Over the years, I have written many articles about addiction for this magazine and professional journals. In addition, during my long career as a therapist, I have treated a great many addicts. Some years ago, I turned my attention to treating addicted cigarette smokers and created a program called Smoke Quitters.
What inspired me to create Smoke Quitters was that cigarette smoking is the causative factor in about 12,000 deaths each year in Israel, with one out of six of these deaths attributed to secondhand or passive smoke inhalation. The Smoke Quitters program was based on a cognitive-behavioral model of addiction and was very successful in helping many people quit smoking.
A different smoking behavior has emerged over the past several years which caught my attention; the electronic cigarette, or e-cigarette, often referred to as vaping. Vaping is promoted by the tobacco industry as a “safe” way to smoke, since it is predominantly a nicotine device minus the 7,000 toxic chemicals (200 of which are carcinogenic) found in regular cigarettes. Also, the message to young people is that if you choose to continue smoking or want to cut down or even quit smoking, then use e-cigarettes.
Personally, I am both repulsed and saddened when I see a person vaping, often young people or teens. Every puff is followed by a cloud of smoke, and people who are nonsmokers are likely to inhale some of these vapors if they are near the user. I began to wonder how safe is vaping, and do the claims made by those marketing these devices hold up under scientific scrutiny.
First, a quick review of the prevalence of smoking tobacco products in Israel. According to the Israel Ministry of Health (2019), roughly 20% of the adult population smokes a pack of cigarettes a day or more. The proportion of male smokers is 25.6 %, which is higher than women smokers: 14.8 %. About 22% of 11th and 12th graders smoke a pack a day.
A 2019 Health Ministry survey found that more than a quarter of teens who smoke use electronic cigarettes. For a sixth of them, the electronic cigarette was their first smoking experience, sometimes as early as age 12, with the notion that electronic cigarettes are “less harmful” than regular cigarette use.
SO WHAT is the truth about vaping?
1. Vaping exposes users to fewer toxic chemicals but it still contains plenty and has caused injuries
Vaping does expose you to fewer toxic chemicals. However, there has been an outbreak of lung injuries and deaths associated with vaping. These cases appear to be related to users who modify their vaping with some substances such as THC, the psychoactive ingredient found in cannabis.
The CDC (the US’s Centers for Disease Control and Prevention) has also identified vitamin E acetate, a thickening agent often used in THC vaping products, and it was found in all lung fluid samples of thousands of smokers who developed lung disease as a result of vaping. The CDC warning followed: “Do not modify or add any other ingredients that were not included by the manufacturer.”
2. Vaping contains a number of potentially harmful substances, and others we can't yet identify
The manufacturers of e-cigarettes claimed that the product would deliver only pure nicotine to the user, making it safer than regular cigarettes. However, research from the John Hopkins University on vape ingredients published in October 2021 revealed that there are thousands of chemical ingredients in vape products, most of which are not yet identified.
The researchers were able to identify several potentially harmful substances, including caffeine and three chemicals never previously found in e-cigarettes; a pesticide and two flavorings linked with possible toxic effects and respiratory irritation.
3. Vaping can still harm you
Research has shown that vaping is bad for the heart and lungs.
4. Vaping is still highly addictive
Nicotine is the primary agent in regular cigarettes and in e-cigarettes, and it is highly addictive. So there is a greater risk that teens who vape will become seriously addicted to nicotine and even go on to smoke cigarettes. Studies support this concern. Youth who use e-cigarettes are three to four times more likely to begin smoking conventional cigarettes.
5. Vaping can have harmful consequences
There are numerous potentially harmful consequences of vaping. Adolescents with asthma are particularly vulnerable to adverse lung effects from e-cigarettes.
Help is available
Whether addicted to regular smoking or vaping, one should strongly weigh the risks vs benefits of smoking. Perhaps this is why seven out of 10 smokers state they would like to quit but don’t have the confidence that they can succeed.
The best type of treatment available for quitting smoking is smoke cessation. These programs, like the Smoke Quitters program, provide a structured sequential method of treatment, using cognitive-behavioral principles. They are often accompanied by a nicotine replacement or other approved products to help with the process of weaning off tobacco use.
The Smoke Quitters program was based on three stages. First, an introduction to the science of smoking cigarettes and its effect on health. This was followed by the next stage, which included interventions to strengthen the motivation to quit and the actual cessation of smoking.
The last stage included teaching participants to identify and cope with the high-risk triggers associated with relapsing, in order to prevent the return to smoking.
One can turn to the Israel Cancer Association or your health fund for help and referral to a smoke cessation treatment program.
My advice to anyone who has not started smoking: Don’t. It’s an expensive habit that will eventually compromise your health and the health of others.
The writer is a marital, child and adult psychotherapist practicing in Jerusalem and Ra’anana and provides online video conferencing psychotherapy. firstname.lastname@example.org