It is one of the most useful sentences you can hear in a vaping assessment, because it tells you two things at once. The client has looked at the label. And the label has not told them what they think it has.
With cigarettes, the first questions are easy: how many a day, since when. With vaping, the answers to “how much” and “how strong” are hidden in a device type, a bottle size and a label written in units most people cannot read. This article is about getting those answers anyway, and about what they are for in vaping cessation work.
Device, bottle, label: three questions before any number.
Three Kinds of Vape
The CDC describes three main types of e-cigarette (Centers for Disease Control and Prevention [CDC], 2024):
Disposable — pre-filled and sometimes rechargeable, but not designed to be refilled.
Pre-filled pods or cartridges — a rechargeable device with pods that are replaced.
Refillable — a rechargeable device with a tank or chamber filled with e-liquid from a bottle.
The type decides how you ask about amount. For a disposable, the question is how many a week and how much liquid each one holds. For pods, how many pods a week. For a tank, how many millilitres a day, or how long a bottle lasts.
“I don’t know” is a real answer, too. In the 2024 National Youth Tobacco Survey, more than one in five students who currently used e-cigarettes were not sure what type of device they used (Park-Lee et al., 2024). In my own consultations, adults often don’t know either, especially when someone else buys the product. It is worth a box of its own rather than a guess.
What the Label Can Say
E-liquid strength is usually printed in one of two ways: milligrams of nicotine per millilitre of liquid (mg/ml), or a percentage. Some products carry no usable label at all, because the packaging is gone, the product was bought from someone else, or the label is simply unclear.
The percentage is where it goes wrong. In a survey of 310 adults who vape, participants correctly compared two nicotine concentrations only about half of the time, and they did worse when a concentration was shown as a percentage than as mg/ml. They also judged percentages as weaker than the same strength written in mg/ml (Morean et al., 2021). A later study in adolescents and young adults found the same pattern and showed that clearer labels could fix much of it (Morean et al., 2022).
That is the client who says “only five percent”. The number looks small because it is a percentage.
Two Kinds of Percent
A percentage on a label can mean two different things. Weight by volume (w/v) means grams of nicotine per 100 millilitres of liquid. Weight by weight (w/w) means grams of nicotine per 100 grams of liquid (United States Pharmacopeia [USP], n.d.).
For w/v, the conversion is exact: 1% w/v is 1 gram in 100 ml, which is 10 mg/ml. So 2% w/v is 20 mg/ml.
For w/w, you need the density of the liquid, because a millilitre of e-liquid weighs more than a gram. E-liquid often contains propylene glycol and glycerine as its base (National Academies of Sciences, Engineering, and Medicine [NASEM], 2018). Propylene glycol has a specific gravity of about 1.04, and glycerine about 1.26 (National Oceanic and Atmospheric Administration [NOAA], n.d.-a, n.d.-b). Depending on the mix, 1% w/w therefore works out at somewhere between 10.4 and 12.6 mg/ml. A 5% w/w liquid is roughly 52 to 63 mg/ml.
If the label says only “5%” and not which kind, a practical working range is about 50 to 63 mg/ml, depending on how the percentage is defined.
In practice
2% ≈ 20 to 25 mg/ml
5% ≈ 50 to 63 mg/ml
If in doubt, write down exactly what the label says.
A Reference Point from the EU
In the European Union, the Tobacco Products Directive limits nicotine-containing e-liquid to 20 mg/ml, tanks and cartridges to 2 ml, and refill containers to 10 ml (European Parliament and Council of the European Union, 2014, Article 20). Rules elsewhere differ. But the EU limit is a useful reference point: a 5% w/w liquid is well above what can be legally sold in the EU.
Working It Out, Label by Label
What the label says
How to work out mg/ml
Nicotine a day
mg/ml
as printed
ml a day × mg/ml
% w/v
% × 10
ml a day × mg/ml
% w/w
% × 10.4 to % × 12.6
a range
% of unknown kind
% × 10 to % × 12.6
a range
No label, or don’t know
—
no figure; amount and cost only
Two examples. A client who uses 2 ml a day of a 20 mg/ml liquid has about 40 mg of nicotine in the liquid they vape each day. A client who gets through about 0.7 ml a day of a 5% w/w pod liquid has somewhere between 36 and 44 mg. In both cases, this is nicotine in the liquid, not nicotine taken in by the body.
What the Number Is Not
This is the part to say out loud, to the client and to yourself.
The figure is nicotine in the liquid, not nicotine in the body. It is also only as good as what went into it: a label can be missing, unclear or wrong, and amounts are easy to misjudge.
So it is an indication for the conversation, not a measurement. It must not be used to choose, calculate or adjust nicotine replacement or any medication. Those decisions follow your own guidelines and clinical judgment.
Why It Is Still Worth Doing
Because the conversation changes when the client sees it. “Only five percent” becomes “that’s more than I thought”. Millilitres a day become a cost a week, a month and a year. And the label, once read properly, becomes something the client can track themselves when they start to cut down or switch.
It also changes what you ask next. A client on a strong nicotine salt liquid all day and a client on a weak liquid now and then are in different places, even if both say they “vape a bit”.
My Vaping Story puts this on paper. Page 3 records the kind of vape, the flavors, where it is bought and exactly what the label says; page 4 works out the millilitres, the nicotine and the cost by label type, with each calculation and its source listed and a clear statement of what the figures are for. The first page, how vaping began, is also free on its own: My Vaping History.
References
Centers for Disease Control and Prevention. (2024, May 15). About e-cigarettes (vapes). https://www.cdc.gov/tobacco/e-cigarettes/about.html
European Parliament and Council of the European Union. (2014). Directive 2014/40/EU on the manufacture, presentation and sale of tobacco and related products, Article 20. https://www.legislation.gov.uk/eudr/2014/40/article/20
Morean, M. E., Wackowski, O. A., Eissenberg, T., Delnevo, C. D., & Krishnan-Sarin, S. (2021). Adults who use e-cigarettes have difficulty understanding nicotine concentrations presented as mg/ml and percent nicotine. Addictive Behaviors, 120, 106965. https://doi.org/10.1016/j.addbeh.2021.106965
Morean, M. E., Wackowski, O. A., Eissenberg, T., Delnevo, C. D., Krishnan-Sarin, S., & Gueorguieva, R. (2022). Novel nicotine concentration labels improve adolescents’ and young adults’ understanding of the nicotine strength of electronic nicotine delivery system products. Nicotine & Tobacco Research, 24(7), 1110–1119. https://doi.org/10.1093/ntr/ntac024
National Academies of Sciences, Engineering, and Medicine. (2018). Public health consequences of e-cigarettes (Chapter 5, Toxicology of e-cigarette constituents). The National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK507184/
National Oceanic and Atmospheric Administration. (n.d.-a). Glycerine. CAMEO Chemicals. https://cameochemicals.noaa.gov/chemical/8708
National Oceanic and Atmospheric Administration. (n.d.-b). Propylene glycol. CAMEO Chemicals. https://cameochemicals.noaa.gov/chemical/9030
Park-Lee, E., Jamal, A., Cowan, H., et al. (2024). Notes from the field: E-cigarette and nicotine pouch use among middle and high school students — United States, 2024. MMWR. Morbidity and Mortality Weekly Report, 73, 774–778. https://www.cdc.gov/mmwr/volumes/73/wr/mm7335a3.htm
United States Pharmacopeia. (n.d.). <1160> Pharmaceutical calculations in pharmacy practice. https://www.uspnf.com/sites/default/files/usp_pdf/EN/USPNF/c1160.pdf
“I can stop for one day. I just do not know what happens when my family arrives.”
