Ending Smoking or Vaping

The Surgeon General’s Report on Smoking Cessation, released in January 2020, proved that smoking cessation is beneficial at any age. It reduces risks of premature death and can add as much as a decade to life expectancy.

Most people who smoke cigarettes (and many who vape) want to end their habit. Nicotine is the primary addictive drug in cigarettes and most vapes, and when a person inhales nicotine, it takes about ten seconds for the drug to reach the brain. Smoking increases the number of nicotine receptors in the brain, making the body crave more nicotine. When nicotine levels drop, the brain experiences withdrawal symptoms and cravings.

Quitting smoking at any age, but particularly in younger years, is associated with lower death rates. Beneficial effects are evident as early as three years after cessation. The same applies to vaping, among the 11% of adults aged 18 to 24 years who vape. More than half of adults who vape nicotine plan to quit using e-cigarettes, and one-quarter attempted to quit in the past year. Some succeed on their own, but many need help to quit vaping

No smoking or vaping

Source: iStock/Michael Cristalli

According to research, nicotine is the third most addictive drug, after heroin and cocaine. Fewer than one in ten adults who smoke cigarettes succeed in quitting each year.

Nicotine Replacement Therapy

There are plenty of nicotine replacement therapy (NRT) choices for people wishing to end smoking, including the transdermal patch, mouth spray, gum, and lozenges, equally effective. The U.K. has approved a nicotine-containing mouth spray for vaping cessation. Many people use NRT to get through the early stages of cessation, while those with more severe nicotine addiction use it for longer-term maintenance. A meta-analysis of 19,488 people who smoked cigarettes found a 15.2% quit rate after six months among those who received medication plus counseling, compared to an 8.6% quit rate among those who received brief advice or usual care.

Medications: Varenicline and Bupropion

The primary prescribed drugs to help smokers end their habit are varenicline and bupropion.

Varenicline

Varenicline, better known as Chantix, is FDA-approved to help adults stop smoking cigarettes. Varenicline reduces nicotine cravings by stimulating the alpha-4 beta-2 nicotinic receptor—but to a lesser degree than nicotine. A clinical trial of 8,144 people found that those who used varenicline had a higher six-month quit rate compared to those who used bupropion or the nicotine patch; however, each therapy was more effective than taking a placebo. Varenicline was safe and effective for cessation of e-cigarette use in a study published in the August 2024 American Journal of Preventive Medicine.

“We had a 15% difference in quit rates, with those in the medication group having a quit rate of 45 percent,” said Lisa Fucito, Ph.D., lead author and director of the Tobacco Treatment Service at the Yale Cancer Center and Smilow Cancer Hospital. Fucito is an associate professor of psychiatry at Yale School of Medicine.

Lisa Fucito, PhD

Source: Yale

Bupropion

Bupropion (immediate-release and extended-release) was originally approved as an antidepressant (Wellbutrin). The drug increases smoking quit rates compared with placebo in short- and long-term studies. It may be a good choice if the smoker or vaper has a history of depression, especially depression preceding smoking. Bupropion is generally equal in efficacy to NRT.

Vapers: Another Possible Treatment

Cytisinicline, a plant-based alkaloid, is similar in structure to nicotine. It interacts with nicotine receptors in the brain and helps reduce withdrawal symptoms and cravings associated with vaping cessation. Out of 160 adult e-cigarette users in a new study, those who took cytisinicline over 12 weeks were more than twice as likely to successfully quit vaping in weeks 9 to 12 as those who took a placebo—31.8% vs. 15.1%. If approved, the drug could become the first FDA-authorized treatment for vaping.

Progress in developing medications for vapers

Despite the fact that at least 11 million people use e-cigarettes, there are no approved medication options to help them stop. Previous studies have shown that most people using e-cigarettes want to quit. However, it was not clear whether NRTs worked for e-cigarettes.

Recent research is encouraging. The positive Yale varenicline study and the cytisinicline study for e-cigarette cessation are not surprising, since the two drugs work similarly. However, varenicline is available in the U.S. in generic versions while cytisinicline has not received FDA approval.

