7.18 Alternative therapies and emerging treatments

Last updated: October 2016 

Suggested citation: Greenhalgh, EM., Stillman, S., & Ford, C. 7.18 Alternative therapies and emerging treatments. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from: http://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-18-unproven-methods

7.18.1 Acupuncture

Acupuncture involves applying needles or surgical staples to the skin of the ear or other parts of the body. Related treatments include acupressure, laser therapy, and electrostimulation, all of which aim to stimulate acupuncture points on the body. A Cochrane review published in 2014 concluded that, although there is weak evidence for short-term effects, there is no consistent, bias-free evidence that acupuncture, acupressure, or laser therapy are effective for long-term smoking cessation. It also concluded that electrostimulation is not effective for smoking cessation. Due to the popularity of these interventions, the authors suggest that more robust research is justified; however, they are not likely to be more effective than existing evidence-based strategies.1

A subsequent small pilot study of intensive acupuncture for smoking cessation found that, following two one-hour acupuncture sessions weekly for 12 weeks, only three of the 28 participants were confirmed abstinent at 12 weeks, and only one participant was abstinent at 26 weeks. However, almost half of the participants (43%) failed to complete the full treatment, suggesting that it may have been too onerous.2 Naturalistic research in the US found that ear acupuncture was associated with successful quitting among patients in a residential drug rehabilitation unit, many with a dual diagnosis of drug dependence and personality disorder.3 A randomised controlled trial of ear acupuncture in the general population suffered from high dropout rates, and there was no difference between groups for cessation or withdrawal symptoms.4

7.18.2 Hypnotherapy

Hypnotherapy is often purported to assist with quitting smoking, and aims to act on underlying impulses to weaken the desire to smoke or strengthen the will to stop. A 2010 review of hypnotherapy for smoking cessation failed to show that it had a greater effect on sustained quit rates than other interventions or no treatment, and there was insufficient evidence as to whether it could be as effective as counselling.5 Since then, a small number of studies have continued to explore its efficacy. A randomised controlled trial published in 2013 concluded that a single session of group hypnotherapy does not appear to be more effective for smoking cessation than a group relaxation session; both yielded success rates of about 15–18%.6 Another randomised controlled trial, this time with patients hospitalised for cardiac or pulmonary illness, found that hypnotherapy was more effective than nicotine replacement therapy in improving abstinence rates.7

7.18.3 Exercise

Regular exercise has been suggested as a strategy for managing nicotine withdrawal and weight gain, and it does appear to be effective for reducing cravings.8 A small study in Canada found that an acute bout of exercise provided additional craving relief to the nicotine lozenge in recently quit smokers, suggesting exercise may complement existing therapies and maximise reductions in cravings.9

Despite their promise, a 2014 Cochrane review of exercise interventions for smoking cessation found that only two of the 20 trials supported the use of exercise as a long-term cessation aid; the remaining trials were too small or not intensive enough to reliably draw conclusions. The authors call for larger and more rigorous trials.10 A preliminary randomised controlled trial published in 2014 attempted to address some of these shortcomings, and found that exercise was associated with lower levels of depressive symptoms and higher verified abstinence rates (though this did not reach statistical significance).11 Another randomised controlled trial of an exercise-aided smoking cessation intervention program for women with built-in maintenance components found that it enhanced cessation rates 14 weeks after the intervention, but the effects were not sustained at weeks 26 and 56.12 Yoga

Yoga is one of the most widely used complementary and alternative therapies. Despite suffering from some methodological limitations, a growing body of research suggests that practising yoga is beneficial for both mental and physical health.13-15 A recent review of yoga interventions for smoking cessation concluded that such interventions hold promise for smoking cessation, with the majority of studies showing that it increased quitting rates. More high quality research is needed to draw firm conclusions.16

7.18.4 Biomedical risk assessment

Giving smokers a biomedical risk assessment of their smoking has been suggested as a possible strategy for increasing cessation rates.17 This involves providing smokers who have contact with healthcare systems feedback on the biomedical or potential future effects of smoking (e.g. through measurement of lung function, exhaled carbon monoxide, arterial ultrasounds, lung cancer screening or genetic susceptibility to lung cancer). However, a 2012 Cochrane review found that of 15 studies that provided smokers with feedback on the physical effects of smoking using physiological measurements (for example, exhaled carbon monoxide measurement or lung function tests), only two significantly increased long-term quitting.18 A 2015 randomised controlled pilot study similarly found that lung age feedback did not improve quit rates or compliance at 28-day follow-up in smokers seeking intensive treatment.19 Nonetheless, results from a 2016 systematic review of the integration of smoking cessation interventions within the context of lung cancer screening programs appear more promising; participation in a lung screening trial appears to promote cessation and may represent a teachable moment to quit.20