That is the consultation hidden inside the Great American Smokeout®.
In 2026, the Great American Smokeout falls on Thursday, November 19. Thanksgiving falls exactly one week later, on Thursday, November 26. That makes Thanksgiving day eight for anyone who uses the Smokeout as their quit date.
Day one is public. Day eight is private.
Day one has a name, a campaign, a reason, and a clean start. Day eight has travel, food, alcohol, family roles, old arguments, football, grief, boredom, cleanup, and somebody stepping outside after dinner.
That is why the Great American Smokeout can be more than a one-day awareness event. For practitioners, it can become a structured week-one plan.
Day eight. The table is set, and someone is stepping outside.
What the Great American Smokeout Actually Offers
The Great American Smokeout is organized by the American Cancer Society and is held each year on the third Thursday in November. The idea grew from earlier local events. The first official Smokeout was organized by the California Division of the American Cancer Society in 1976, and the American Cancer Society took it nationwide in 1977. The American Cancer Society describes it as an opportunity for people who smoke to commit to a smoke-free life, “not just for a day, but year round” (American Cancer Society, n.d.-a, n.d.-b).
In 2026, that day is November 19. Thanksgiving in the United States is the fourth Thursday of November, and in 2026 it falls on November 26 (Timeanddate.com, n.d.).
That timing matters.
A quit date is not just a date. It is a behavioral anchor. It gives the client something specific to prepare for, tell someone about, and return to after a difficult moment.
But the Smokeout is not the whole intervention. It is the opening move.
The real work is what happens in the first days after the public starting point, when nicotine withdrawal, routine disruption, and real-life triggers begin to overlap.
Why Day Eight Matters
The timing is not only symbolic.
Withdrawal symptoms such as anger, anxiety, low mood, difficulty concentrating, impatience, insomnia, and restlessness typically peak within the first week after stopping and last two to four weeks (Hughes, 2007). Day eight falls just after that peak, while many of those symptoms may still be present.
The first week is also when many quit attempts end. Among smokers who tried to quit without treatment, most relapse occurred within the first eight days. The authors concluded that cessation interventions should focus on the first week of abstinence (Hughes et al., 2004).
For a client who starts on Smokeout day, Thanksgiving lands at the end of exactly that window.
And the first week is not only about nicotine. It is about losing the small rituals that used to organize the day.
The cigarette after waking. The cigarette after food. The cigarette when the house becomes too loud. The cigarette when the conversation turns uncomfortable. The cigarette outside with someone who understands.
For many of the clients I work with, a family gathering is not just a meal. It can be a cue-rich environment: food, alcohol, stress, people who smoke, old roles, overstimulation, and emotional load. Thanksgiving can bring all of that to one table.
In a trial of an individually tailored cessation treatment, 300 women were followed through the first seven days of their quit attempt. Alcohol use, the presence of others who were smoking, and negative mood were each linked to stronger urges and a higher chance of lapse. When all three came together, urge and lapse risk were highest (Lam et al., 2014).
That does not mean Thanksgiving has to ruin the quit attempt.
It means Thanksgiving needs to be part of the quit plan before it arrives.
The First Week Is Not a Motivation Test
According to the CDC, about two in three U.S. adults who smoked in 2022 wanted to quit, and about half had tried in the past year, but fewer than one in ten quit successfully that year. Quitting often takes multiple tries, and using counseling and medication together provides the best chance of quitting successfully (Centers for Disease Control and Prevention, 2024).
That matters in practice because many of the clients I see interpret early difficulty as evidence that they are not ready.
They may say:
“I was fine until dinner.”
“I was doing well, then my brother lit up.”
“I had one after dessert, so I ruined it.”
“I knew I could not do holidays without smoking.”
The professional task is to reframe the first week.
Not: “Can this person prove they have enough willpower?” But: “Can we predict the first high-risk situation and give it a plan?”
The first week after the Great American Smokeout is a rehearsal for real life. Thanksgiving simply makes the rehearsal visible.
Day One: Make the Quit Public Enough
A quit attempt does not need to be announced to everyone. Some clients hate that. They fear pressure, embarrassment, or the feeling of being watched.
But a completely private quit can become fragile. Nobody knows why the client is irritable. Nobody knows not to offer a cigarette. Nobody knows why the person leaves the table for ten minutes.
A useful middle ground is “public enough.”
Ask the client:
Who needs to know?
Who does not need to know?
What sentence will you use if someone offers you a cigarette?
Who can help without making it a performance?
The people around a client can do more than stay out of the way. Guidance for family and friends from the UCSF Smoking Cessation Leadership Center emphasizes being there to offer support: agreeing on rules for where smoking is allowed, listening without judging, and staying positive even after a slip (University of California San Francisco Smoking Cessation Leadership Center, n.d.).
A simple sentence is often enough:
“I am using the Smokeout as my quit day. I do not need a big conversation about it, but please do not offer me one.”
That sentence does two things. It protects the quit attempt, and it protects the client from becoming the family project.
Days One to Seven: Build the Thanksgiving Map
Between Smokeout day and Thanksgiving, the client has a week to learn.
Not to become perfect. To gather data.
The most useful questions are concrete:
What time of day is hardest?
Is the craving physical, emotional, social, or routine-based?
Which cigarette do you miss most?
What do you do after meals now?
What happens when you are tired?
What happens when someone else smokes?
What would Thanksgiving add to this pattern?
This is where a worksheet helps, because the client does not have to remember everything in the consultation. They can map the pattern as it appears.
The goal is not to remove every trigger. That is not realistic.
The goal is to stop being surprised by the obvious ones.
Thanksgiving: The Four High-Risk Moments
For many clients, Thanksgiving does not create one craving. It creates several predictable moments.
1. Before arriving
This is the anticipatory cigarette: the one before entering the house, before hosting, before seeing family, before pretending everything is fine.
Practice translation: Plan the arrival. Where will the client park? What will they do with their hands before going inside? Who will they text if the urge appears before the event has even begun?
2. After eating
In my consultations, the cigarette after a meal is one of the moments clients name most often. Food, a full stomach, the chair pushed back, and then the hand reaches for the pack.
Practice translation: Replace the sequence, not only the cigarette. Stand up. Clear plates. Brush teeth. Make tea. Walk outside without smoking. Hold something else.
