If you are looking at smoking cessation options, you have four serious choices and a lot of marketing telling you each one is the answer. This article puts them side by side using what the published research shows. We sell cold laser therapy, so you should read this knowing we have a stake in the comparison. We have written it the way we would want it written if we were on the other side of the conversation.
Why people compare these four
The four methods on this page (nicotine replacement therapy, varenicline, hypnotherapy, and cold laser) cover the four main mechanisms anyone has tried at scale: replace the drug, block the receptor, change the belief, or stimulate the recovery. Other approaches exist, including electronic cigarettes as harm reduction and cognitive behavioural therapy as a standalone. They are not on this page because the evidence base for them is either smaller or harder to compare to a single-mechanism intervention.
Nicotine Replacement Therapy: Patches, Gum, Lozenges
Mechanism. Deliver a controlled, lower dose of nicotine through a non-combustion route. Taper down over weeks or months. The receptor stays occupied, withdrawal symptoms stay mild, and the dose comes down on a schedule.
Evidence. This is the best-studied cessation intervention in the world. Cochrane meta-analyses of more than 130 trials show NRT roughly doubles quit rates compared with placebo at six months (Hartmann-Boyce et al., 2018). Six-month abstinence rates land around 17 to 19 percent with NRT versus around 10 percent without. That is real, and it is also a long way from "most people quit successfully."
Strengths. Available without a prescription. Cheap. A month of patches runs about C$70. Safe in almost everyone. Combinations (patch plus gum) work better than either alone.
Limits. Replaces nicotine but does nothing for the dopamine downregulation that drives long-term relapse. Many people quit nicotine and never get past the months-long flat that follows, and end up returning to it. NRT also assumes you can taper. People who use high-concentration vaping pods often find the standard patch doses inadequate.
Varenicline (Champix, Chantix)
Mechanism. A partial agonist at the alpha4beta2 nicotinic receptor. It binds the same receptor nicotine binds, produces a much weaker activation, and blocks nicotine from binding if you do smoke. Cravings drop, and any cigarette you do smoke is less rewarding.
Evidence. Multiple Cochrane reviews and the landmark EAGLES trial put varenicline at the top of the cessation league table. Twelve-week quit rates of 33 to 38 percent versus 8 to 10 percent on placebo (Cahill et al., 2016; Anthenelli et al., 2016). Six-month rates remain materially higher than NRT.
Strengths. The most effective single agent we have. Works for many people who failed NRT. Generic versions are available, which has brought costs down to roughly C$120 to C$200 for a 12-week course.
Limits. Prescription only. Nausea is common in the first weeks and is the most frequent reason people stop. Vivid dreams. A small but real subset of people experience low mood or irritability during treatment. The EAGLES trial put rates of serious neuropsychiatric events at parity with placebo, but the FDA boxed warning history makes some prescribers cautious.
Bupropion (Zyban, Wellbutrin)
Mechanism. A norepinephrine and dopamine reuptake inhibitor originally developed as an antidepressant. The mechanism for smoking cessation is not fully understood. It appears to dampen the dopamine deficit during withdrawal and reduce the rewarding effect of nicotine.
Evidence. Roughly doubles quit rates compared with placebo, comparable to NRT and somewhat below varenicline (Howes et al., 2020).
Strengths. Useful when nicotine is not the only target. Many people who smoke have co-occurring depression, and bupropion treats both. Non-nicotine option.
Limits. Prescription only. Lowers the seizure threshold, so it is not used in people with seizure history, eating disorder history, or heavy alcohol use. Insomnia and dry mouth are common.
Hypnotherapy
Mechanism. Guided suggestion in a relaxed state, aimed at changing the smoker's relationship to cigarettes: the belief that they are enjoyable, the association with stress relief, the identity of being a smoker.
Evidence. The Cochrane review of hypnotherapy for smoking cessation rated the trial quality as low to very low and concluded the evidence does not show hypnotherapy is more effective than other counselling approaches (Barnes et al., 2019). Some individual practitioners report strong results. The controlled-trial data does not support a population-level claim.
Strengths. Non-invasive, no medication, no physical side effects. Some people respond strongly. The first session is often enough for people who do respond.
Limits. Response is inconsistent and not well predicted in advance. Many sessions can be expensive. Does not address the underlying neurochemistry, only the conscious associations.
Cold Laser Therapy
Mechanism. Low-level laser light applied to specific auricular and body points. Stimulates endorphin and enkephalin release, supports mitochondrial ATP production through photobiomodulation, and engages the same reward pathways nicotine had been driving. Detailed mechanism in our how it works and photobiomodulation articles.
Evidence. Smaller and lower-quality than the evidence for NRT or varenicline. A systematic review of laser acupuncture for smoking cessation found a positive short-term effect compared with sham, though trial heterogeneity was high (White et al., 2014). The honest summary: the signal is there, the evidence base is thinner, and larger trials are needed. We have written about this directly in Does Laser Therapy to Quit Smoking Actually Work?.
