Tobacco, vaping and nicotine dependence — formative SAQs

SAQ 1 — Dependence assessment and evidence-based cessation (10 marks)

A 16-year-old seen alone discloses daily use of a pod vaping device for nine months, with craving on waking, irritability without it, and two failed attempts to stop. They want help quitting. They have no acute symptoms. [9] [8]

Questions

1. Frame the assessment you will perform, including the principle that guides when dependence can begin. (4 marks) [5]
2. Outline the stepwise cessation plan, naming the 5 A's, the brief-intervention method, and the pharmacotherapy you would offer and in what order. (6 marks) [8] [7]

Model answer

Assessment (4). First secure time alone and state conditional confidentiality with its limits. Take a product-specific history — which product (pod device), age of initiation, frequency (daily, with use on waking), triggers, withdrawal symptoms (irritability, craving), and failed quit attempts. Quantify use (any, past-30-day, daily). Apply DSM-5 tobacco use disorder criteria and a validated tool such as the Hooked on Nicotine Checklist to grade dependence. Assess readiness to change and screen for co-occurring depression, anxiety, other substance use and pregnancy risk. The guiding principle is that nicotine dependence in adolescents is a biological process that can begin before daily use, often within days to weeks of first exposure, because the developing brain is highly nicotine-sensitive — so craving on waking and failed quit attempts already indicate established dependence despite the young person's framing. [5] [9]

Cessation plan (6). Run the 5 A's: Ask about all products, Advise with a clear personalised message, Assess willingness and dependence, Assist with counselling and medication, Arrange follow-up within one to two weeks. Deliver the brief intervention with motivational interviewing — open questions, affirmation, reflective listening, summaries — to evoke the young person's own reasons for quitting rather than lecture. Add structured behavioural support: a quit date, trigger management, coping skills, social support, and a digital or text-message program (a randomised trial showed a tailored text program increased abstinence in adolescent e-cigarette users). For pharmacotherapy, offer nicotine replacement therapy first-line — a patch for baseline nicotine plus a short-acting form for breakthrough craving; consider bupropion SR or varenicline where NRT is inadequate or dependence is severe, with region-specific licensing caution and neuropsychiatric monitoring. Frame relapse as part of the quitting process, not failure. [8] [7] [10]