Addiction experts say smoking is a habit more formidable than cocaine or heroin. Of the 46 million American adults who indulge, close to three-quarters of them say they want to quit, and nearly half of those hooked make at least one annual attempt to curb the habit. Yet even when their addiction confines them to tiny, dark rooms or takes them outside in sub-zero temperatures, dedicated smokers can’t seem to restrain their impulse to light up.

But great battles have been won against this killer habit. For the first time, more people are ex-smokers than current smokers. However, the war wages on, and the casualties remain high. Even today, this habit accounts for one out of five deaths in the United States.

Patches and prescriptions represent familiar — and highly publicized — weapons used against the discomforts that come with quitting this habit. But smokers searching for supportive nonsmoking strategies will discover allies in alternative approaches as well.

Many former smokers credit acupuncture with assisting them in overcoming the powerful desire for nicotine fixes that has sent leagues of quitters sifting through ashtrays and trash cans for cigarette butts. And recent studies are beginning to validate what these successful ex-smokers have known all along. Acupuncture works, and its methodology is pretty clear-cut.

“Standard acupuncture protocol for smoking dependency involves inserting three or four needles into specific points on each ear,” says Randy Baca, D.C., a Denver-area chiropractor certified in acupuncture. “It’s a very small gauge needle, the thickness of a hair, so the treatment is painless.

“The patient lies still, while the needles remain in place for 20 to 30 minutes,” Baca adds. Usually, five to eight treatments are necessary, and two or three sessions per week are optimum.

Clients don’t really feel anything during the treatments, Baca says. It’s after the sessions that they really reap the benefits. Acupuncture has a physiological effect. Clients report that cigarettes actually taste repulsive. So, it’s really an aversion-type therapy.

“Acupuncture is an aid,” Baca says. “It’s not a guarantee. It’s not a cure.” He says if a smoker isn’t “good and ready” to quit, they shouldn’t waste their time or money on this therapy. So, before he treats any individual, he verifies they’re not looking for a quick fix. They need to be truly tired of the cost, the smell, and the fear of health consequences of smoking.

Where acupuncture alone gives ground, the joined forces of acupuncture and education may bring victory. A New Hampshire study demonstrated that together education and acupuncture delivered a powerful one–two punch to entrenched smoking habits — especially for those participants who smoked the most, the longest. That’s great news for career smokers.

“In our study, we saw a 40 percent success rate for those who completed the treatment plan,” says Ian Bier, N.D., Ph.D., president of I.B. Scientific, a company specializing in natural medicine research. “In other words, if participants showed up and did their acupuncture and education, there was a 40 percent quit rate over 18 months.”

Bier says that although both acupuncture and educational information on quitting have a positive effect alone, they are much stronger together. And when it comes to comparing any of the “alternative” means of nonsmoking control to its chemical cousin, Bier takes a strong stance.

“One problem that occurs with the chemical means of quitting support is that people will continue smoking while using the patch or gum, which can be dangerous due to the potential for overdosing on nicotine,” he says. “Obviously, there’s no such possible side effect with acupuncture.”

While acupuncture may be the weapon of choice for some chronic smokers searching for ways to loosen this habit’s hold, other cigarette dependents have turned to hypnosis.

A 2004 Texas A&M hypnosis study reported a phenomenal 81 percent quit rate, with 48 percent of the participants maintaining abstinence 12 months posttreatment.

“Our impressions from the study are that hypnosis — when delivered individually and in multiple sessions with follow-up counseling especially tailored to the participant — is likely to be effective,” says Gary Elkins, Ph.D., professor in the Department of Psychiatry and Behavioral Science at Texas A&M University, College of Medicine and one of the authors of the study. “People who are more highly hypnotizable or who have stronger expectations for success may benefit more,” he adds.

“We believe hypnosis relieves stress and reduces withdrawal symptoms,” Elkins says. “Also, with hypnosis, it may be possible to reinforce the person’s motivation by reminding them of the reasons they want to stop smoking.” Elkins says an effective program is delivered by professionals with training in medicine, psychology, mental health, and clinical hypnosis. “I also believe that an effective program involves multiple sessions with some individualization to meet the client’s preferences for mental imagery and motivation.”

Sally Greer, Ph.D., a clinical psychologist specializing in hypnotherapy, has been doing just that in her practice for the last 25 years. By tailoring the program to her clients’ strengths, as well as gearing the protocol toward their personalities and accommodating their personal requests, Greer creates hybrid nonsmoking regimens for every individual.

Because there are so many misconceptions about hypnosis, Greer takes the time to introduce new patients to the therapy. “Hypnosis is not about control,” she says. “It’s simply a skill. It’s really about relaxing imagery.”

Greer reinforces in-session work with customized 20-minute tapes. Most clients can find that amount of time in their schedules, no matter how busy they are, to quiet withdrawal symptoms, she says.

“Nicotine is a powerful drug to overcome,” Greer says. Nicotine — and the absence of it — may impact the use of food and alcohol. After all, you’re changing significant patterns. Allow a minimum of one month for your metabolism, lifestyle, and habits to integrate, she adds.

One aspect of the nonsmoking life many prospective nonsmokers are not prepared for is the sense of loss, Greer says. For people who regarded cigarettes as good companions, a real sadness may come with the conclusion of the habit. It’s as important to acknowledge this emotion as it is to move past it.

Perhaps the least scientifically studied alternative means for quitting smoking belongs to aromatherapy. But, while research regarding this area remains sparse, people who actually do the quitting will attest to the force of fragrance. Many victorious quitters have stated that sniffing scents like lavender or cloves (even chocolate), kept their cigarettes unlit during the most trying of times.

A little known fact to consumers is that cigarette companies use essential oils to flavor their products, says Geraldine DePaula, M.D., a psychiatrist, and founder/president of Aroma Medica. It’s not such a leap, then, to believe that herbal and aromatic concoctions can conquer cigarette cravings.

“A ‘drag’ gives smokers instant reinforcement and keeps them hooked,” DePaula says. “One of the reasons smokers have a difficult time quitting, even with nicotine substitutes, is the lack of that immediate ‘boost.’”

DePaula believes that aromatherapy can replace that stimulation and mood lift. She has developed a product that acts on brain receptors in the same way nicotine does. By taking three or four deep breaths of her product when confronted with the desire to smoke, then waiting five minutes, many people find they can subdue their yearning for tobacco.

In fact, DePaula encourages all potential nonsmokers to cultivate the practice of breathing deeply, because usually the act of smoking is the only time they inhaled and exhaled fully. That’s why activities like meditation, yoga, or chanting complement quitting lifestyles, she says.

“People who have the hardest time quitting are those who use the habit to self-medicate,” DePaula says. “Because smoking acts as a stimulant, those people who are depressed, have ADHD, or any other disorder — and who remain undiagnosed and untreated — may rebound despite their best intentions. Caring for the underlying condition may make quitting more uncomplicated.”

A little aromatherapy when in smoke-free situations — say, while traveling on long flights or visiting ailing relatives — might just offer the positive reinforcement reluctant smokers need to incite them into attempting nonsmoking routines, DePaula says.

But whether using a pharmacological means, an alternative approach, a combination of the two, or simply going cold turkey, all experts agree that the single most important ingredient in any successful nonsmoking strategy is not the prescriptions, the paraphernalia, or the philosophies — but the smoker’s desire to quit.

And, if at first you don’t succeed, don’t be discouraged. Remember, quitting takes practice. Most ex-smokers triumphed over cigarettes only after failing more than a handful of attempts.

This is one struggle you can’t afford to lose.

“Just keep trying,” Greer says. “Your life depends on it!”