Counselling and quitlines: how phone, text and group support compare

Counselling means structured talk and practical coaching from a trained person, aimed at planning the quit, handling cravings and recovering from slips. It can be given face to face, by phone, in a group, or in some cases through text messages. Cochrane's review of telephone counselling, which pooled 104 trials with 111,653 participants, found that among people who called helplines, extra telephone counselling raised the chance of stopping smoking from 7% to 10%. This page explains how counselling works, how the different formats compare, and how national quitlines are organised. This site is an information publication. It offers no counselling and no personal advice.

What counselling involves

The CDC describes quit coaches as people trained to help smokers quit, who listen, encourage and give practical tips. A coach asks what kind of help a caller wants and about past quit attempts, then suggests the type of programme that might suit them. Topics the CDC lists include dealing with cravings and withdrawal, getting the right help from friends and family, which websites, apps and texting programmes may help, and whether to use medicine and how. A coach can also help a caller handle setbacks.

Counselling is often paired with medicine. The nicotine replacement and prescription medicine pages cover the drug side, and preparing to quit covers planning.

Quitlines and telephone counselling

Smokefree.gov, run by the US National Cancer Institute, describes quitlines as free, anonymous telephone counselling services where a caller talks to a trained counsellor and together they build a strategy or find tips for staying on track. The CDC says quitlines provide many of the services and similar support available in a stop-smoking class or from a doctor, and can be a valuable complement to a doctor's care.

In the Cochrane review (evidence to May 2018), most studies tested proactive counselling, where counsellors phone the person. Among helpline callers, those who got multiple sessions of proactive counselling had higher quit rates than those given self-help materials or brief counselling in a single call (risk ratio 1.38, 95% interval 1.19 to 1.61; 14 trials, 32,484 participants). For people who had not called a helpline but were offered calls, quitting rose from 11% to 14% (risk ratio 1.25, 1.15 to 1.35; 65 trials, 41,233 participants). Three trials found that offering three to five calls beat offering one (risk ratio 1.27, 1.12 to 1.44). Cochrane rated the evidence moderate certainty and noted that few of the studies were well designed. Evidence on reactive counselling, where the person initiates calls, was inconclusive.

National quitlines in the United States

Quitlines exist across the United States. Both the CDC and Smokefree.gov give 1-800-QUIT-NOW as the national number, and Smokefree.gov states that calling it connects the caller directly to their state's quitline, with hours and services varying from state to state. This site does not describe any one state's programme, and anyone outside the US should look for the equivalent service in their own country.

The CDC also says quit coaches can help people link to quit-smoking medicines through their insurer or community programmes, and that coaching is available in several languages. Smokefree.gov lists an additional option, a National Cancer Institute LiveHelp chat with an information specialist, available Monday to Friday, 9:00 a.m. to 9:00 p.m. Eastern time.

Text messages and apps

A Cochrane review of 26 studies and 33,849 participants found moderate-certainty evidence that automated text messaging produced higher quit rates than minimal support (risk ratio 1.54, 95% interval 1.19 to 2.00; 13 studies, 14,133 participants). Text messaging added to other support also helped (risk ratio 1.59, 1.09 to 2.33; four studies). For smartphone apps the evidence was very low certainty and showed no benefit (risk ratio 1.00, 0.66 to 1.52), so the review called for more trials. The review's plain-language summary put the text messaging effect at an increase of 50% to 60%.

Group programmes

Cochrane's review of group-based programmes found 66 trials. Compared with self-help materials, groups improved quit rates (risk ratio 1.88, 95% interval 1.52 to 2.33; 13 trials, 4,395 participants), which Cochrane rated moderate certainty. Compared with brief support from a healthcare provider the benefit was smaller (1.22, 1.03 to 1.43) and rated low certainty. There was no sign that group formats beat individual face-to-face counselling of similar intensity (0.99, 0.76 to 1.28).

How support adds to medicine

Cochrane's overview of behavioural support found that counselling, and financial rewards for quitting, helped more people quit for six months or longer, whether or not they also used medicines. A Cochrane review of extra behavioural support for people already using medicine found about 17% quit in groups receiving less or no support, compared with about 20% in groups receiving more (risk ratio 1.15, 95% interval 1.08 to 1.22; 65 studies, 23,331 participants). Comparisons across all methods are on quit methods compared.

Support is not only for the planning stage. Smokefree.gov notes that many ex-smokers try stopping many times before they succeed, and the relapse and slips page covers what to do after a slip. Anyone with a mental health condition, pregnancy, heart disease or severe symptoms during withdrawal should also speak to a clinician or pharmacist.

The short version

Telephone, text and group support all have Cochrane evidence behind them, with the clearest gains over self-help or minimal support, while evidence for smartphone apps is weak. In the US, 1-800-QUIT-NOW connects callers to their state quitline. A clinician or pharmacist can advise on medicine, pregnancy, heart conditions and mental health alongside counselling.