoke was clearly weaker after a short bout of exercise, even moderate exercise, and the authors rated this evidence as strong. Exercise programmes added to treatment, however, did not clearly increase the number of people who stopped smoking for good, although in a review of 24 studies involving 7,279 adults the certainty of this result was low. A person with heart disease should agree with their doctor what kind of exercise is safe for them.

A review of studies on quitting unaided found that without any help only 3 to 5 percent of people who tried to quit were not smoking six months or a year later. Even so, in the 2025 survey by Poland's National Institute of Public Health (PZH), only 18.4 percent of people who had tried to stop smoking had looked for help from a doctor, a psychotherapist or a stop-smoking programme.

Medication increases the chance of quitting. When medication is combined with sessions with a therapist, the chance is even higher. A Cochrane review covered 65 studies with more than 23,000 people taking medication. People who also talked to a therapist in person or by phone were about 10 to 20 percent more likely to quit than those taking medication alone. In studies combining medication with support, specialists usually held 4 to 8 sessions. Telephone counselling also helps people quit. A Cochrane review of 104 studies found that among people who had called a quitline themselves, those whom a counsellor called back several times quit more often than those who received only written materials or had a single conversation.

The table shows the percentage of people who were not smoking after at least six months, separately for groups using a given medicine and for groups without it, based on a Cochrane analysis of 319 studies involving 157,000 adults. We checked prices in online pharmacies in September 2026.

The price of a patch course in the table is for the 24-hour patch; the 16-hour 25 mg patch costs PLN 57 to 112 for 7 patches. The cost of treatment with gum, lozenges or spray depends on how many doses are used each day. Nicotine mouth spray costs PLN 62 to 85 for 150 sprays.

Some methods advertised as a way to quit smoking did not work in studies, or there is not enough evidence that they work. These include:

• acupuncture, acupressure, laser therapy and electrostimulation: a review of 38 studies found no reliable evidence that acupuncture, acupressure or laser therapy help people stay off cigarettes for at least six months, and electrostimulation turned out to be ineffective;
• hypnosis: 14 studies involving 1,926 people were not enough to tell whether hypnosis helps more than other forms of support or quitting without help, and if it does bring a benefit, the authors say it is small at most;
• anti-anxiety medicines such as diazepam and buspirone: a review of studies found no consistent evidence that they help people quit, and diazepam belongs to the benzodiazepines, which can themselves cause dependence;
• SSRI antidepressants such as fluoxetine, paroxetine and sertraline: a review of 115 studies of antidepressants did not show that they help people stop smoking, unlike bupropion;
• dietary supplements: under EU law and Polish food safety legislation they are classed as food, so before they go on sale they do not have to pass the effectiveness testing required for medicines, and their labels and advertising must not present them as treating disease.

There is also not enough evidence for motivational interviewing on its own, in which a therapist helps someone who is unsure whether to quit think the decision through. In a review of 37 studies involving more than 15,000 smokers, the certainty of the results was low, and the conclusion applies to this one technique, not to every form of work with an addiction therapist.

Cytisine, called cytisinicline in newer package leaflets, is a plant alkaloid found in the seeds of the laburnum tree, among other plants. Its structure resembles nicotine and it acts on the same receptors in the brain, but more weakly. That is why it eases cravings and withdrawal symptoms, and a cigarette smoked during treatment gives less pleasure. The Polish Register of Medicinal Products lists 17 cytisine products, 11 of which are sold without a prescription, and a pack for the whole course costs PLN 40 to 78 in online pharmacies.

Cytisine has been tested in several trials, including a study carried out in Warsaw: among 740 smokers who, apart from the medicine, received only brief advice and a few follow-up phone calls, 8.4 percent of those taking cytisine and 2.4 percent of those taking placebo did not smoke for a year after treatment. In a New Zealand study of 1,310 people, after one month 40 percent of those taking cytisine and 31 percent of those using nicotine replacement therapy said they were not smoking. In an Australian comparison with varenicline, 11.7 percent of people taking cytisine and 13.3 percent of those taking varenicline stayed smoke-free for six months. The study did not show that cytisine is at least as effective, but side effects led 16.5 percent of patients to stop taking cytisine, compared with 34.3 percent for varenicline.