Strengths. No medication, no nicotine, no prescription. The treatment is painless and takes 20 to 40 minutes. It addresses the dopamine and endorphin deficit directly rather than replacing nicotine. The Success Partnership guarantee on our Platinum protocol means we continue working with you if the protocol does not deliver on the first round.
Limits. Limited published evidence compared with pharmacological options. Outcomes vary by protocol, device, and clinic. Out-of-pocket cost is similar to a 12-week varenicline course or several months of NRT at the entry level, and higher at the Platinum tier. Not yet covered by most insurance plans in Canada.
The Honest Comparison
| Method | 6-month quit rate | Mechanism | Prescription | Common side effects | Typical cost (CAD) |
|---|---|---|---|---|---|
| Patches and gum (NRT) | ~17 to 19% vs ~10% on placebo | Replace nicotine, taper | No | Skin or mouth irritation | $70 to $200 / 12 weeks |
| Varenicline (Champix) | ~25 to 30% vs ~10% on placebo | Partial receptor agonist | Yes | Nausea, vivid dreams, mood | $120 to $200 / 12 weeks |
| Bupropion (Zyban) | ~17 to 19% vs ~10% on placebo | Dopamine and norepinephrine | Yes | Insomnia, dry mouth | $100 to $180 / 12 weeks |
| Hypnotherapy | Inconsistent, low-quality evidence | Behavioural and belief change | No | None physical | $100 to $300 / session |
| Cold laser therapy | Positive signal, evidence thinner | Endorphin release and photobiomodulation | No | None reported | $325 to $2,094 / protocol |
Two caveats on these numbers. Quit rates depend heavily on the population studied, how strict the abstinence definition is, and the support around the intervention. Treat these as ballpark figures, not exact predictions for any individual.
Which Option Fits Which Person
A few patterns from the research and from working with thousands of clients:
- You have not tried anything yet. Start with NRT or varenicline. They have the strongest evidence and the lowest barrier to access.
- You have tried NRT and the cravings or the long flat got you. Varenicline and laser therapy both address what NRT does not. Varenicline acts at the receptor, laser acts on the reward system.
- You cannot tolerate or do not want medication. Laser therapy is the option on this page that meets that bar with any supporting evidence behind it.
- Nicotine is part of a larger picture (anxiety, depression, multiple substances). Bupropion treats co-occurring mood. Our mental health and complex addiction protocols address the broader pattern.
- You have already quit and are dealing with the flat. This is the strongest indication for laser therapy. Photobiomodulation supports the dopamine system during the recovery window that NRT and varenicline do not cover.
If you want to talk through which fits your situation, you can book a session or read what to expect at a first laser therapy session.
Frequently Asked Questions
Which has the highest quit rate?
Varenicline has the strongest single-agent quit rate in controlled trials, around 25 to 30 percent at six months versus about 10 percent on placebo. Combining methods, for example varenicline plus behavioural support, raises that further. No single method gets a majority of people to lifetime abstinence on its own.
Is cold laser therapy as effective as Champix?
The published evidence does not support that claim. Varenicline has a much larger and higher-quality evidence base. Laser therapy has a positive signal in the trials that exist, but those trials are smaller and more variable in quality. The case for laser therapy is strongest as a complement to other approaches or for people who cannot use medication.
Can I combine these methods?
Yes, with care. NRT plus laser therapy is well tolerated. Varenicline plus laser therapy works for some people but should be discussed with your prescriber. Combining two prescription medications (varenicline plus bupropion) is done in some clinics but requires medical supervision.
What about e-cigarettes for quitting?
Vaping as a cessation tool has growing evidence in adults who smoke combustibles. The most recent Cochrane review concluded nicotine-containing e-cigarettes likely beat NRT for quit rates (Hartmann-Boyce et al., 2021). The trade-off: many people who switch end up with long-term vaping dependency, which has its own withdrawal pattern. We covered this in vaping vs smoking.
Why is the laser therapy evidence base smaller?
The pharmacological options have been studied in industry-funded trials with thousands of participants. Laser acupuncture trials have mostly been smaller, academic, and lower-funded. The mechanism is plausible and the small trials are positive. The field needs larger, better-controlled studies to make the same confident claims that NRT and varenicline can make.
What if a method does not work?
Most quit attempts do not succeed on the first try, regardless of method. The research consistently shows that repeat attempts have higher success rates than first attempts. Our Success Partnership is built around that reality. We continue working with you within the protocol rather than treating one round as the whole answer.
References
- Hartmann-Boyce J, Chepkin SC, Ye W, et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews. 2018.
- Cahill K, Lindson-Hawley N, Thomas KH, et al. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews. 2016.
- Anthenelli RM, Benowitz NL, West R, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES). The Lancet. 2016.
- Howes S, Hartmann-Boyce J, Livingstone-Banks J, et al. Antidepressants for smoking cessation. Cochrane Database of Systematic Reviews. 2020.
- Barnes J, McRobbie H, Dong CY, et al. Hypnotherapy for smoking cessation. Cochrane Database of Systematic Reviews. 2019.
- White AR, Rampes H, Liu JP, et al. Acupuncture and related interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2014.
- Hartmann-Boyce J, McRobbie H, Lindson N, et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews. 2021.