Brief Answer: Below steps will help you. Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 29 year old male • Known case of anxiety and smoking addiction (15 years) • History of 2 abstinent attempts for 2 year duration each. • Complaints of: anxiety on quitting smoking. Cigarette contains nicotine. Nicotine addiction is one of most severe addiction. Every addiction in medical terms considered as chronic relapsing illness, means there is always risk of relapse. So, do not get de-motivated or feel guilt due to relapse, and start efforts again to quit as soon as possible after each relapse. But always remember in every quit attempt (smoke free period) body repair itself to significant extent. Cold XXXXXXX method (stopping smoking suddenly) is associated with severe discomfort for person due to withdrawal. So, many physicians (including me) do not advise it. Common withdrawal of nicotine are: Anxiety, Dysphoric mood, Craving for tobacco, Weakness, Irritability, Restlessness, Insomnia, Increased appetite and Difficulty in concentrating So anxiety is a one of the symptom of nicotine withdrawal. Many person had anxiety disorders, in such person anxiety is more severe during withdrawal. Patient with anxiety disorder also try to self medicate them-self by substance use like: smoking, alcohol or cannabis, but instead of improvement, severity of anxiety increases in long term. There is no scientifically proved natural remedy to quit smoking. For de addiction following scientifically proved steps will help you: -Consent of the patient: you himself seeking guidance from us -Motivational interviewing: you are already motivated to quit smoking, but need to maintain this motivation -Stoppage of smoking with prevention of discomfort or withdrawal: Nicotine replacement for short duration -relapse prevention: by anti craving treatment with medicines like Bupropion SR -maintenance treatment. First you reduce number of cigarettes smoked per day. You reduce it 1 cig every alternate day. Same time medicine like Bupropion SR are given to reduce craving for smoking. We have many patients who stopped smoking with its help. But for that you need prescription from psychiatrist. After 14 days of start of Bupropion SR, fixed a quit date to stop smoking completely. Throw your all remaining cig and associated material like lighters on that day, otherwise they will create craving for smoking. Inform your friends and family member for quit date as it will increase your motivation. After stopping smoking you may experienced some nicotine withdrawal like anxiety, headache, poor concentration, restlessness and increase appetite. For that you can use nicotine replacement in form of Nicorette (nicotine) gum according to your requirement given on pack for 2-3 months. You can also use mouth fresheners like Elaichi or normal chewing gum during craving for smoking. After that you are free from smoking. This process will also help you in controlling stress and anxiety. Always remember being smoke free, need high level of motivation. So maintain your motivation. I have simplified steps to quit smoking for you. It is better if you quit under some de addiction specialist (psychiatrist), as it is a specialized area and keep follow up to remain motivated. Avoid place, person and situations which create craving for smoking, as much as possible. Many psychiatrist and psychologist provide relapse prevention sessions to prevent relapse, which is also helpful specially in your case, as you had relapsed 2 times in past after quitting smoking for 2 years, each time. I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards,

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