According to the Summary of Product Characteristics, one pack of 100 tablets is enough for the whole course:

• days 1 to 3: one tablet every 2 hours, up to 6 a day;
• days 4 to 12: one tablet every 2.5 hours, up to 5 a day;
• days 13 to 16: one tablet every 3 hours, up to 4 a day;
• days 17 to 20: one tablet every 5 hours, up to 3 a day;
• days 21 to 25: 1 or 2 tablets a day.

Smoking has to stop by day 5 of treatment at the latest, and smoking during treatment can make side effects worse. If the course does not help, the patient stops it and can start another one after 2 to 3 months. Cytisine is not used in unstable angina, after a recent heart attack or stroke, in clinically significant heart rhythm disorders, or during pregnancy and breastfeeding. The Summary of Product Characteristics does not recommend it for people under 18 or over 65, or for patients with impaired liver or kidney function, and advises caution in conditions including ischaemic heart disease, high blood pressure, diabetes, peptic ulcer disease, an overactive thyroid and schizophrenia. Women who could become pregnant should use effective contraception during treatment, and those on hormonal contraception should also use a barrier method, such as a condom. The most common side effects include dry mouth, nausea, heartburn, headache, sleep problems, irritability and increased appetite.

Nicotine replacement therapy supplies nicotine, which eases withdrawal symptoms, without the patient inhaling smoke that contains carcinogens. All of its forms are available in Poland without a prescription: 16-hour patches in strengths of 10, 15 and 25 mg, 24-hour patches in strengths of 7, 14 and 21 mg, 2 and 4 mg gum, lozenges and pastilles, and a mouth spray. A patch releases nicotine slowly over many hours, while gum, a lozenge or the spray helps you get through a sudden craving. In a Cochrane review of 16 studies involving more than 12,000 people, a patch combined with a fast-acting form, such as gum, helped people quit more effectively than a single form used on its own, and the product information allows this combination for strongly dependent people and for those whom a single form did not help.

The dose depends on how strong the dependence is. According to its Summary of Product Characteristics, the 24-hour patch is worn at 21 mg for 6 weeks, then at 14 mg for 2 weeks and at 7 mg for 2 weeks, and a person who smokes up to 10 cigarettes a day starts at 14 mg; the course should not last longer than 10 weeks. A strongly dependent person wears the 16-hour 25 mg patch for 8 weeks and then gradually lowers the dose to 15 and 10 mg over 4 weeks. Patients usually chew 8 to 12 pieces of 4 mg gum a day, no more than 15, for at least 3 months, and then gradually cut down.

The product information advises caution after a recent heart attack or stroke, in unstable angina, severe heart rhythm disorders and uncontrolled high blood pressure, and a person diagnosed with heart or blood vessel disease should not combine a patch with gum or lozenges without a doctor's assessment. Young people aged 12 to 17 may use 24-hour patches only if a doctor recommends them, and lozenges if a doctor or pharmacist recommends them; the spray is not given to anyone under 18.

Can nicotine patches or gum be used during pregnancy and breastfeeding?

The Summary of Product Characteristics for the nicotine patch states that during pregnancy it is best to quit smoking without medication, and the UK NICE guidelines base the treatment of pregnant women on support from a therapist and do not recommend cytisine, varenicline or bupropion at that time. According to the product information, cytisine is contraindicated during pregnancy and breastfeeding, bupropion is not used in pregnancy, and varenicline is best avoided in pregnancy. If a woman cannot quit without medication, the doctor may recommend nicotine replacement therapy for 2 to 3 months. According to the product information, gum or lozenges may be a better choice then, because they give a lower daily dose than a patch, while a patch may be more suitable if she has nausea. In a Cochrane review of 9 studies involving 2,336 pregnant women, nicotine replacement therapy may have increased the chance of quitting later in pregnancy, but studies comparing it with placebo did not confirm a difference. No difference was shown in the rates of miscarriage, premature birth, low birth weight or birth defects compared with the control group either, although the certainty of these data is low. Nicotine used in replacement therapy passes into breast milk. According to the Summary of Product Characteristics for NiQuitin, the baby's exposure is relatively small and less dangerous than passive smoking. The mother should breastfeed just before taking the next dose of nicotine.