3. Around alcohol
Many of the clients I see say the same thing: the first drink is where the plan gets harder. In the first week of a quit attempt, drinking was associated with stronger urges and a higher chance of lapse (Lam et al., 2014). The U.S. clinical practice guideline lists drinking alcohol among the situations to recognize in advance, and advises: “Because alcohol is associated with relapse, the patient should consider limiting/abstaining from alcohol while quitting” (Agency for Healthcare Research and Quality, 2009; see also Tobacco Use and Dependence Guideline Panel, 2008).
Practice translation: Do not simply say “avoid alcohol” unless that fits the client. Ask for a specific plan: first drink delayed, alcohol-free option in hand, no drinking outside with smokers, leave before the second high-risk window.
4. The outside group
For some people, the smoking area is not about nicotine alone. It is the quieter room. The honest conversation. The break from the table. The place where the client knows how to belong.
It is also where several risks come together. In real-time reports from people trying to quit, first lapses were more likely when smoking was permitted, when cigarettes were easily available, and when other smokers were present (Shiffman et al., 1996).
Practice translation: If the client loses the cigarette, they may also lose the break. Give them a replacement exit. A walk, a dishwashing job, a phone call, a porch moment with water, or a reason to step away that does not require smoking.
A Slip Is Not the Same as a Relapse
This may be the most important sentence in the whole Thanksgiving plan.
A slip is not the same as a relapse.
MedlinePlus describes a slip as smoking one or more cigarettes and then going back to not smoking, and distinguishes it from a total relapse to full-time smoking. Its advice to patients after a slip: stop again right away, look at what led to the slip and take steps to avoid that situation in the future, keep using nicotine replacement therapy if they are using it, and remember that “a slip does not mean you failed” (MedlinePlus, 2024).
That is essential for Thanksgiving.
In my experience, what ends a quit attempt is often not the cigarette itself. It is the conclusion the client draws from it: that the attempt no longer counts.
“What happened before it?” “What did the cigarette do for you?” “What do we change for the next high-risk moment?” “How do you return to the plan tonight, not next Monday?”
The phrase I like is:
“One cigarette is information. A pack is a pattern. Let us interrupt the pattern.”
For the day after a slip, the free worksheet A Month With One Bad Day walks the client through what happened and how they carry on.
What Professionals Can Do Before Smokeout Day
The Great American Smokeout gives a practitioner a ready-made seasonal doorway. It can be used in primary care, pulmonary care, counseling, coaching, group work, workplace wellness, and community health.
The key is to avoid treating it as a motivational poster.
Use it as a structured preparation point.
A practical consultation could include:
Set November 19 as day one, if the client agrees.
Ask what Thanksgiving will look like.
Identify the top three smoking cues expected on Thanksgiving.
Decide what happens after the meal.
Decide what happens if someone offers a cigarette.
Decide what happens if there is a slip.
Review medication or nicotine replacement options within your scope and local guidance.
Arrange follow-up before or just after Thanksgiving.
That follow-up matters. A client may be proud, ashamed, confused, or exhausted after the holiday. Do not let Thanksgiving become the silent test they either pass or fail alone.
What This Means for the Worksheet
A useful Smokeout worksheet should not only ask for a quit date.
It should ask for day eight.
That is what The Eight-Day Bridge is built around. Four pages that follow the week in order:
The Eight-Day Bridge. The two dates that hold the week together: day one and day eight. One moment planned for each of the eight days, and the person who knows.
Before Day One. What leaves the house, who the client tells, the medication conversation, and the first twenty-four hours planned where it matters.
The Table Plan. Filled in a day or two before the occasion: the moments to expect, what the client drinks and how much, what happens after the meal, the sentence for when someone offers, where to go for ten minutes, and the drive home.
The Day After. How it went, what helped, a thought check if the client smoked, and the next seven days. The bridge does not end at day eight.
That last part is easy to miss.
Thanksgiving is not the finish line. It is the first real-world stress test. Day nine matters because the client needs to know the quit attempt continues after the holiday, even if the holiday was imperfect.
Day eight has an open field for the occasion. The same plan works for a Christmas dinner, a birthday, or Canadian Thanksgiving.
The Practical Message
The Great American Smokeout is day one.
Thanksgiving is day eight.
That makes 2026 a useful teaching moment for professionals. It shows the client something honest: quitting is not only about choosing a date. It is about carrying that date into the first meal, the first argument, the first drink, the first person who says, “Are you really still doing that?”
The answer does not have to be dramatic.
It can be:
“Yes. I am still doing it. I am just getting through today.”
And for many clients, that is the work.
I built The Eight-Day Bridge to hand to a client for exactly this week: two dates that hold it together, Before Day One, The Table Plan for the occasion itself, and The Day After, with a thought check for a slip and the next seven days.
Page one is free in the worksheet library. The full set of four fillable pages to use with your clients, in A4 and US Letter with a practice license, is $2.99.
I am a registered nurse in the Netherlands, qualified in asthma and COPD, with twenty-five years in pulmonary care. I work in a hospital pulmonology outpatient clinic. I am also a smoking cessation coach listed in KABIZ, the Dutch quality register for healthcare professionals, which means I work to the national care standard for tobacco and nicotine dependence.
The worksheets exist because I kept wanting to hand someone a single page that did not lecture them, and could not find one.
Evidence-informed and developed with reference to current tobacco-dependence and smoking-cessation guidelines, using CBT-informed behavioral tools to support structured cessation conversations.
Every page is built on national standards for tobacco dependence and on published evidence, and checked against the guidance in each. See the seven guidelines. Support tool only. Not medical advice, and not a substitute for the clinical judgment of the practitioner using it. Medication decisions follow your own national guidance and local cessation protocols.
New articles, case notes and worksheets are announced to the newsletter, at most once a month. Free worksheets · Practice sets
Hughes, J. R. (2007). Effects of abstinence from tobacco: Valid symptoms and time course. Nicotine & Tobacco Research, 9(3), 315–327. https://doi.org/10.1080/14622200701188919
Hughes, J. R., Keely, J., & Naud, S. (2004). Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction, 99(1), 29–38. https://doi.org/10.1111/j.1360-0443.2004.00540.x
Lam, C. Y., Businelle, M. S., Aigner, C. J., McClure, J. B., Cofta-Woerpel, L., Cinciripini, P. M., & Wetter, D. W. (2014). Individual and combined effects of multiple high-risk triggers on postcessation smoking urge and lapse. Nicotine & Tobacco Research, 16(5), 569–575. https://doi.org/10.1093/ntr/ntt190
Shiffman, S., Paty, J. A., Gnys, M., Kassel, J. A., & Hickcox, M. (1996). First lapses to smoking: Within-subjects analysis of real-time reports. Journal of Consulting and Clinical Psychology, 64(2), 366–379. https://doi.org/10.1037/0022-006X.64.2.366
Tobacco Use and Dependence Guideline Panel. (2008). Treating tobacco use and dependence: 2008 update. U.S. Department of Health and Human Services. https://www.ncbi.nlm.nih.gov/books/NBK63952/
I hear that sentence most weeks, and it is almost never the end of the story. Ask three more questions and it usually turns out the patch was 14 mg, it was worn for four days, there was nothing for the sudden cravings, and nobody explained that there should have been.
