Vaping products remain the top choice to quit smoking, which I support as a tool for tobacco harm reduction: this has to remain the primary focus given the burden on patient health, admission to hospital rates, and the economy.
However, many users want to stop because of concerns about health risks, financial costs, and being ‘a slave to their vape’. Quitting vaping comes with its own set of challenges that healthcare providers need to address through recommended guidance, although at present these remain fairly scarce. This is largely in part due to the lack of data in the current medical landscape coupled with the vast majority of resources being put into smoking cessation for tobacco harm reduction.
But what about those who actually want to quit? And especially those who have never smoked?
With the focus being on how effective a tool they are for smoking cessation, a significant subgroup are going neglected. This subgroup includes children, who should never be exposed to nicotine in any form.
This piece gives healthcare providers practical tools and strategies to help patients break free from vaping dependency.
We explore evidence-based methods that follow current healthcare guidelines – from the first assessment to building personalised plans that help guide you in your support of clients who wish to stop vaping.
Initial Patient Assessment
Patient assessments are the first-line of successful vaping cessation interventions. Creating targeted treatment strategies involve using techniques generic to addiction of all kinds, including smoking, before you can niche down into vaping specific strategies.
Vaping History and Pattern Analysis
The first step is to calculate nicotine intake patterns. This includes tracing the types of vaping products used, frequency of use, and specific vaping behaviour. Daily usage patterns help determine dependency levels. Healthcare providers should pay special attention to patients who vape within five minutes of waking as an example of a high-level of dependency.
Motivation and Barriers Assessment
The next step should be to review why patients want to quit vaping. Money worries, health issues, and breaking free from nicotine dependency top the list of common reasons according to the NCSCT, backed by a paper in the scientific literature analysing the top reasons quoted by users of the top Reddit forum for discussion on quitting vaping, r/QuitVaping, with 54,000 users at the time of writing.
Scaling techniques to measure patients’ confidence are advised to enable quitting, with confidence on a liner scale from 1-10. Scores below 7 point to the need for gradual cessation approaches, but any plan should be discussed with the client on an informed pros and cons basis of each method available and the clients wishes respected.
Risk Stratification
To risk stratify users more likely to relapse, the following factors should be taken into consideration:
- Current nicotine dependency levels
- Previous quit attempts and outcomes
- Presence of dual use with traditional cigarettes
- Environmental factors like partner vaping or workplace policies
Patients with low confidence scores or multiple risk factors need more intensive support mechanisms. Similar to treatment durations for quitting smoking with the use of NRT, plans often extend to 8-12 weeks. Adolescents need a slightly different assessment approach that focus on resource allocation and out-of-home usage patterns.
Creating Personalised Quit Plans
Personalised quit plans are the foundations of successful vaping cessation. Fairly intuitive but also backed by the research we do have available, tailored client-centric approaches substantially boost success rates.
Specific guidance from the NCSCT gives advice about suggested weaning strategies using refillable devices to help make the weaning process more manageable than direct from disposable vapes, being much higher in nicotine content and causing higher peaks and troughs, likely to increase cravings and withdrawal symptoms.
Setting Realistic Goals
Allow clients to gather supportive resources and develop alternative coping strategies. Like smoking, there are a number of individualised plans available that range from gradual nicotine reduction to complete cessation with behavioural support alone.
Choosing Appropriate Interventions
Patient’s individual needs should determine the selection of interventions. Healthcare providers can suggest several evidence-based options:
- Gradual Reduction: A systematic decrease in nicotine strength (20mg-18mg-12mg-6mg-3mg-0mg), with a 1-2 week interval between dropping nicotine strength as a guideline and altered according to the severity of withdrawal symptoms and cravings. This is the method of choice favoured by most clients backed by literature.
- Nicotine Replacement Therapy (NRT): There is currently only one licensed NRT specifically for use in vaping cessation, Nicorette Mist. This isn’t ideal as it is more of a craving management and doesn’t provide the baseline level of nicotine available through transdermal patches.
- Behavioural Support: Formal counselling sessions can help inform the client about the various methods that can be used to aid their quitting attempt, and these can be translated across from the similar behavioural patterns used for smoking cessation advice given the significant number of common similarities.
- Healthy Coping Strategies: Physical activities, breathing exercises, or distraction techniques again similar to those used for the more commonly available guidance on smoking.
- Digital Platforms: Hello, here we are!
Developing Support Networks
A strong support system is vital for long-term success. Healthcare professionals should encourage patients to:
- Tell friends and family about their quit experience
- Connect with successful ex-vapers who can offer guidance and motivation
- Join support groups or online communities (with caution, as some participants can be put off by others failures or negative posts)
- Keep regular contact with you as their healthcare provider
For clients who are ex-smokers, emphasise that relapse to vaping remains nowhere near as harmful as returning to smoking and should be reinforced as part of a relapse strategy.
Special Population Considerations
Different quitting strategies need to be adopted to work for specific patient sub-groups, with each coming with its own set of challenges and needs.
Pregnant Women
Although much safer than smoking during pregnancy, nicotine as a substance in itself should not be considered harmless. Animal studies with significant implications related to humans have shown it is far from safe. The protection of foetuses from nicotine exposure is crucial, with nicotine passing through the placenta and potentially disrupting brain and lung development.
Adolescent-Specific Approaches
Young people find it harder to quit vaping. Research shows that 90% of adult smokers picked up the habit before turning 18. Consider the use of these targeted strategies, which we are trying to build as part of our campaign:
- Text messages and social media support programmes
- Peer groups and counselling sessions
- Youth-focused digital tools and mobile apps
- Support systems built around family
Young people often want to quit because of money concerns, health effects, and feeling glued to their vape. The common belief among teenagers that vaping is relatively safe should be challenged in a non-judgmental way.
Research indicates that nicotine can disrupt the formation of brain circuits that control attention, learning, and susceptibility to addiction. This disruption may lead to cognitive impairments and increased vulnerability to substance dependence.
Dual Users of Vaping and Smoking
Dual users need detailed support to address both forms of nicotine use. Many start vaping to quit smoking but don’t deal very well with making the complete switch according to a BMJ published paper.
The aim should be for complete cessation of both products, with some patients needing to quit in stages, with the focus on stopping smoking first. Treatment plans must tackle the complex reasons behind dual use, such as social factors and replacement behaviours.
Clinical Tools and Resources
Standardised clinical tools and resources to help their patients quit vaping through evidence-based care.
Assessment Templates
Several tools help healthcare providers confirm vaping dependence and guide treatment choices, while providing quantitative data to monitor progress. These key assessment tools include:
- E-cigarette Fagerström Test for Nicotine Dependence (E-FTND)
- Electronic Dependence Scale (EDS)
- Hooked on Nicotine Checklist (HONC)
- Patient Health Questionnaire (PHQ-9) to screen for depression
Conclusion
Healthcare professionals help patients break free from vaping addiction using proven methods. A complete assessment comes first, followed by custom quit plans that work for different groups of patients and tailored towards individual needs.
Staying current with new research and treatment methods is of paramount importance as vaping cessation knowledge grows. They can guide patients to quit vaping with the highest possible cessation rates by using structured assessments, targeted treatments, and the right resources effectively.
I hope this article is of use to any therapist who aims to help their client overcome vaping addiction with the highest chance of complete cessation success.