Varenicline works in a similar way to cytisine. In a Cochrane review of 75 studies, more than twice as many people quit smoking on varenicline as on placebo. Varenicline also helped more often than a single form of nicotine replacement therapy or bupropion, and in two studies comparing it directly with cytisine, the difference in effectiveness between the two medicines could have been down to chance. In July 2021, batches of Champix were found to contain the impurity N-nitroso-varenicline above the permitted limit, and the Chief Pharmaceutical Inspectorate issued a notice about halting distribution of the medicine and recalling several batches. The marketing authorisation remains valid, and the European Medicines Agency considers the shortage to be over. Even so, in September 2026 none of the online pharmacies we checked had Champix for sale.

Of the bupropion products in Poland, only Zyban is authorised to treat nicotine dependence, and the others whose product information we checked are authorised to treat depression. In the Register of Medicinal Products, the Zyban authorisation expired in December 2023, and in September 2026 the medicine was unavailable in all the pharmacies we checked. According to its Summary of Product Characteristics, Zyban is taken for at least 7 weeks and is not used in people who have ever had a seizure, bulimia, anorexia or bipolar disorder, or in people who are suddenly stopping alcohol or benzodiazepines, among other groups. At a dose of 300 mg a day, seizures occur in roughly 1 in 1,000 people.

A missed tablet of cytisine, varenicline or bupropion

The leaflet for Desmoxan tablets advises against taking a double dose to make up for a missed one. The patient therefore does not go over the highest daily dose in the schedule, for example 6 tablets on days 1 to 3, and after missing several tablets talks to a doctor or pharmacist about how to continue. According to the Champix package leaflet, a forgotten tablet should be taken as soon as possible, unless the next dose is due within 3 to 4 hours. In that case, the missed dose should be skipped. A double dose should not be taken. After a missed dose of Zyban, the next dose should be taken at the usual time, without doubling it. Bupropion is not taken in doses above 150 mg at a time, and at least 8 hours must pass between doses.

A late patch change and the daily limit for nicotine gum

A 24-hour patch is applied once a day at the same time and is not worn any longer, because after that it releases less nicotine. If the change is late, the patient does not put on two patches at once. Gum, lozenges and spray are used when a craving strikes, so there is no dose to catch up on, but there is a daily limit, for example 15 pieces of gum.

How can you tell you are getting too much nicotine?

According to the manufacturers of NiQuitin patches and Nicorette gum, the people most likely to take too much nicotine are those who smoked little before treatment and those who keep smoking or using an e-cigarette during treatment. The symptoms resemble nicotine poisoning. They include nausea, vomiting, excessive salivation, abdominal pain, diarrhoea, pallor, sweating, headache, dizziness and marked weakness. The patient should then stop using nicotine, remove the patch, rinse the skin with plain water, without soap, and contact a doctor. Low blood pressure, a weak or irregular pulse, difficulty breathing and seizures need immediate medical help. A cytisine overdose causes similar symptoms and also needs urgent medical help.

Many smokers feel that a cigarette calms them down. What a cigarette actually does is relieve, for a short time, the irritability and anxiety caused by nicotine withdrawal. In a Cochrane review of 102 studies, people who stopped smoking later had slightly fewer symptoms of anxiety and depression and a better mood than people who carried on smoking. The same was true for people with mental illness. The authors say the certainty of these data ranges from very low to moderate. They also write that, on average, mental health did not get worse after quitting in these studies.

However, the product information for cytisine and varenicline warns that low mood can be a symptom of nicotine withdrawal and can, rarely, lead to suicidal thoughts or suicide attempts. Quitting smoking, with or without medication, can also be linked to a worsening of mental illness, such as depression. A person under psychiatric care should tell their psychiatrist about the plan to quit, especially if they take clozapine, olanzapine or fluvoxamine, because the levels of these medicines rise after quitting smoking.

