How to answer a nursing PICO Question using supporting data (Solved)

How to answer a nursing PICO Question using supporting data (Solved)

PICO: Is the effectiveness of smoking cessation greater when using unassisted “cold turkey” method than pharmacological therapy?

Introduction: Smoking is the leading cause of death in the USA. It is linked to approximately 440,000 deaths annually, with a loss of $ 100 billion in medical bills and productivity annually (Zhitar, 2022). In addition, it is estimated that adult women and men smokers lose 14.5 and 13.2 years of their life, respectively. One of the effective measures to improve population health is to reduce smoking rates. Smoking cessation is abstinence from tobacco products for not less than six months, preferably one year (Zhitar, 2022). Understanding the methods and their real-world application is essential to achieving higher smoking cessation rates. This paper aims to illustrate the effectiveness of cold turkey compared to pharmacotherapy in smoking cessation.

Effectiveness of Cold Turkey in Smoking Cessation Compared to Pharmacotherapy

Cold turkey and pharmacotherapy are methods applicable in smoking cessation, but their effectiveness varies. Cold turkey is a technique of instant cessation of smoking without the aid of other replacement therapies, for example, nicotine. In contrast, pharmacotherapy entails gradually reducing smoking with the aid of drugs and replacement therapies (Peckham, 2022).

Tobacco use is linked to head and neck squamous cell carcinoma. Its cessation is an effective method to discontinue exposure to carcinogens, thus reducing the risk of the disease (Khariwala et al., 2022). In this case, cold turkey is effective because it frees individuals from harmful substances sooner than pharmacotherapy, where one has to adjust and use other supportive therapies to quit smoking.

The major benefit of cold turkey is reduced temptation to smoke again, unlike pharmacotherapy, where an individual can smoke again (Peckham, 2022). The temptation to smoke again can lead to relapse, which is not the goal of a smoke cessation program. Research indicates that quitting smoking using cold turkey is more successful than pharmacotherapy (Peckham, 2022). The study followed up with participants at 28 days and six months after ceasing smoking, and the findings were that those who quit abruptly were more successful than those who gradually stopped smoking. The results indicated that 22 % and 15.5 % of the abrupt and gradual cessation groups were abstinent, indicating that cold turkey is more effective than pharmacotherapy in scenarios where relapse is avoided.

Nicotine is an addictive substance, and its absence in the addicted body can cause withdrawal. Individuals who apply cold turkey in quitting smoking don’t introduce nicotine into their bodies, unlike pharmacotherapy which is introduced in small amounts (Peckham, 2022). Nevertheless, in cold turkey, the body eliminates all nicotine in 2 days (48 hours), making it a most effective method of smoking cessation for non-chronic addicts compared to pharmacotherapy, where an individual has to wait for a long period to quit smoking fully. Complete avoidance of smoking helps smokers get past the withdrawal period effectively and more quickly than those who gradually quit smoking.

Smokers who use cold turkey to quit smoking don’t suffer from side effects experienced by those using the pharmacotherapy agents, such as Bupropion and varenicline. Bupropion is used to lower the craving for tobacco (Peckham, 2022). However, its use is associated with the following side effects, dry mouth, difficulties in sleeping, and behavioral changes, i.e., suicidal thoughts, agitation, anger, and depression. Also, varenicline is known to cause headaches, disturb sleep patterns, nausea, constipation, suicidal ideations, and depression, which is not the case when using cold turkey.

Studies indicate that continuous and long-term use of pharmacotherapy agents might lead to dependence, for example, on nicotine replacements (Khariwala et al., 2022). The findings show that most abstinent smokers cannot function without nicotine polacrilex gum. Also, the agents are associated with increased fetal heart rate, thus dangerous to intra-uterine life, which is not the case in cold turkey.

Adapting to the cold turkey method to cease smoking is not costly, unlike pharmacotherapy (Khariwala et al., 2022). The pharmacotherapy method involves payment for nicotine replacement products and other smoking cessation drugs, which are not incurred in the cold turkey approach. Also, in pharmacotherapy, individuals will have to inquire from care providers about the general use of drugs, which is quite expensive.

Individuals who adopt cold turkey in smoking cessation are more likely to benefit from quitting immediately. The blood pressure and heart rate usually return to normal within 20 minutes after the last smoking event (Hemphill, 2022). Also, the carbon monoxide is expected to decrease 72 hours post taking the last cigarette or tobacco-related substances. Finally, the circulatory and pulmonary systems improve within a few weeks, making cold turkey the best method where the results are needed instantly.

Pharmacotherapy is a gradual approach used to cease chronic smoking (Hemphill, 2022). The pharmacotherapy agents are very useful in repressing the negative smoking withdrawal symptoms, including headache, nausea, depression, suicidal thoughts, etc. They work by minimizing the withdrawal symptoms and blocking nicotine’s effects, limiting the adverse effects. Although the rate of relapse associated with pharmacotherapy is high, it is an effective and safe method of chronic smoking cessation compared to cold turkey.


Smoking cessation is the abstinence from tobacco products for a period not less than six months to 1 year. One of the effective measures to improve population health is to reduce smoking rates. It is essential to understand the methods of smoking cessation and their real-world application to achieve higher rates of smoking cessation. The common methods used in smoking cessation are cold turkey and pharmacotherapy. Cold turkey involves cessation of smoking abruptly without other supportive therapies or agents, while pharmacotherapy involves cessation of smoking with aid from supportive agents gradually.

The pharmacotherapy approach is associated with relapse, dependence on supportive agents, withdrawal symptoms, including dizziness, headache, nausea, depression, suicidal thoughts, and constipation, etc., Also, some pharmacotherapy agents are not safe during pregnancy because it tempers the mother and fetal heart rate. Moreover, it is quite expensive to adopt a pharmacotherapy approach in managing smoking cessation, unlike cold turkey. Furthermore, cold turkey is linked to immediate benefits of quitting smoking, including normal blood pressure and pulse rate within 20 minutes after the last smoking event, reduction of carbon monoxide within 72 hours, and improvement of the pulmonary and circulatory system in a few weeks post smoking cessation.

The pharmacotherapy approach is a very effective method of managing and ceasing chronic smoking because it caters to withdrawal symptoms, unlike the cold turkey method. From the above, it is safe to argue that cold turkey is a very effective method for smoking cessation because of the less harm and  more benefits to an individual.


Hemphill, I., 2022. Quit Smoking Cold Turkey: What to Expect – K Health. [online] K Health. Available at: <> [Accessed 10 June 2022].

Khariwala, S., Rubin, N., Stepanov, I., Nollen, N., Ahluwalia, J., Nelson, H. and Hatsukami, D., 2022. “Cold turkey” or pharmacotherapy: Examination of tobacco cessation methods tried among smokers prior to developing head and neck cancer. [online] Available at: <> [Accessed 10 June 2022].

Peckham, A., 2022. Is it bad to ‘quit cold turkey?’ Smoking, alcohol, drugs, and more. [online] Available at: <> [Accessed 10 June 2022].

Zhitar, S., 2022. Nicotine Replacement Therapy | Right Path Addiction Treatment Center. [online] Right Path Addiction Treatment Center. Available at: <> [Accessed 10 June 2022].

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