That client did not fail nicotine replacement therapy. They were never shown how to use it.
Medication is still discussed too briefly in most consultations. Some clients are afraid of side effects. Some stop early because the cravings came back anyway. Some feel that using medication means they are not really quitting by themselves. And some were simply asked “do you want medication?” and said no, because that is what you say to a question you do not understand.
So the useful question for practice is not which medication has the strongest evidence. It is how medication gets explained, matched and supported in a real quit attempt.
This is a summary of where the guidance and the recent research stand on varenicline, nicotine replacement therapy, bupropion and cytisine, and what each of those means once someone is sitting in front of you.
Patch, tablets, and someone to ask. The plan only works if the client can follow it.
What Medication Is Actually For
Medication does not make the emotional, behavioural and social layers of smoking disappear. It was never going to.
What it does is lower the biological pressure of withdrawal. That matters more than it sounds.
Most people do not go back to smoking because they lack insight. They go back because craving, low mood, irritability, broken sleep and a bad afternoon all arrive in the same week, and the cigarette is the fastest thing available. Medication puts a little more space between the urge and the hand.
That space is where your work happens. It is the room in which someone can use a coping plan, get to the next appointment, change a routine, delay an impulse, practise a different response.
Which gives a sentence worth saying out loud:
Medication does not quit for you. It steadies the body while you learn how to live without cigarettes.
Where the Guidance Stands
The WHO published its first clinical treatment guideline for tobacco cessation in adults in 2024. It recommends varenicline, nicotine replacement therapy, bupropion and cytisine as pharmacological options for people who smoke and want to stop. Varenicline, NRT and bupropion are named as first-line, and combination NRT — a patch plus a short-acting form — is listed as an option for anyone using NRT. The certainty is high for varenicline, NRT and bupropion, and moderate for combination NRT and cytisine (World Health Organization, 2024).
NICE updated its own guidance in February 2025 and added cytisinicline to the list of options that, combined with behavioural support, are more likely to result in someone stopping. That list now reads: cytisinicline, a combination of short-acting and long-acting NRT, varenicline, and nicotine-containing e-cigarettes. Bupropion remains prescribable but is not on it. NICE also sets a clear limit: cytisinicline is not to be offered to people aged 66 and over (National Institute for Health and Care Excellence, 2025).
The Canadian Task Force takes the same direction, recommending that people who smoke be offered evidence-based support including behavioural help, pharmacotherapy or both, with the choice made together (Canadian Task Force on Preventive Health Care, 2025).
The practical point underneath all three: medication is not an extra reserved for heavy smokers. It is a standard part of cessation care, and the work is in matching it to the person.
Varenicline: Strong Evidence, Poorly Explained
Varenicline remains one of the most effective options available. The evidence behind the WHO recommendation is high-certainty, and it puts varenicline ahead of placebo, ahead of bupropion, and ahead of single-form NRT (World Health Organization, 2024).
That does not mean every client should be on it. It means the conversation about it has to be a real one.
What people need to understand before they start:
why it is usually started before the quit date
that it reduces what a cigarette gives you, rather than removing the wish for one
that cravings will still happen
what to watch for, and when to contact the prescriber
why finishing the course matters
The common failure is quiet and predictable. Someone expects the medication to remove every urge, has an urge in week two, and concludes it is not working. Then they stop taking it, and then they smoke.
A better sentence to hand over at the start:
This may lower the intensity of the urge and take the reward out of smoking. You will still notice cravings. They should be easier to sit through.
Craving is not failure. If nobody says that, the client will decide it is.
NRT: Not One Product, a System
Nicotine replacement therapy gets dismissed more often than anything else, usually by people who have tried it informally and badly.
The evidence is unambiguous on one point. Cochrane found high-certainty evidence that combination NRT — a patch plus a fast-acting form such as gum or a lozenge — produces higher long-term quit rates than a single form, roughly 17 to 37 percent higher, across sixteen studies and more than twelve thousand participants (Theodoulou et al., 2023).
Which makes sense the moment you picture a day. The patch is the floor under the whole day. The gum, lozenge or spray is for the moments that break through it: the coffee, the car, after dinner, the difficult phone call.
Said plainly to a client:
The patch is the background. The gum is for the moments that come through it.
So “have you tried NRT?” is not the question. These are:
Which form did you use?
What strength, and for how long?
Did you have anything for sudden cravings?
What made you stop using it?
Did anyone explain how to combine two forms?
Nine times out of ten the answer to the last one is no.
Bupropion: Still There, With Conditions
Bupropion is still in the WHO guideline as a first-line option, and it still works. But the same guideline shows it producing lower quit rates than varenicline and lower than combination NRT, and more people leaving treatment because of side effects than with placebo (World Health Organization, 2024).
So it is not a casual suggestion. It needs a proper medication history, a contraindication check, and a prescriber who knows the person.
One question opens most of that up:
Have you ever stopped a medication because of side effects, or because it made you feel not quite yourself?
The answer tells you what to expect this time, and often prevents someone quietly stopping in week three without telling anyone.
Cytisine: Old Drug, New Attention
Cytisine has been used in central and eastern Europe for decades. What is new is the evidence behind it and the regulatory movement around it.
The ORCA-3 trial, published in 2025, gave 792 adults who smoked at least ten cigarettes a day either six weeks of cytisinicline, twelve weeks, or placebo, all with behavioural support. On the twelve-week course, 30.3 percent were abstinent in the final four weeks of treatment against 9.4 percent on placebo, and 20.5 percent against 4.2 percent were still abstinent at twenty-four weeks. Cravings dropped further than on placebo, and 1.7 percent stopped treatment because of side effects (Rigotti et al., 2025).
Treatment duration differs from the other options. NICE notes a twenty-five day course for the cytisine product licensed in the UK, against twelve weeks for varenicline. In ORCA-3 the twelve-week cytisinicline course produced higher abstinence at twenty-four weeks than the six-week course, 20.5 percent against 6.8 percent (Rigotti et al., 2025).
But availability is where this gets local. Licensing, product names, age limits and guideline status differ from country to country. NICE added cytisinicline in February 2025 and excluded people aged 66 and over. Elsewhere it may not be licensed at all (National Institute for Health and Care Excellence, 2025).
For NRT, combining is settled. Patch plus fast-acting beats one form alone, with high-certainty evidence behind it (Theodoulou et al., 2023).
For varenicline plus NRT, it is less tidy. A 2025 systematic review found low-certainty evidence that the combination may improve long-term quit rates compared with varenicline alone, and that it is generally well tolerated. Side effects were somewhat more common, and skin reactions notably so where a patch was used (Zhou et al., 2026).
Low certainty is not nothing, and it is not proof either. It means this is a conversation, not a default.
The question to hold in mind is not whether more is stronger. It is:
Would this person be helped by tighter craving control, or would a more complicated plan be the thing they abandon?
Medication only works if it gets taken.
What This Changes in the Room
The old question was: do you want medication?