The EAGLES trial, which involved more than 8,000 smokers, looked at whether stop-smoking medicines increase the risk of psychiatric symptoms. Among people with mental disorders, moderate or severe neuropsychiatric symptoms occurred in 6.5 percent of those taking varenicline, 6.7 percent of those taking bupropion, 5.2 percent of those using a nicotine patch and 4.9 percent of those taking placebo. The authors did not find that the medicines significantly increased the risk of such symptoms. Even so, the Summary of Product Characteristics for varenicline advises stopping the medicine straight away and seeing a doctor if serious symptoms appear, such as suicidal thoughts, aggression or sudden mood swings.

A nicotine e-cigarette helps people stop smoking cigarettes, but someone who has switched to one is still taking nicotine. In a Cochrane review from August 2026, after at least 6 months of follow-up, 4 more people in every 100 had quit cigarettes among those given a nicotine e-cigarette than among those using nicotine replacement therapy. Serious side effects probably occurred about equally often in both groups; the certainty of this result was rated as moderate. In a UK study of 886 smokers, 18 percent of e-cigarette users and 9.9 percent of people using nicotine replacement therapy were not smoking after a year, but 80 percent of those who had given up cigarettes with the help of an e-cigarette were still using it. The WHO considers e-cigarettes harmful to health.

Heated tobacco products contain tobacco and, according to the WHO, do not help people stop using it. In a Cochrane review from 2022, no study had looked at whether they helped anyone quit smoking, and all the randomised studies had been funded by tobacco companies. The WHO describes nicotine pouches as a highly addictive product that is not free of risk. Cigarette substitutes are especially popular among younger adults: according to PZH, 19.8 percent of men and 12 percent of women aged 20 to 39 use e-cigarettes, heated tobacco, pouches or chewing tobacco every day.

The medicines described on this page have been studied mainly in cigarette smokers, but according to its product information the 24-hour patch can also be used by people who want to stop using e-cigarettes or nicotine pouches.

Does quitting smoking put abstinence from alcohol at risk?

Research does not support this. Among people dependent on alcohol or drugs, the proportion of smokers is two to four times higher than in the population as a whole. In a review of 35 studies involving 5,796 such people, either in treatment or after treatment, help with quitting smoking did not change the proportion of patients who stayed off alcohol and drugs. In these studies, stop-smoking medicines increased the number of people who stopped smoking, especially when combined with sessions with a therapist, while sessions alone made no clear difference. The authors rate the quality of these data as low.

Does smoking cannabis with tobacco make it harder to quit?

Yes, because the tobacco added to a joint delivers nicotine. In an international survey of 33,687 cannabis smokers, 77 to 91 percent of people from European countries and 4 to 16 percent of people from North and South America mixed it with tobacco. A summary of 47 studies found that cannabis withdrawal symptoms occurred in 47 percent of regular users. Irritability, restlessness and sleep problems appear after stopping either substance. A review of 20 studies did not show that treatment clearly helps people stop using either of them, so it is not known whether it is better to give up tobacco and cannabis at the same time or one after the other.

Is a hookah less harmful than a cigarette?

Studies do not show that. In an experiment involving 31 people who smoked a hookah for up to 45 minutes on one occasion and a single cigarette on another, the highest blood nicotine levels were similar. After the hookah, however, carbon monoxide levels in the blood were about three times higher, and participants inhaled an average of 48.6 litres of smoke, compared with 1 litre from a cigarette.

Yes. In a UK study involving more than a million women, even those who smoked fewer than 10 cigarettes a day were twice as likely to die within 12 years as women who had never smoked, and across all smokers the risk of death was almost three times that of non-smokers. In a US study involving more than 200,000 adults, smokers lived more than 10 years less than people who had never smoked.

