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If you鈥檝e ever smoked and tried to quit, you know how hard it can be. Nicotine is so addictive that smoking, or using tobacco in other forms, may be the toughest unhealthy habit to break. But it鈥檚 possible to quit. Just ask the millions of ex-smokers, who now outnumber smokers in the United States.

There are two main obstacles to quitting: the physical withdrawal from nicotine, and the mental and emotional withdrawal from a habit that had become a soothing part of daily routine.

Nicotine replacement, in the form of nicotine patches, gum, sprays, inhalers, and lozenges, can help overcome the physical addiction. Medications such as varenicline (Chantix) and bupropion (Zyban) can also help. They can help reduce the cravings for a cigarette, and may also make smoking less pleasurable.

Two new studies of these medications offer good news to smokers who want to quit but haven鈥檛 been able to do it with just nicotine replacement.

Two Duke University researchers asked 222 smokers who weren鈥檛 able to kick the habit with just nicotine replacement to take varenicline alone or varenicline plus bupropion while continuing to use a nicotine patch. After 12 weeks, 40% of those taking both medications were no longer smoking, compared to 25% of those taking only varenicline. The results were .

, a South African team compared varenicline plus nicotine replacement with varenicline alone. The combination worked better, with 49% of the 446 participants no longer smoking at 24 weeks, compared to 33% of those using just a nicotine patch.

These results don鈥檛 suggest smokers take varenicline and bupropion as a first step in smoking cessation. Both drugs must carry a 鈥渂lack box鈥� warning on their labels to highlight an increased risk of serious mental health events including changes in behavior, depressed mood, hostility, and suicidal thoughts. And the South African study found that smokers taking varenicline along with nicotine replacement experienced more quitting-related side effects, including nausea, sleep problems, constipation, and depression. But when nicotine replacement alone hasn鈥檛 helped, adding varenicline with or without bupropion may lead to success.

Plan ahead

If you want to quit, you can help yourself become a non-smoker with proper planning. One model commonly used to help people break addictions is called 鈥渟tages of change.鈥� According to this model, behavior change rarely occurs at one particular moment in time. Instead, you are more likely to journey through several distinct stages before attaining your goal.

1. In this phase, you may be thinking of changing now or in the future, but not seriously. You might know that smoking can cause health problems. But you don鈥檛 really believe smoking is a problem for you.
2. You recognize that quitting is probably right thing to do. But you still are uncertain if you want or need to quit.
3. You鈥檝e accepted the idea of quitting and start looking for ways to accomplish it.
4. You take one or more definite steps. Maybe you set a quit date, or sign up for a stop-smoking group. And you quit smoking鈥攁t least for a while.
5. You are tempted to return to smoking. This is true for any type of behavior change. Understand that this is expected. Therefore, you need to develop strategies ahead of time to address it, even if you smoke one or two cigarettes.

Don鈥檛 give up

If you succeed on your first attempt to quit smoking, congratulations! If not, try again when you are ready. The average person makes several attempts before quitting for good.

Using nicotine replacement is a good way to deal with nicotine withdrawal symptoms. If it doesn鈥檛 work, ask your doctor about the possibility of adding varenicline or bupropion. Cognitive behavioral therapy and support groups can help break the mental and emotional attachment to cigarettes.

However long it takes, quitting is beneficial. In a study , researchers from the German Cancer Research Center in Heidelberg showed that quitting smoking reduces the risk of dying鈥攅ven in people who quit in their 80s.