Edited by Tanvi Kankan
Nicotine Addiction and Vapes
Nicotine, a highly addictive chemical derived from the tobacco plant, is known to be a stimulant. It accelerates messages between the body and brain to cause the person to feel more energized, awake and confident. Nicotine is consumed through cigarettes, pipe tobacco, chewing tobacco, wet and dry snuff, etc. Another upcoming way of consuming nicotine is through E-cigarettes or Electronic Nicotine Delivery Systems (ENDS), commonly called Vapes.
Nicotine Vapes simulate feelings of tobacco smoking by heating the nicotine inside. They are considered to be a safer alternative to burning the nicotine in traditional cigarettes. E-cigarettes are therefore seen by many people as a step towards quitting smoking. Evidence of that public approval can be seen in the work of Association of Vapers India that advocates for vaping as the only proven ‘most effective method’ for smokers to quit tobacco.
Nonetheless, the Indian Government banned sale and manufacturing of vapes in 2019 on the premise of insufficient evidence in its efficacy against tobacco cessation. Even though research is divided on whether the ban means that nicotine vapes are more harmful than traditional cigarettes or not, the ban is proving to be ineffective as vapes continue to be bought either online or from local markets. This becomes a cause of concern because it also opens a scope for unregulated and illegally produced vapes that could be made of harmful amounts of chemicals (much above the mentioned amounts) leading to addictive behaviors and severe health related consequences for consumers.
Unseen Facets of Nicotine Vape Use and Dependence
There are plenty of resources available on the internet on the harmful effects of nicotine vapes on a person’s health (such as effects on brain development, increased risk for lung and cardiovascular diseases). However, it may be difficult for vape users to stop even when they are aware of these side effects partly because of the nature of the vape’s nicotine hit. Judith Grisel, a former nicotine addict and author of Never Enough: The Neuroscience of Addiction was quoted saying,
“The delivery of nicotine in vapes is even quicker than cigarettes, which is hard
to do..that’s the biggest factor in addictive liability if it’s the same
chemical: the speed with which you get the hit.”
Further, withdrawal symptoms tend to dissuade people from stopping vaping. Some commonly experienced withdrawal symptoms include: headaches, nausea, dry mouth, sore throat, increased appetite, weight gain, dizziness, anxiety, frustration and depression.
Nicotine vapes, however, are becoming a health risk for a less obvious reason today, which is, the normalization of their usage as the safer vice. This is in terms of how they are rarely seen as harmful to health as much as they are seen as means for relaxation or leisure. It provides a relative relief to people who vape from societal surveillance.
Increasing trends of vape use have been found especially amongst the youth. Factors that support them include tempting flavors, pocket friendly sizes and non-intimidating designs. Unlike cigarettes where the smell of smoke can be attention grabbing, vapes leave no residual smell and hence no scope of suspicions. In 2019, The Times of India reported on vaping especially amongst kids in Delhi schools.
"The students use the excuse that they are using the devices to rid themselves of their
smoking habit. It’s difficult to catch errant students since there is little to no smell”
the article quoted a teacher.
What Those Looking to Change their Vaping Behavior Can Keep in Mind
These reasons contribute to the generally lax attitude around vaping. If you are considering whether you need to examine or change your vape use, it is recommended you consult a professional, such as a psychiatrist, clinical psychologist or substance use/de addiction specialist. However, here are some factors that can help you begin the process of behavior change and reducing nicotine vape use.
Dependence is a cumulative effect of a range of biopsychosocial factors
By biopsychosocial factors we mean, a range of biological, psychological and socio-cultural reasons (such as genetic history, family history, events of trauma, mental health concerns, place in the society in terms of their sex, gender, caste, religion, ability, economic status etc). Together these provide a more complete understanding of how a person develops nicotine dependence or is at risk of it. The nature of these influences tend to go beyond the individual’s control and can contribute to their risk of addiction and recovery process.
An example of one such factor is the current policy structure of India that is about treatment and rehabilitation of persons living with addiction. Policies such as the Narcotics Drugs and Psychotropic Substances Act (NDPS) have been critically examined to find an unfair focus on punishing the person living with addiction rather than offering them financial, medical and psychological assistance. Treatment at de-addiction centers either goes unsupervised and/or is mainly directed at enhancing the will of the person instead of intervening in the unsupportive environment around them. These systemic reasons can create a large gap in assessing the rehabilitation system as well as set back a person’s recovery journey significantly.
If we don’t keep this in mind while considering quitting, the success of our efforts may simply be measured by our supposed level of intent or will, which can be very demotivating if we face challenges in the process. Remembering that the problem might lie in the larger state and community support systems can be crucial to not feel unfairly responsible for one’s situation and be more patient with oneself. Ultimately, dependence is only a symptom of the problem, not the problem itself.