The earlier someone quits, the more years of life they gain. In the US study, people who quit between the ages of 25 and 34 gained about 10 years of life compared with those who kept smoking. Quitting between 35 and 44 gave about 9 years, and between 45 and 54 about 6 years. In the UK study, women who quit before the age of 40 avoided more than 90 percent of the extra risk of death that comes with continued smoking, and those who quit before 30 avoided more than 97 percent.

The first changes come quickly. According to the WHO, after just 12 hours without a cigarette the level of carbon monoxide in the blood returns to normal, after 2 to 12 weeks circulation and lung function improve, and within 1 to 9 months coughing and shortness of breath ease. After a year, the risk of coronary heart disease is about half that of a smoker, and after 15 years it is the same as for a non-smoker.

Coughing and spirometry results after quitting smoking

In the first weeks, the cough may get worse. A UK study followed 174 people who were quitting with a patch and counselling. After a week without cigarettes, they reported coughing, a sore throat and sneezing more often than before quitting, and after 1 and 2 weeks also mouth ulcers and cold symptoms. Coughing up blood, or shortness of breath that gets worse from day to day, needs urgent medical help.

The Lung Health Study included smokers aged 35 to 60 with mild or moderate chronic obstructive pulmonary disease. In those who quit, the volume of air breathed out in the first second (FEV1) rose by an average of 47 ml in the first year and then fell by 31 ml a year, compared with 62 ml a year in those who carried on smoking. After 5 years, chronic cough, phlegm, wheezing and shortness of breath were least often reported by people who had not smoked at all during that time.

Does quitting smoking help after a heart attack?

Yes. In a review of observational studies, people with heart or blood vessel disease who quit smoking had a 39 percent lower risk of dying from cardiovascular causes than those who kept smoking. Studies of this kind show a link but do not prove that the whole difference comes from quitting. In a review of 82 studies of hospital patients, the number of people who stopped smoking increased with support that started in hospital and continued for more than a month after discharge, while support that ended earlier showed no clear benefit.

How many weeks before surgery should you quit smoking?

The sooner the better, but a shorter break also makes a difference. In a 2025 analysis of 55 studies, mostly observational, people who had stopped smoking at least 4 weeks before surgery had 31 percent fewer complications overall and 33 percent fewer wound healing complications than people who smoked up to the day of the operation. After at least 8 weeks without cigarettes there were 37 percent fewer lung complications, and after 2 weeks 27 percent fewer. In two small studies, intensive support started 4 to 8 weeks before surgery, with weekly sessions and nicotine replacement therapy, reduced the number of complications. Brief advice did not reduce complications. The patient should tell the anaesthetist that they are using a patch or another stop-smoking medicine.

Does blood sugar go up in people with diabetes after quitting smoking?

It may, for a while. In a UK study of 10,692 smokers with type 2 diabetes, glycated haemoglobin (HbA1c) in those who quit rose by an average of 0.21 percentage points in the first year, and after 3 years it was similar to that of people who kept smoking. The rise was not explained by weight gain. The manufacturers of nicotine gum and patches advise people with diabetes to check their glucose more often after quitting, and any change in the dose of diabetes medicines is a decision for the doctor.

Smoking damages the gums and the tissues that hold the teeth in place. In a review of prospective studies, smokers had an 85 percent higher risk of periodontitis, and in a review of long-term studies a more than two and a half times higher risk of losing teeth than people who had never smoked. The WHO also lists stained teeth, a changed sense of taste and bad breath. After quitting, the risk goes down: in former smokers, the risk of periodontitis was not significantly different from that of people who had never smoked, and the risk of tooth loss was close to that of people who had never smoked. These were observational studies.

Smoking also gets in the way of dental treatment. Dry socket is a painful complication after a tooth extraction in which the blood clot falls out of the wound or breaks down. In a review of studies, this complication occurred in about 13.2 percent of smokers and 3.8 percent of non-smokers. In an analysis of 32 studies involving 14,115 patients, smokers were twice as likely to have an early dental implant failure. According to a meta-analysis of 115 studies, the risk of mouth and throat cancer is more than three and a half times higher in smokers than in people who have never smoked. It doubles with as few as 6 cigarettes a day or after 7 years of smoking. Within 10 years of quitting, it falls by half.

