Is it true? Do a vast majority who succeed in fully arresting their chemical dependence upon nicotine do so by quitting cold turkey? While empirical evidence, attempts, and a handful of recent high-quality observational findings suggest yes, a complete and accurate nicotine cessation picture has yet to be painted.

The most fundamental quitting question of all is, under real-world conditions, how do most end their brain's dependence upon smoked, vaped, or pouched nicotine?

At long last, did 2024 "cold turkey" study findings answer this question?

Unfortunately, the quitting product industry, its funded organizations, and the neo-nicotine industry (PDF) have financial incentives to make sure this core recovery question remains unanswered. Meanwhile, the U.S. Department of Health and Human Services has endorsed cessation guidelines heavily influenced by pharmaceutical industry funding: guidelines that declare which quitting methods are considered science-based and which are not.

Government health agencies such as the FDA, CDC, NCI, and AHRQ have heavily invested their reputations in approved products. For example, the U.S. government’s “Explore Quit Methods” page at SmokeFree.gov (maintained by the NCI and NIH) lists 13 quitting methods, including advertising specific brand name quitting products such as Nicoderm CQ, Nicorette, Nicotrol, Wellbutrin, Zyban, and Chantix.

Not mentioned is “cold turkey,” the method that every year helps more Americans quit smoking than all mentioned approved products combined. It’s as if the SmokeFree.gov website, like the June 2000 U.S. cessation guideline, was authored by paid pharmaceutical industry consultants.

Cold Turkey Defined

Cold turkey is defined as the “abrupt complete cessation of the use of an addictive drug.” Nicotine dependence is the common thread between addictions to cigarettes, e-cigarettes, nicotine pouches, heated tobacco products, smokeless tobacco, cigars, pipes, and persistent NRT use.

Definitionally armed, reflect on the irony of 2018 researchers referring to abruptly switching from smoked nicotine to vaped nicotine as having quit “cold turkey.” It’s akin to an alcoholic claiming to have quit cold turkey after trading their bottle or can for powdered alcohol capsules.

What about 2024 “cold turkey” research findings? Do they support the reluctant admission within the U.S. Surgeon General’s 2020 smoking cessation report that “most smokers who quit successfully do so without medications or any type of formal assistance,” with “population surveys suggesting that cold turkey quitters do as well or better than those who use over-the-counter NRTs”?

A little, but not much.

Keep in mind that the Surgeon General’s 2020 report relied almost exclusively on results from randomized smoking cessation clinical trials, studies populated entirely by treatment-seeking quitters. Like the trials themselves, the 700-page report ignores nicotine dependency recovery. Absent from nearly 300 randomized trials were the vast majority of real-world quitters, those wishing to quit without the use of approved products, including all dreaming of successfully navigating withdrawal via cold turkey.

2024 Cold Turkey Findings

A PubMed search returned 7 journal articles published during 2024 that mention “cold turkey” within the study's summary (abstract). Five studies focused on attempts at quitting vaping e-cigarettes, 1 addressed attempts at ending dual use of both cigarettes and e-cigarettes, while 1 investigated acupuncture quit smoking attempts.

Once again, no study published during 2024 provided Earth’s 1.25 billion nicotine users with a complete population-level quitting picture, indicating which methods are the most effective and which are the most productive in helping those addicted to nicotine break its grip on their minds and lives.

Bejarano 2024 came closest. This study sought to identify factors associated with successful e-cigarette quitting attempts among 586 users, of which 27.5% had successfully quit. The most commonly attempted e-cigarette quitting method overall was cold turkey (63.1%), which accounted for 70.8% of successful quitters.

Holt 2024 (1) surveyed 1,563 college psychology course students, 356 of which reported an e-cigarette quitting attempt. According to the study, quitting "cold turkey," using willpower, and replacing e-cigarette use with another activity were the most frequently endorsed quitting strategies.

Holt 2024 (2) involved 2,007 college e-cigarette users from 6 schools who completed a one-hour survey. The study found that "unassisted cessation methods were most common [e.g., cold turkey (68%), willpower (53%)]." Interestingly, without presenting any supporting data indicating cold turkey success rates, the authors suggest that students would benefit from increased access to approved quitting products.

Kierstead 2024 randomly selected 695 of 7,110 Reddit vaping cessation support group posts generated between 2015 and 2021. Noting a strong increase in peer-to-peer vaping posts over time, the study found that among quitting strategies, 38.33% of the 695 posts suggested cold turkey quitting, 17% indicated the use of quit smoking products, and 10.5% were associated with tapering nicotine intake.

Nguyen 2024 involved semi-structured tobacco cessation interviews of 14 young adults who were dual users of both cigarettes and e-cigarettes. “Participants expressed a strong desire for dual tobacco cessation and had attempted to quit both tobacco products, mostly "cold turkey." Interestingly, 71% (10/14) intended to quit e-cigarettes during the next 6 months, while only 43% (6/14) intended to quit cigarettes.

Lin 2024 found that among 3,137 surveyed e-cigarette ever-users, cold turkey was the most attempted quitting method (41%) followed by cutting down/tapering (25.5%).

Sicker 2024 investigated smoking cessation acupuncture as a quitting alternative. It relied upon 42 completed surveys by patients whose medical records indicated tobacco use. It found that 76% of patients reported prior quitting attempts, with 65% reporting a cold turkey attempt, 45% using nicotine replacement products, 23% using Chantix, 19% using bupropion (Wellbutrin or Zyban), 3% trying hypnosis, and no respondents reporting an acupuncture attempt.

40 Years of Research Neglect

Fourteen years ago Chapman and MacKenzie authored “The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences.” “We know of no campaigns that highlight the fact that most ex-smokers quit unaided even though hundreds of millions have done just that,” they wrote. “Smoking cessation is becoming increasingly pathologized, a development that risks distortion of public awareness of how most smokers quit to the obvious benefit of pharmaceutical companies.”

“With approximately two-thirds to three-quarters of ex-smokers stopping unaided, our finding that 91.3% of recent intervention studies focused on assisted cessation provides support for the inverse impact law of smoking cessation.”

The FDA’s 1984 approval of Nicorette nicotine gum instantly made free “cold turkey” quitting public enemy #1. What are the keys to successful cold turkey quitting and can they be easily shared? How many quitting "experts" can answer that question? Will 2025 witness the creation of the first-ever wide-angle snapshot of how U.S. nicotine dependency recovery is occurring? If cold turkey is found to be both the most productive and effective quitting method, will those findings again be suppressed?

Stay tuned.

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John R. Polito received his JD from the University of South Carolina School of Law in 1985. He is a former 3-pack-a-day thirty-year smoker and the 1999 founder of WhyQuit. A nicotine cessation educator since 2000, John mentored under Joel Spitzer for two decades, presenting more than 100 live nicotine dependency recovery programs modeled after Joel's programs. He is the author of "Freedom from Nicotine - The Journey Home," "Smart Turkey," 6 peer-reviewed journal articles, and founder and director of Turkeyville, a 17,000-member Facebook support group exclusively for cold turkey quitters. Email: johnpolito54@gmail.com

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