7.18.5 Aversive conditioning

Aversive conditioning involves pairing an unwanted behaviour with an unpleasant stimulus. Aversion methods for smoking cessation include rapid smoking, covert sensitisation (smoking while imagining unpleasant associations), smoke holding, electric shocks, silver acetate or pairing smoking or urges to smoke with other unpleasant methods or products. Most of these methods are not supported by evidence.21, 22 A Cochrane review of aversive smoking concluded that rapid smoking (which requires smokers to take a puff every few seconds to make smoking unpleasant) may be effective, but due to the poor quality of many of the studies, further research is warranted.22 Another study found that a single night of olfactory aversive conditioning during sleep (i.e., pairing cigarette odour and profoundly unpleasant odours) significantly reduced cigarette-smoking behaviour, and this effect persisted for several days.23

7.18.6 Transcranial magnetic stimulation

Targeting the brain reward circuitry that underlies addiction with artificial stimulation appears to be a promising treatment for tobacco use.24 Building on research showing that repetitive transcranial magnetic stimulation (TMS) affects cigarette consumption, general craving, and cue-induced craving,25, 26 a recent study found that high-frequency deep TMS treatment significantly reduced cigarette consumption and nicotine dependence. Combining TMS with exposure to smoking cues enhanced reduction in cigarette consumption, leading to an abstinence rate of 44% at the end of the treatment and an estimated 33% 6 months later.27

7.18.7 Cutting down to quit

See Section 7.6.2 for a detailed discussion of abrupt versus gradual cessation.

Recent news and research

For recent news items and research on this topic, click here (Last updated March 2018)    



1. White AR, Rampes H, Liu JP, Stead LF, and Campbell J. Acupuncture and related interventions for smoking cessation. Cochrane Database of Systematic Reviews, 2014; 1:CD000009. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24459016

2. McFadden DD, Chon TY, Croghan IT, Schroeder DR, Mallory MJ, et al. Trial of intensive acupuncture for smoking cessation: A pilot study. Acupuncture in Medicine, 2015. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26124197

3. Stuyt EB. Ear acupuncture for co-occurring substance abuse and borderline personality disorder: An aid to encourage treatment retention and tobacco cessation. Acupuncture in Medicine, 2014; 32(4):318–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24824499

4. Zhang AL, Di YM, Worsnop C, May BH, Da Costa C, et al. Ear acupressure for smoking cessation: A randomised controlled trial. Evidence-Based Complementary and Alternative Medicine, 2013; 2013:637073. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24191168

5. Barnes J, Dong C, McRobbie H, Walker N, Mehta M, et al. Hypnotherapy for smoking cessation. Cochrane Database of Systematic Reviews, 2010; 10:CD001008. Available from: http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD001008/pdf_fs.html

6. Dickson-Spillmann M, Haug S, and Schaub MP. Group hypnosis vs. Relaxation for smoking cessation in adults: A cluster-randomised controlled trial. BMC Public Health, 2013; 13:1227. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24365274

7. Hasan FM, Zagarins SE, Pischke KM, Saiyed S, Bettencourt AM, et al. Hypnotherapy is more effective than nicotine replacement therapy for smoking cessation: Results of a randomized controlled trial. Complementary Therapies in Medicine, 2014; 22(1):1–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24559809

8. Haasova M, Warren FC, Ussher M, Janse Van Rensburg K, Faulkner G, et al. The acute effects of physical activity on cigarette cravings: Systematic review and meta-analysis with individual participant data. Addiction, 2013; 108(1):26–37.