Do cigarettes and e-cigarettes harm young people's gums?

In a Polish study of 992 fifteen-year-olds, bleeding gums were found in 25.1 percent of the students. After taking into account factors such as oral hygiene habits, smoking cigarettes was linked to a more than two and a half times higher chance of bleeding gums, and using e-cigarettes to an almost twice as high chance. A cross-sectional study does not prove cause and effect, however, and in a review of studies of adolescents and young adults the certainty of the findings on e-cigarettes and oral health was rated as low. E-cigarettes are very popular among students: in the 2024 ESPAD survey, 37.2 percent of students aged 15 and 16 and 50.9 percent of those aged 17 and 18 had used them in the 30 days before the survey.

After a year without cigarettes, body weight is on average 4.67 kg higher, and it rises fastest in the first 3 months. In a meta-analysis of 62 studies published in the BMJ, people who quit without medication weighed an average of 1.12 kg more after a month, 2.85 kg more after 3 months and 4.23 kg more after six months. The differences between people are large: according to the authors' calculations, after a year about 16 percent of people weigh less than before they quit, while 13 percent gain more than 10 kg. Weight went up in a similar way in people taking stop-smoking medication. Increased appetite is one of the symptoms of nicotine withdrawal.

Even with the weight gain, quitting smoking still protects the heart. In an analysis of Framingham Study participants, people without diabetes who had quit smoking within the previous 4 years put on more weight than people who had quit long before. Even so, their risk of heart and blood vessel disease was about half that of smokers. If obesity develops after quitting smoking, it calls for proper treatment.

Smoke also harms people who do not smoke themselves, and there is no level of exposure that is safe for them. The WHO estimates that of the more than 7 million deaths caused by tobacco worldwide each year, more than 1.6 million are among non-smokers who breathed in other people's smoke. Data from 192 countries gathered in an analysis for 2004 show that at the time 33 percent of non-smoking men and 35 percent of non-smoking women were exposed to other people's smoke.

Children are especially at risk. In 60 studies of babies and young children, smoking at home was linked to a 54 percent higher chance of lower respiratory tract infections and a more than two and a half times higher chance of bronchiolitis. In children whose mothers smoked after giving birth, the chance of middle ear disease was 62 percent higher, and wheezing and asthma occur at least 20 percent more often in children who breathe in smoke, according to a review of studies that followed children for many years. In 2022, 28.8 percent of Polish students aged 13 to 15 were exposed to tobacco smoke at home.

Does smoking on the balcony protect a child?

It is not known whether it gives enough protection. A Swedish questionnaire study involved 1,990 children aged 12 to 24 months. Significant differences in chronic cough after an infection and in wheezing without an infection were found between the children of parents who smoked at home and the children of non-smoking parents. The authors concluded that the belief that smoking outdoors protects a child needs further research, and a questionnaire cannot establish what caused these differences.

How can you protect a child from nicotine poisoning from stop-smoking medicines?

According to the manufacturer of Nicorette gum, a dose of nicotine that an adult smoker tolerates well can cause severe or even fatal poisoning in a small child. Patches, gum, lozenges and spray should be kept out of children's reach, and a used patch should be folded in half, sticky side in, before it goes in the bin. If you suspect that a child has swallowed nicotine gum or a lozenge, sucked on a patch or stuck one on their skin, get urgent medical help.

Most people who try to quit without help go back to cigarettes, most often in the first week. Anyone who smokes even one cigarette during treatment should talk to their doctor or therapist about what led up to it: stress, alcohol, being around smokers or a missed dose of medicine. According to the Summary of Product Characteristics for cytisine, a course that has not worked should be stopped, and a new one can be started after 2 to 3 months. According to WHO guidelines, after a relapse it is important to work out what made treatment difficult and to plan the next attempt.

