What is the best approach to help a patient quit vaping?

Helping Patients Quit Vaping

The most effective approach to help patients quit vaping combines behavioral counseling using the 5 A's framework with pharmacotherapy (varenicline or combination nicotine replacement therapy) plus structured follow-up, achieving significantly higher quit rates than either intervention alone. 1, 2

Initial Assessment and Engagement

• Ask about vaping at every visit as a vital sign, normalizing the conversation and creating opportunities for intervention. 1
• Use the 5 A's framework: (1) Ask about vaping use, (2) Advise to quit through clear, personalized messages, (3) Assess willingness to quit, (4) Assist in quitting, and (5) Arrange follow-up and support. 1
• Even brief advice to quit (as little as 3 minutes) increases cessation rates, though longer interventions are more effective. 1

For Patients Ready to Quit

Pharmacotherapy Options

Varenicline is the first-line pharmacological treatment for vaping cessation, with low-certainty evidence showing it doubles quit rates compared to placebo (RR 2.00,95% CI 1.09-3.68). 2

• Start varenicline 1-2 weeks before the quit date with standard titration, continuing for at least 12 weeks. 3, 2
• Combination nicotine replacement therapy (NRT) using a patch plus rapid-delivery form (gum, lozenge, or inhaler) is more effective than single NRT and represents an alternative first-line option. 1, 4
• Bupropion SR is another option but is contraindicated in patients with seizure history. 3

Behavioral Counseling (Essential Component)

Provide at least 4 counseling sessions of 10-30 minutes each over 12 weeks, as combining pharmacotherapy with behavioral support significantly increases quit rates compared to either alone. 1, 5, 4

• Set a specific quit date and help the patient prepare for it. 6, 5
• Focus on practical strategies: removing vaping products from home/work, identifying high-risk situations and triggers, developing specific coping strategies, and problem-solving based on previous quit attempts. 1, 5
• Provide social support as part of treatment and encourage support outside of treatment. 1

Structured Follow-Up Schedule

• First follow-up within 2-3 weeks of the quit date to reassess status and risk of relapse. 5, 3
• Continue follow-up contacts at least monthly for the first 3 months. 5
• At each visit, assess for relapse risk factors and adjust the treatment plan as needed. 6, 5

For Patients Not Ready to Quit

• Use the "5 R's" approach: discuss the (1) Relevance of quitting personally, (2) Risks of continued vaping, (3) Rewards of quitting, (4) Roadblocks to quitting, and (5) Repeat this intervention at future visits. 1, 6
• Offer to help when they become more motivated to quit. 6

Alternative and Adjunctive Approaches

Text message-based interventions may help youth and young adults (ages 13-24) quit vaping, with low-certainty evidence showing a 32% increase in cessation rates (RR 1.32,95% CI 1.19-1.47). 2

• Programs like "This is Quitting" from the Truth Initiative specifically target teens and young adults. 1
• Nicotine tapering (reducing nicotine concentration and restricting vaping times) coupled with behavioral counseling may be effective, though evidence is very limited. 7, 2

Referral Resources

• National quitlines: 1-800-QUIT-NOW (1-800-784-8669) provide telephone counseling, text messaging, web coaching, and may offer free NRT samples. 1
• Web-based programs: BecomeAnEX (Truth Initiative) offers resources for quitting vaping with individualized quit plans and text message support. 1
• Consider referral to specialized behavioral therapy if standard interventions fail or if comorbid depression/anxiety worsens during cessation. 5

Critical Pitfalls to Avoid

• Do not delay pharmacotherapy when patients are motivated—this misses the critical window of readiness. 5
• Never provide pharmacotherapy without behavioral counseling—combination therapy is significantly more effective than either alone. 1, 4
• Do not provide inadequate counseling duration—sessions should be at least 10 minutes, with multiple sessions over 12 weeks. 5, 3
• Failing to arrange follow-up support significantly reduces cessation success. 6, 5
• Do not discontinue therapy prematurely—complete the full 12-week course and consider extending to 24 weeks. 3

Special Considerations

• Monitor for mood changes during cessation attempts, especially in patients with depression or anxiety history. 5
• Discourage concurrent alcohol or other substance use during the quit attempt, as these are associated with relapse. 6
• If initial treatment fails, consider combination NRT with intensified behavioral therapy or combining varenicline with NRT. 3

Evidence Quality Note

The evidence base for vaping cessation is still developing. Most recommendations are adapted from robust tobacco smoking cessation evidence, with emerging specific data for vaping cessation showing similar principles apply. 1, 2 The 2025 Cochrane review identified only 9 RCTs for vaping cessation specifically, with most evidence being low to very low certainty due to imprecision and limited data. 2 However, the biological similarity of nicotine addiction across delivery methods supports applying established tobacco cessation strategies to vaping cessation. 1