It invites a no, because it asks someone to decide about a thing they have not been told anything about.
The better question is: what would make this attempt more survivable for you?
And then the ones underneath it:
What happened the last time you tried?
Did the cravings build slowly, or arrive all at once?
Did you stop the medication early? What made you stop?
Were you afraid of the side effects, or of something else?
Did you decide it was not working because you still had urges?
Do you need steady cover through the day, something for the spikes, or both?
What would make a plan feel manageable rather than one more thing to fail at?
These turn medication from a product into a plan that belongs to the person.
What a Medication Conversation Should Cover
The aim is not to talk everyone into medication. It is to make sure nobody declines it because nobody explained it.
how dependent this person actually is
previous attempts, and what happened in them
previous experience with these medications specifically
fear of side effects, named out loud
medical history and contraindications
pregnancy or breastfeeding, where relevant
mental health history, where relevant
cost and access, which decides more than we like to admit
prescription or over the counter
what behavioural support runs alongside it
Prescribing sits with whoever is licensed to do it where you work. The translating does not. That part is yours.
The Short Version
Varenicline has the strongest evidence. Combination NRT beats a single form, and most people have never been shown how. Bupropion still has a place, with screening. Cytisine is worth watching, and worth checking locally before you mention it. Combining varenicline with NRT may help some people, on low-certainty evidence, and adds side effects.
None of that answers the question practitioners actually face, which is not which medication is best.
It is which support fits this person’s dependence, fears, previous attempts, medical history and ordinary Tuesday.
Medication does not replace the conversation. Used properly, it is what makes the conversation possible.
Who Wrote This
I am a registered nurse in the Netherlands, qualified in asthma and COPD, with twenty-five years in pulmonary care. I work in a hospital pulmonology outpatient clinic. I am also a smoking cessation coach listed in KABIZ, the Dutch quality register for healthcare professionals, which means I work to the national care standard for tobacco and nicotine dependence.
The worksheets exist because I kept wanting to hand someone a single page that did not lecture them, and could not find one.
Evidence-informed and developed with reference to current tobacco-dependence and smoking-cessation guidelines, using CBT-informed behavioral tools to support structured cessation conversations.
Every page is built on national standards for tobacco dependence and on published evidence, and checked against the guidance in each. See the seven guidelines. Support tool only. Not medical advice, and not a substitute for the clinical judgment of the practitioner using it. Prescribing decisions, doses and suitability follow your own national guidance and the product information.
Questions
Which stop-smoking medication works best?
Varenicline has the strongest evidence, and combination NRT is close behind. But the medication someone will actually finish beats the one with the better trial results.
My client says patches did not work. What now?
Ask which form, what strength, for how long, and whether they had anything for sudden cravings. Most people have used a single low-dose form for a few days. That is not a fair test of NRT.
What is combination NRT?
A patch for steady background cover, plus a fast-acting form such as gum, lozenge or spray for the moments that break through. High-certainty evidence shows it produces higher long-term quit rates than a single form.
Is cytisine available where I work?
That depends entirely on your country. Licensing, product names, age limits and guideline status differ. Check locally before raising it with a client.
Can varenicline and NRT be used together?
Low-certainty evidence suggests it may improve quit rates compared with varenicline alone, with somewhat more side effects. Whether it is appropriate, and who may prescribe it, follows your own national guidance.
Does medication replace behavioural support?
No. Every guideline pairs the two. Medication lowers the biological pressure; the support is what changes the routines underneath it.
New articles, case notes and worksheets are announced to the newsletter, at most once a month. Free worksheets · Practice sets
National Institute for Health and Care Excellence. (2025). Tobacco: Preventing uptake, promoting quitting and treating dependence (NICE Guideline NG209). https://www.nice.org.uk/guidance/ng209
Rigotti, N. A., Benowitz, N. L., Prochaska, J. J., Rubinstein, M., Clarke, A., Blumenstein, B., Cain, D. F., & Jacobs, C. (2025). Cytisinicline for smoking cessation: The ORCA phase 3 replication randomized clinical trial. JAMA Internal Medicine, 185(6), 648–655. https://doi.org/10.1001/jamainternmed.2025.0628
Theodoulou, A., Chepkin, S. C., Ye, W., Fanshawe, T. R., Bullen, C., Hartmann-Boyce, J., Livingstone-Banks, J., Hajizadeh, A., & Lindson, N. (2023). Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews, 2023(6), Article CD013308. https://doi.org/10.1002/14651858.CD013308.pub2
Zhou, X., Huang, Z., Song, Q., Xia, X., Cheng, A., Liu, Z., Shi, S., Gao, Y., Xiao, D., & Wang, C. (2026). Efficacy of combined varenicline and nicotine replacement therapy compared with varenicline or nicotine replacement therapy alone for smoking cessation: A systematic review and meta-analysis. Addiction, 121(3), 499–509. https://doi.org/10.1111/add.70235
“I only smoke a few cigarettes now, but I vape all day.”
That sentence has changed how I open the consultation. I used to ask how many cigarettes a day. Now I ask what is on the desk.
The client may no longer call themselves a smoker. Cigarette use has dropped. The morning cigarette is gone, the car cigarette is rarer, the pack lasts longer than it used to. On paper this looks like progress.
Something else has quietly taken its place.
The vape is on the desk. In the car. Beside the bed. In the bathroom. During screen time, after meals, between tasks, during stress, boredom, conflict, tiredness, and every moment of moving from one thing to the next. What began as a way out of smoking has become a second routine, with its own cues and its own job to do.
Both on the table at once. This is the pattern the assessment has to find.
Vaping is not one thing. For some adults who smoke, a nicotine e-cigarette is a route away from tobacco. For others it becomes dual use, where cigarettes and vaping live side by side. For a third group the smoking has stopped and the dependence has not.
The job is not to sort every client into one of those boxes. It is to work out what the vaping is doing for this person, what risk it is taking away, what dependence it is holding in place, and what you are allowed to offer where you work.
Why Dual Use Deserves the Question Now
Recent population data from England explain why this belongs in the assessment. Jackson and colleagues followed adults in England between 2016 and 2024. Among adults who smoked, the share who also vaped stayed flat until mid-2021 and then rose sharply. The pattern shifted too: away from smoking daily and vaping now and then, toward vaping daily and smoking now and then.
That shift matters more than the numbers.
A client who smokes less but vapes all day does not experience their dependence as smaller. The source has changed. The smell has changed. What the neighbours see has changed. The loop is still running, and often it runs more continuously than before, because a vape fits into thirty seconds and a cigarette does not.
So “how many cigarettes a day” is no longer enough. The assessment also needs:
whether they vape, and how often
when they vape, and in which rooms
whether smoking and vaping happen on the same day
whether the vape is replacing cigarettes or has been added to them
what they actually want: to stop smoking, to stop vaping, or to be free of nicotine
Without structure, the answer stays vague. “I just do it all day.” With structure, the pattern becomes something you can both look at.
What the Evidence Actually Says
The evidence is strongest when the question is narrow: can a nicotine e-cigarette help an adult stop smoking tobacco?