2. Beginning with identifying addictive behaviors
Penn State College of Medicine developed a useful 10 item questionnaire that might give individuals an initial idea of the extent of their dependence. The questionnaire asks about one’s frequency and patterns of using e-cigarettes. Answers are measured to give a degree of dependence ranging from not dependent to high dependence (click for scoring key here). This questionnaire can be useful for someone to have a starting idea about what addictive behaviors to e-cigarettes could look like. However, results should not be used to make assumptions or conclusions about the individual’s behaviors without seeking a proper professional and medical input.
3.On making space for both self and the other in the journey to recovery
For seeking help, it is very important to have a support system in place in the form of family, colleagues, friends and healthcare providers. Because dependence can be quite relentless in nature, support systems may also see a lot of back and forth from time to time. This can make seeking treatment from a healthcare provider seem more difficult. The process requires a balance of developing enough trust in the doctor along with comfort and self-confidence to voice fears and concerns. It is important that someone trying to overcome dependence is aware of their right to ask questions and recover from it with dignity irrespective of what stage they are at. Some of the questions that can be asked of oneself could be:
● How is vaping nicotine hurting my general health?
● What kind of side effects will I experience after I quit?
● How can my family and friends help me?
● Where can I find resources, such as counselling, support groups or reading material?
● (In case of medicines prescribed) How will this medicine help me/ Why do you think this is the best medicine to be prescribed at this point/What kind of effects will I have from it?
The journey of recovering from dependence can be a challenging one. It is helpful to cultivate and use any support system we might have, but even then, the chances of slips or lapses may feel too real sometimes. Feelings of anger, guilt or shame may develop. During such times, it is helpful to be compassionate and patient with ourselves. Allowing oneself rooms for error and seeing them as crucial to recovery is an act of power in itself. Thus, being gentle and forgiving toward the self could be a key means in working through this behavior.
Resources
References
Sharan, R., Chanu, T., Chakrabarty, T. and Farsalinos, K., 2020. Patterns of tobacco and e-cigarette use status in India: a cross-sectional survey of 3000 vapers in eight Indian cities. Harm Reduction Journal, 17(1).
Breaking up with my Juul: why quitting vaping is harder than quitting cigarettes. the Guardian. (2022). Retrieved 31 August 2022, from https://www.theguardian.com/society/2019/oct/10/breaking-up-with-my-juul-why-quitting-vaping-is-harder-than-quitting-cigarettes.
Nicotine Withdrawal: Symptoms, Treatments & Other Remedies. Cleveland Clinic. (2022). Retrieved 31 August 2022, from https://my.clevelandclinic.org/health/diseases/21587-nicotine-withdrawal.
Can vaping damage your lungs? What we do (and don’t) know - Harvard Health. Harvard Health. (2022). Retrieved 6 September 2022, from https://www.health.harvard.edu/blog/can-vaping-damage-your-lungs-what-we-do-and-dont-know-2019090417734.
Vaping new headache for Delhi schools as fad catches on | Delhi News - Times of India. The Times of India. (2022). Retrieved 31 August 2022, from
https://timesofindia.indiatimes.com/city/delhi/delhi-vaping-new-headache-for-schools-as-fad-catches-on/articleshow/69501206.cms.
Thampi, V., Nair, R., Rawat, R., Makhaik, A. and Dey, S., 2018. A Review Study on Vaping and Status of Vaping in India. Journal of Cancer Clinical Trials, 03(02).
Bhave, S. and Chadi, N., 2021. E-cigarettes and Vaping: A Global Risk for Adolescents. Indian Pediatrics, 58(4), pp.315-319.
What Exactly Is the Biopsychosocial Model of Addiction?. Psychology Today. (2022). Retrieved 31 August 2022, from https://www.psychologytoday.com/us/blog/understanding-addiction/202107/what-exactly-is-the-biopsychosocial-model-addiction.
Narcotic Drugs and Psychotropic Substances Act, 1985. Indiacode.nic.in. (2022). Retrieved 31 August 2022, from https://www.indiacode.nic.in/handle/123456789/1791?sam_handle=123456789/1362.
India's Anti-Narcotics Law is in Urgent Need of Rehab. The Wire. (2022). Retrieved 1 September 2022, from https://thewire.in/law/indias-anti-narcotics-law-is-in-urgent-need-of-rehab.
Raghavan, A. (2022). India Needs To Start Looking at Addiction as a Psycho-Social Problem – The Wire Science. Science.thewire.in. Retrieved 1 September 2022, from https://science.thewire.in/health/india-addiction-psycho-social-problem-investment-rehabilitation/.
Ctimaine.org. (2022). Retrieved 31 August 2022, from https://ctimaine.org/wp-content/uploads/2019/11/Penn-State-assessment_Comms.pdf.
Maineaap.org. (2022). Retrieved 31 August 2022, from https://www.maineaap.org/assets/conferences/Penn-State-Electronic-Cigarette-Dependence-Index.pdf.
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