After a successful course, extending treatment may lower the risk of relapse, but the benefit depends on the medicine. In a Cochrane review of 81 studies on relapse prevention, taking varenicline for an extra 12 weeks reduced the number of people who went back to smoking, although this medicine is hard to get in Poland today. In people who had quit without any help, nicotine replacement therapy may have protected against relapse. In people who had quit as part of treatment, programmes teaching them to recognise difficult situations did not reduce relapses if they began only after quitting. Sessions with a therapist have been shown to work mainly when they go hand in hand with medication.

Is it easier to quit when your partner quits too?

People who are close to each other often quit smoking at around the same time. In an analysis of data on 12,067 Framingham Study participants, the chance that someone was still smoking was 67 percent lower when their spouse had quit and 36 percent lower when a friend had quit. This was an observational study, so it does not prove that one person quits because the other one did. Programmes that taught partners and friends how to support someone who was quitting did not clearly increase the proportion of non-smokers after six months or a year, according to a summary of 14 studies.

Smoking tobacco is the leading cause of death among men in Poland. According to a report by the Agency for Health Technology Assessment and Tariff System (AOTMiT), which cites the Global Burden of Disease analysis, in 2019 smoking was responsible for 26.6 percent of deaths among men, and among women it was the second leading cause of death, responsible for 13.8 percent of deaths.

How much does smoking cost the state budget and the NFZ?

In 2025, the state budget collected PLN 31.1 billion in excise duty on tobacco products, or PLN 33.4 billion including e-cigarette liquids and novel tobacco products. As reported by the Supreme Audit Office (NIK), revenue from tobacco products was 9.3 percent below forecast, and cigarette sales fell by 18.2 percent. According to a report by the National Health Fund (NFZ), treating patients whose main diagnosis was one of a selection of tobacco-related diseases cost at least PLN 2.28 billion in 2019. This figure does not include sick leave, disability benefits or lost working time, so it cannot be set directly against excise revenue.

How much do cigarettes cost smokers and their families?

According to Statistics Poland (GUS), a pack of 20 cigarettes cost PLN 21.61 on average in 2025. A person who smokes a pack a day therefore spends about PLN 7,888 a year on cigarettes, and about PLN 79,000 over 10 years, even without price rises. Price rises, however, are built into a law passed in October 2024: the fixed part of the excise duty on cigarettes is PLN 345 per 1,000 cigarettes from March 2025, PLN 414 in 2026 and PLN 476.10 from 2027. In the household budget survey, tobacco products accounted for an average of PLN 20.40 a month per household member in 2024, counting children and non-smokers too.

Are fewer people smoking in Poland?

For many years, yes. In a GUS survey, the share of men who smoked every day fell from 29 to just under 21 percent between 2014 and 2019, and the share of women from 17 to 14 percent. According to Poland's National Institute of Public Health (PZH), this decline stopped after 2020, and the share of men who smoke rose slightly. The two surveys used different methods, so their results are not compared directly. Some smokers also use other nicotine products: in the PZH survey, 23 percent of daily smokers also used e-cigarettes, heated tobacco, nicotine pouches or chewing tobacco, and excise revenue from e-cigarette liquids rose by 76.9 percent in 2025. Since July 2025, the law has banned selling or giving e-cigarettes and nicotine pouches to anyone under 18.

The benefits of quitting smoking start in the first hour and keep growing for years. According to the WHO, just 20 minutes after the last cigarette the heart rate and blood pressure drop, after 10 years the risk of lung cancer is about half that of a smoker, and after 5 to 15 years the risk of stroke is the same as for a non-smoker. A pack a day also stops taking almost PLN 8,000 a year out of the household budget.

No one has to quit smoking alone. Without any help, only 3 to 5 people in 100 are not smoking six months or a year later, and medication together with sessions with an addiction therapist improves those odds. At Nasz Gabinet clinics, the doctor chooses a medicine after reviewing the patient's health conditions, the medicines they take and how previous attempts to quit went. An addiction therapist helps the patient plan what to do in the situations when the urge to smoke is strongest. We treat patients at our practices in many cities and online, and no referral is needed for the first appointment.