The Cochrane living review on this question is updated as new trials appear. Its conclusion is that nicotine e-cigarettes help people stop smoking for at least six months, and that they work better than nicotine replacement therapy. The same review is careful about safety: it did not detect evidence of serious short-term harm, but longer and larger trials are needed before anyone can call it settled.
Which leaves a distinction that is easy to skip over in a consultation.
Stopping smoking is not the same as stopping nicotine.
Someone can leave combustible tobacco behind completely and still be tied to the cravings, the routine, the relief, the hand going to the mouth. From a harm point of view they have gained a great deal. From a dependence point of view, very little has changed for them.
The evidence on how to help someone stop vaping is far younger. A 2026 review found eleven completed trials. Eleven. Set that against the hundreds behind stopping smoking and you have the position a practitioner is working from.
Of those eleven, tailored text-message programmes showed promise, though not in every trial. Varenicline gave the most consistent signal, in studies that were small and short. For nicotine replacement therapy and cytisine, nothing held up once the treatment stopped.
That is not a reason to do nothing. It is a reason to be honest about what we know, which is what our clients deserve anyway.
The 95 Percent Figure
One number comes up in almost every conversation about vaping: that it is 95 percent less harmful than smoking.
It is worth knowing where it came from. In 2014 a small expert panel scored a range of nicotine products for relative harm, and e-cigarettes came out at four percent of the maximum. The panel said themselves that hard evidence was lacking for most products on most of the criteria they used (Nutt et al., 2014). Public Health England quoted the resulting figure in 2015, and it has been repeated ever since (McNeill et al., 2015).
It was publicly challenged the same year in the BMJ, where the authors argued the estimate rested on weak evidence, and it has been defended just as firmly since (McKee & Capewell, 2015).
You do not need to settle that argument to work well. What is useful is to notice that none of the seven guidelines below rests its recommendation on that number. If a client brings it up, and they will, the honest answer is that vaping is clearly less harmful than smoking when it fully replaces combustible tobacco, that it is not harmless, and that the long-term picture is still being written.
Seven Countries, Seven Positions
International guidance does not speak with one voice on vaping, and that is the point of this section rather than a problem with it.
Some countries are open to nicotine e-cigarettes for adults who smoke. Others prefer licensed treatments first. The regulation differs as well: what sits on a shop shelf in one country needs a prescription in another. Here is where each of the seven stands, and what it means once the door is closed and the client is sitting down.
Country
What the guideline says
In the room
Netherlands
Not recommended as a quit aid. Limited room after several failed attempts, and only with intensive behavioural support and an open conversation about the disadvantages. For stopping vaping: behavioural support, with NRT where needed.
Start with behavioural support. If a client raises vaping, discuss the disadvantages openly and keep follow-up close.
United Kingdom
NICE lists nicotine-containing e-cigarettes among the options more likely to result in stopping, alongside behavioural support. NCSCT is explicit that switching away from smoking comes before being nicotine-free.
Vaping can be discussed as one route away from smoking, with complete switching as the aim and a later plan to reduce vaping.
Ireland
The HSE does not recommend vaping as a way to stop smoking, and points to licensed medicines and a trained advisor. Separate advice exists for people who want to stop vaping.
Offer licensed medicines and trained support first. For stopping vaping, work on readiness, triggers and a concrete plan.
Canada
The Task Force suggests against e-cigarettes for most people, with exceptions: failed attempts, unwillingness to use other options, strong preference. Shared decision-making and long-term uncertainty are stressed.
Offer the proven options first. If vaping is considered, name the uncertainty and agree on a limited duration.
United States
No e-cigarette is FDA-approved as a quit aid. The USPSTF finds the evidence insufficient. The CDC allows possible benefit only where vaping completely replaces smoked tobacco. Dual use is not treated as protective.
No approved product, and the evidence is judged insufficient rather than unfavourable. Offer the proven options first, and if a client already vapes, find out whether it fully replaces smoking.
Australia
Nicotine vaping products sit inside a regulated framework, reasonable only after first-line treatment has failed. Dual use should be avoided and the duration kept short. For vaping cessation: dependence, triggers, context, follow-up.
Assess dependence, triggers and context, and arrange follow-up. Avoid dual use and keep it short.
New Zealand
The most accepting of the seven. Vaping is part of national stop-smoking guidance for adults who smoke, and vape kits are offered through services. Not harmless, not for non-smokers, and stopping vaping is the next step.
Vaping may be part of an adult’s route away from smoking. Dual use and ongoing dependence still need managing.
Seven countries, seven positions on vaping. Follow the guidance where you work.
Seven countries, seven positions. That is exactly why a worksheet used internationally should not tell you to recommend vaping, and should not tell you to rule it out either. It should help you have a better conversation inside your own rules.
Switching Completely Is Not Dual Use
Across the seven, one point repeats: complete switching and dual use are not the same thing.
If an adult moves entirely from tobacco to a regulated nicotine vape, several countries treat that as a route to less harm. When the smoking continues alongside the vaping, the benefit becomes hard to find. Cigarettes stay harmful at low numbers, and both patterns stay alive.
Which gives three sentences that sound similar and are not:
“I vape instead of smoking.”
“I smoke less, but I vape all day.”
“I stopped smoking, but now I cannot stop vaping.”
Three sentences. Three different plans.
The first needs relapse prevention, and later a plan to come off the vape when the ground feels solid. The second needs an honest look at whether the vape is replacing cigarettes or simply widening the pattern. The third needs support for stopping vaping, and room for what sits underneath it: dependence, identity, stress, and the fear of going back to cigarettes.
The Question to Ask Before Any Advice
Instead of “is vaping good or bad”, the more useful question is: what is the vaping doing here?
It may be holding off withdrawal, keeping the cigarettes down, holding back a relapse, taking the edge off stress, filling boredom, managing appetite, keeping someone inside a group, going with the screen, giving the hands something, or getting a person from one task to the next.
Most clients do not experience it as a behaviour at all. They experience it as background noise. It is always nearby, and the hand often gets there before the urge has been noticed.
Which is why the small moments matter.
Why Vaping Hides Better Than Smoking
A cigarette has a shape. It takes time. It has a beginning and an end. It happens outside, after a meal, with coffee, on a break, in a designated spot.
A vape does not need any of that. A few puffs while scrolling. A few when the laptop opens. A few in the car before the engine starts. A few after an uncomfortable message. A few after finishing something. A few before sleep.
None of it looks like a session, which is why the client genuinely does not know how often they do it. They only know the device is almost always within reach.
So the assessment has to include routine and context, not only quantity. These questions do the work:
When is the vape usually in your hand?
What is the first moment of the day you reach for it?
Do you vape before you feel a craving, or after?
Which situations would feel harder without it?
Where has vaping replaced smoking, and where has it been added to it?
If you stopped tomorrow, what are you most afraid would happen?
None of them require you to be for or against vaping. They only reveal what the behaviour is for.