“People can get to very high levels of nicotine exposure with these e-cigarette products, and can use them nearly constantly throughout the day. So, the question we all have is, ‘Can any pharmacotherapy stand up to this challenge?’” Fucito said. E-cigarettes can last 5,000 or more puffs, making them easier to use than cigarettes but harder to track in terms of intake.

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“We need more pharmacotherapy treatments to help address the really strong physical dependence that can develop from e-cigarette use," Fucito said. "People undergo significant withdrawal when they try to stop, and that withdrawal is so unpleasant and hard to manage with just behavioral support alone." None of the participants in the study experienced serious side effects. Most side effects were along the lines of nausea, insomnia, or vivid dreams. Another piece of good news: Those who stopped vaping didn’t boomerang back to cigarettes.

Psychotherapy

Cognitive behavioral therapy (CBT) helps patients identify smoking triggers—people, places, and things spurring behavior—and teaches them relapse-prevention skills. Mindfulness helps patients learn to induce a state of detachment from thoughts, urges, and cravings that led to past relapses.

Other Interventions

Short periods of aerobic exercise reduce the urge to smoke. A review of the literature on technology-based smoking-cessation interventions (the internet, personal computer, and cell phone) found these supports can increase the likelihood of adults quitting smoking. Adolescents with a history of vaping who participated in a first-of-its-kind text message Truth Initiative program called "This is Quitting" were 35% more likely to report that they had quit vaping after seven months compared with adolescents who did not participate in the program. Semaglutide, the active ingredient in Ozempic and Wegovy, may help people quit smoking, but more research is needed before it can be prescribed for this purpose. Some studies suggest semaglutide may reduce nicotine cravings and decrease the need for smoking cessation medication and counseling. Exercise also has been used in tobacco cessation programs.

Telephone support and quit lines

All states offer toll-free telephone numbers ( quit lines) with smoking cessation counselors standing by providing information and support (800-QUIT-NOW or 800-784-8669).

Programs using cell phones and text messages are particularly relevant to young adults aged 18 to 25. A systematic review and meta-analysis of published randomized trials of technology-based interventions for smoking cessation found that subjects increased abstinence by 1.5 times.

Quitting Smoking by Switching to Vaping

Many people believe that switching to e-cigarettes can help adult cigarette smokers reduce harm to their health. People who smoke, healthcare providers, and regulators all want to know whether e-cigarettes could help people quit smoking. One study showed that adding e-cigarettes to standard smoking-cessation was more effective for smoking cessation than NRT. Auer and colleagues in Switzerland conducted a large, multisite trial testing the efficacy of providing e-cigarettes in addition to standard behavioral counseling to adults seeking to stop smoking. The trial showed that adding e-cigarettes to standard-of-care counseling improved smoking-cessation rates without worsening health risks over six months.

Switching from cigarettes to vaping nicotine or e-cigarettes reduces a person's exposure to tobacco toxins. Any benefits derived must be balanced against the risk of teen smoking or use of e-cigarettes.

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) is non-invasive brain stimulation using electromagnetic fields, and it has been used to treat smoking addiction. The FDA approved TMS for smoking cessation in 2020, based on a clinical trial that found its effectiveness comparable to that of bupropion. TMS treatment significantly reduced the number of cigarettes smoked. In one study, six months after treatment, 33% of participants remained abstinent from cigarettes. Adding TMS to varenicline treatment in early randomized trials doubled success rates.

TMS is available in most hospitals and many psychiatrists’ offices for treating depression. Medicare and insurance cover it for major depression but not commonly for smoking cessation.

Conclusion

Whether individuals are addicted to smoking cigarettes or e-cigarettes (or other devices like cigars or pipes), it’s best to end the addiction as soon as possible to avert severe health complications. Some people who smoke cigarettes switch to vaping, thinking they can end their addiction to nicotine. However, the nicotine pull is strong, and instead of quitting nicotine, they may find that they only traded one delivery system (cigarettes) for another.