9. Tritter A, Fitzgeorge L, and Prapavessis H. The effect of acute exercise on cigarette cravings while using a nicotine lozenge. Psychopharmacology, 2015. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25701265

10. Ussher MH, Taylor AH, and Faulkner GE. Exercise interventions for smoking cessation. Cochrane Database of Systematic Reviews, 2014; 8:CD002295. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25170798

11. Abrantes AM, Bloom EL, Strong DR, Riebe D, Marcus BH, et al. A preliminary randomized controlled trial of a behavioral exercise intervention for smoking cessation. Nicotine & Tobacco Research, 2014; 16(8):1094–103. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24812023

12. Prapavessis H, De Jesus S, Fitzgeorge L, Faulkner G, Maddison R, et al. Exercise to enhance smoking cessation: The getting physical on cigarette randomized control trial. Annals of Behavioral Medicine, 2016. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26791022

13. Lin K-Y, Hu Y-T, Chang K-J, Lin H-F, and Tsauo J-Y. Effects of yoga on psychological health, quality of life, and physical health of patients with cancer: A meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2011; 2011. Available from: http://dx.doi.org/10.1155/2011/659876

14. Büssing A, Ostermann T, Lüdtke R, and Michalsen A. Effects of yoga interventions on pain and pain-associated disability: A meta-analysis. The Journal of Pain, 2012; 13(1):1–9. Available from: http://www.sciencedirect.com/science/article/pii/S1526590011007929

15. Cramer H, Lauche R, Langhorst J, and Dobos G. Yoga for depression: A systematic review and meta-analysis. Depression and Anxiety, 2013; 30(11):1068–83. Available from: http://dx.doi.org/10.1002/da.22166

16. Dai CL and Sharma M. Between inhale and exhale: Yoga as an intervention in smoking cessation. Journal of Evidence-Based Complementary and Alternative Medicine, 2014; 19(2):144–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24647095

17. Young R, Hopkins R, Smith M, and Hogarth D. Smoking cessation: The potential role of risk assessment tools as motivational triggers. Postgraduate Medical Journal, 2010; 86(1011):26–33; quiz 1–2. Available from: http://pmj.bmj.com/content/86/1011/26.long

18. Bize R, Burnand B, Mueller Y, Rège-Walther M, Camain J-Y, et al. Biomedical risk assessment as an aid for smoking cessation. The Cochrane Library, 2012. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004705.pub4/full

19. Foulds J, Veldheer S, Hrabovsky S, Yingst J, Sciamanna C, et al. The effect of motivational lung age feedback on short-term quit rates in smokers seeking intensive group treatment: A randomized controlled pilot study. Drug and Alcohol Dependence, 2015; 153:271–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26051163

20. Pineiro B, Simmons VN, Palmer AM, Correa JB, and Brandon TH. Smoking cessation interventions within the context of low-dose computed tomography lung cancer screening: A systematic review. Lung Cancer, 2016; 98:91–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27393513

21. Fiore MC, Jaén M, Carlos Roberto, Baker TB, Bailey WC, Benowitz NL, et al. Treating tobacco use and dependence. Clinical practice guidelines. Rockville, MD: US Department of Health and Human Services, 2008. Available from: http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/index.html

22. Hajek P and Stead LF Aversive smoking for smoking cessation. Cochrane Database of Systematic Reviews, 2001 DOI: 10.1002/14651858.CD000546.pub2. Available from: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000546/frame.html

23. Arzi A, Holtzman Y, Samnon P, Eshel N, Harel E, et al. Olfactory aversive conditioning during sleep reduces cigarette-smoking behavior. The Journal of Neuroscience, 2014; 34(46):15382–93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25392505

24. Barr MS and George TP. Deep repetitive transcranial magnetic stimulation for smoking cessation: Is going deeper better? Biological Psychiatry, 2014; 76(9):678–80. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25282533

25. Amiaz R, Levy D, Vainiger D, Grunhaus L, and Zangen A. Repeated high-frequency transcranial magnetic stimulation over the dorsolateral prefrontal cortex reduces cigarette craving and consumption. Addiction, 2009; 104(4):653–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19183128

26. Li X, Hartwell KJ, Owens M, LeMatty T, Borckardt J, et al. Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex reduces nicotine cue craving. Biological Psychiatry, 2013; 73(8):714–20. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3615051/

27. Dinur-Klein L, Dannon P, Hadar A, Rosenberg O, Roth Y, et al. Smoking cessation induced by deep repetitive transcranial magnetic stimulation of the prefrontal and insular cortices: A prospective, randomized controlled trial. Biological Psychiatry, 2014; 76(9):742–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25038985

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