Working Inside Your Own Guideline
Follow your own national guidance on treatment, medication, prescribing, pregnancy, young people and mental health. That is not up for negotiation and it is not what a worksheet is for.
What a worksheet can do is make the conversation underneath it concrete: whether the vape has replaced the cigarettes or joined them, which cues keep it automatic, what need it is meeting, what this client is ready to change first, and what follow-up you agree on.
Not treatment. Structure for a real conversation.
Where This Leaves the Consultation
“I do not even know when I do it.”
That sentence is not a dead end. It is the most useful thing a client can say, because it tells you the behaviour has gone below the level of decision, and that is something you can work with.
What helps is slowing the client down long enough to find the anchors: the first reach of the day, the screen, the car, the bathroom, the stress puff, the boredom puff, the one after eating, the ones that carry someone from one task to the next.
Once the pattern is visible, the choice becomes ordinary. Protect the quit attempt. Reduce the dual use. Delay the first one. Take the device out of one room. Swap one automatic moment for something else.
Small changes, because automatic nicotine use is built from small moments. And whatever your guideline allows you to offer, that part of the conversation is yours to have.
A worksheet for mapping these micro-triggers, and a one-page comparison of the seven guidelines above, are both being finished. They will be added to the free library.
Who Wrote This
I am a registered nurse in the Netherlands, qualified in asthma and COPD, with twenty-five years in pulmonary care. I work in a hospital pulmonology outpatient clinic. I am also a smoking cessation coach listed in KABIZ, the Dutch quality register for healthcare professionals, which means I work to the national care standard for tobacco and nicotine dependence.
The worksheets exist because I kept wanting to hand someone a single page that did not lecture them, and could not find one.
Evidence-informed and developed with reference to current tobacco-dependence and smoking-cessation guidelines, using CBT-informed behavioral tools to support structured cessation conversations.
Every page is developed with reference to tobacco-dependence guidance and published evidence. See the seven guidelines. Support tool only. Not medical advice, and not a substitute for the clinical judgment of the practitioner using it.
Questions
What is dual use?
Smoking and vaping alongside each other, in any combination. It is not the same as switching completely, and the health picture is different.
Should I recommend vaping to a client who wants to stop smoking?
That depends entirely on where you work and what your role allows. The seven countries above take seven different positions. Follow your own guideline.
My client stopped smoking but cannot stop vaping. What does the evidence offer?
Less than you would like. Eleven completed trials, with tailored text-message support and varenicline showing the most promise, in small and short studies. Behavioural work on cues and routines is where most practitioners are working in the meantime.
Is vaping 95 percent less harmful than smoking?
That figure comes from a 2014 expert scoring exercise, not from a study of harm, and it has been contested since 2015. Vaping is clearly less harmful than smoking when it fully replaces combustible tobacco. It is not harmless, and the long-term picture is not complete.
Who can use the free worksheet?
Any practitioner supporting someone through a quit attempt: coaches, counselors, therapists, nurses, quit advisors, group facilitators.
What does the practice license allow?
One practitioner may use the set with their own clients: in one-to-one sessions, as homework, or in a group they run themselves. You may print it as often as you need, send a blank copy to an individual client of yours, complete pages together in session, and keep a filled copy in a client file where your recordkeeping rules require it.
Is it medical advice?
No. It is a support tool. It does not replace clinical judgment, medication guidance, or the assessment you would make yourself.
New articles, case notes and worksheets are announced to the newsletter, at most once a month. Free worksheets · Practice sets
Jackson, S. E., Cox, S., Shahab, L., & Brown, J. (2025). Trends and patterns of dual use of combustible tobacco and e-cigarettes among adults in England: A population study, 2016–2024. Addiction, 120(4), 608–619. https://doi.org/10.1111/add.16734
Lindson, N., Livingstone-Banks, J., Butler, A. R., McRobbie, H., Bullen, C. R., Hajek, P., Wu, A. D., Begh, R., Theodoulou, A., Ma, C., Notley, C., Rigotti, N. A., Turner, T., Fanshawe, T., & Hartmann-Boyce, J. (2026). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, 2026(8), Article CD010216. https://doi.org/10.1002/14651858.CD010216.pub11
McKee, M., & Capewell, S. (2015). Evidence about electronic cigarettes: A foundation built on rock or sand? BMJ, 351, Article h4863. https://doi.org/10.1136/bmj.h4863
National Institute for Health and Care Excellence. (2025). Tobacco: Preventing uptake, promoting quitting and treating dependence (NICE Guideline NG209). https://www.nice.org.uk/guidance/ng209
Nutt, D. J., Phillips, L. D., Balfour, D., Curran, H. V., Dockrell, M., Foulds, J., Fagerstrom, K., Letlape, K., Milton, A., Polosa, R., Ramsey, J., & Sweanor, D. (2014). Estimating the harms of nicotine-containing products using the MCDA approach. European Addiction Research, 20(5), 218–225. https://doi.org/10.1159/000360220
Zolotarova, T., Moiz, A., Lelièvre, A., & Eisenberg, M. J. (2026). Vaping cessation interventions: A narrative review of randomized controlled trials. Tobacco Prevention & Cessation, 12, Article 46. https://doi.org/10.18332/tpc/222678
Every autumn the same conversation comes back. A client who has been thinking about stopping for months finally says it out loud, and then adds: not right now, though. There is a birthday coming up. Work is busy. January might be better.
The thinking is never the problem. The starting is.
Stoptober exists because of exactly that gap. It is worth knowing what it is, what the evidence behind it actually says, and, if it does not run in your country, how to use the part that does the work.
What Stoptober Is
Stoptober began in England in 2012. The idea was deliberately narrow: get people to stop smoking on the same day, and stay stopped for twenty-eight days.
Not forever. Twenty-eight days.
The campaign was built around a fixed start date of October 1, public messaging, an app, text support, and the visible fact that thousands of other people were starting at the same moment. It was not built on fear. The message was closer to: begin together, aim for a month, use the support that exists.
The 2026 campaign adds three new content themes — mental health, Closer Each Time, and For Everyone — under the standing tagline Let’s Quit Smoking Together. The second of those tackles the stigma of needing more than one attempt.
A month has a shape. October 2026 begins on a Thursday and ends on a Saturday.
Where Stoptober Runs
Stoptober is an English campaign, run for smokers in England.
Versions of it have been adopted elsewhere after the first evaluation came back positive: the Netherlands, France (as Mois sans tabac, which runs in November), and New Zealand have all run their own. The Dutch campaign has been running since 2014, and I have worked through more than ten of them from inside the clinic, which is where most of what follows comes from.
In the United States, Canada, Ireland, and Australia there is no comparable national campaign with the same October structure. There are other moments. The Great American Smokeout falls on the third Thursday of November, which is November 19 in 2026. But there is no shared October month.
That does not put October out of reach. What makes the model work is not the branding. It is the structure underneath it, and the structure is portable.
What the Research Actually Found
The first campaign was evaluated using quit-attempt data from 31,566 smokers, collected through monthly household surveys in England between 2007 and 2012 (Brown et al., 2014).
The findings: Stoptober raised the odds of someone making a quit attempt in October by around 80 percent, and generated an estimated 350,000 additional quit attempts. Modeled out, that came to roughly 10,400 discounted life years saved, at under £415 each in the largest age group, which is favorable compared to other campaigns of the period (Brown et al., 2014).
A later study looked at England across 2012 to 2017 and found more quit attempts in October across the period as a whole, though not consistently from one campaign to the next. The increase appeared larger when the campaign budget was higher, although the authors describe that particular analysis as not conclusive (Kuipers et al., 2020). That is a useful detail: the effect is not magic, and it seems to track with how loudly the message is carried.
In the Netherlands, the 2014 to 2016 campaigns were associated with a short-term rise in people searching online for help with quitting, on a scale comparable to the rise around New Year (Tieks et al., 2019).
One thing the evaluations cited here do not show is that twenty-eight days makes anyone five times more likely to stop permanently. That figure comes from campaign communication rather than from these studies. It is worth knowing which is which before repeating it to a client.
Why a Fixed Date Does Something a Good Conversation Cannot
Ask someone to stop smoking and you are asking them to give up something for the rest of their life. That is an enormous request, and most people have already failed at it at least once.
Ask someone to stop for October and the request changes shape. It has an end. It is survivable. It can be attempted by someone who does not yet believe they can succeed, which describes most people sitting in front of you.
The rest of what the campaign supplies is ordinary and easy to reproduce:
a start date that is not negotiable and not chosen by the client
a period short enough to picture from the beginning
other people doing it at the same time
something to mark each day on
a way back in after a bad day, instead of a verdict
None of that requires a national budget. Most of it fits inside a normal appointment.
Running an October Month Without an Official Campaign
If Stoptober is not a thing where you work, you can still use the shape of it. What you need is a date, a way to count, and a plan for the day it goes wrong.
September is the preparation. Set the quit date in advance and write it down. Identify the three hardest moments the client already knows are coming. Decide now what happens instead. Clear the house before day one rather than on day one.
October is the counting. One box per day. The client is not deciding about the rest of their life at breakfast. They are deciding about today.
The slip is data, not a verdict. This is where most quit months are actually lost. Not on the day someone smokes, but on the day after, when they decide the month is ruined. A month with one bad day in it is still a month.
For a group, the only extra ingredient is that everyone starts on the same date. That is the whole social mechanism, and it works in a waiting room as well as it works on national television.
The Three Days the Campaign Does Not Cover
Stoptober asks for twenty-eight days. October has thirty-one.
Those last three days are not a rounding error. They are the days when the campaign has finished, the messages stop arriving, the group has gone quiet, and the person is still not smoking, alone this time, without the scaffolding that got them there.
Anyone who has worked in cessation recognizes the pattern in November.
That is why the worksheet below runs to the end of the month rather than to day twenty-eight. Not as a criticism of the campaign, which does something no individual practitioner can. As the part that comes after it.
A Free 31-Day Worksheet for Your Clients
The 31-Day Freedom Challenge is a free, fillable worksheet built for exactly this: a client, a month, and one box per day.
One page, in four parts. My Freedom Intentions: the reason, and the person who knows. My 31-Day Countdown Grid: thirty-one boxes in five weeks, each week named for what it tends to be — the physical peak, the habit breaker, the mind reset, the freedom finish, the last stretch. My Freedom Reward, decided in advance. And My Weekly Note, for the week that was hardest and what got the client through it.
Across the top of the page, one line: I am not quitting forever today. I am crossing off one day. Nothing on the page resets.
It comes in US Letter and A4, both digitally fillable in Acrobat Reader on a phone or tablet, and both fine to print.
The download includes a practice license. One practitioner, your own clients, in session, as homework, or in a group you run yourself. Print it as often as you need, or send a blank copy to an individual client. The license page is included in the file, with space for your name, your practice, and the date.
The worksheet and the license page, both in A4 and US Letter.
Who Wrote This
I am a registered nurse in the Netherlands, qualified in asthma and COPD, with twenty-five years in pulmonary care. I work in a hospital pulmonology outpatient clinic. I am also a smoking cessation coach listed in KABIZ, the Dutch quality register for healthcare professionals, which means I work to the national care standard for tobacco and nicotine dependence.
The worksheets exist because I kept wanting to hand someone a single page that did not lecture them, and could not find one.
Evidence-informed and developed with reference to current tobacco-dependence and smoking-cessation guidelines, using CBT-informed behavioral tools to support structured cessation conversations.
Every page is developed with reference to tobacco-dependence guidance and published evidence. See the seven guidelines. Support tool only. Not medical advice, and not a substitute for the clinical judgment of the practitioner using it.
Questions
What is Stoptober?
An October stop-smoking challenge. Participants stop together on October 1 and aim to stay smoke-free for twenty-eight days.
Does Stoptober run in my country?
It runs in England and the Netherlands, and versions have run in France (in November) and New Zealand. There is no comparable national October campaign in the United States, Canada, Ireland, or Australia, but the structure works without one.
Can I run an October challenge without being part of an official campaign?
Yes, and it is worth being plain with clients about it: this is the same idea, run in this practice, not a government program. A fixed date, a month, and something to count on is the working part.
Who can use the free worksheet?
Any practitioner supporting someone through a quit attempt: coaches, counselors, therapists, nurses, quit advisors, group facilitators.
What does the practice license allow?
One practitioner may use the set with their own clients: in one-to-one sessions, as homework, or in a group they run themselves. You may print it as often as you need, send a blank copy to an individual client of yours, complete pages together in session, and keep a filled copy in a client file where your recordkeeping rules require it.
What does the license not allow?
Reselling or rebranding the set, posting it where people who are not your clients can download it, or passing it to a colleague. A colleague can download their own copy. It is free.
Can I use it with a group?
Yes, if it is a group you run yourself.
Is it medical advice?
No. It is a support tool. It does not replace clinical judgment, medication guidance, or the assessment you would make yourself.
New articles, case notes and worksheets are announced to the newsletter, at most once a month. Free worksheets · Practice sets
References
Brown, J., Kotz, D., Michie, S., Stapleton, J., Walmsley, M., & West, R. (2014). How effective and cost-effective was the national mass media smoking cessation campaign ‘Stoptober’? Drug and Alcohol Dependence, 135, 52–58. https://doi.org/10.1016/j.drugalcdep.2013.11.003
Kuipers, M. A. G., West, R., Beard, E. V., & Brown, J. (2020). Impact of the “Stoptober” smoking cessation campaign in England from 2012 to 2017: A quasiexperimental repeat cross-sectional study. Nicotine & Tobacco Research, 22(9), 1453–1459. https://doi.org/10.1093/ntr/ntz108
Tieks, A., Troelstra, S. A., Hoekstra, T., & Kunst, A. E. (2019). Associations of the Stoptober smoking cessation program with information seeking for smoking cessation: A Google trends study. Drug and Alcohol Dependence, 194, 97–100. https://doi.org/10.1016/j.drugalcdep.2018.08.040
