Addiction Articles

Cheat Sheet / Updated 09-30-2024

Want some tips for your sobriety journey? This Cheat Sheet helps you challenge beliefs and societal pressures, break free from sobriety stigmas, understand your willpower’s role, and dispel conceptions about happiness.

Article / Updated 08-10-2023

Unfortunately, ingesting poison into your system daily for many years takes a toll. We say that not to shame or scare you. Mercifully, we’re keeping some of the gory details limited. The reason it’s important to know about these issues is that it may help give you additional motivation for quitting. The good news is that quitting smoking confers substantial health benefits no matter when you do it. The bad news is that you actually have to quit to get these benefits. So, exactly what can you expect in the relatively near term when you quit smoking? Here are a few of the benefits: If you’re an exerciser, your lung function starts to improve after just a few weeks of not smoking. Fertility returns to normal quickly after quitting. The risk of babies born with low birth weight is the same as nonsmokers upon quitting. Your smell and taste will gradually return after six months or less. You won’t cough as much in the first year or so. Your heart disease risk reduces after the first year and improves to that of a nonsmoker after 15 years. Cancer risk reduction takes longer but declines after five years. Your risk of a stroke declines substantially after five years. Smoking effects on the vascular system The circulatory system includes the heart, arteries and veins and is responsible for delivering oxygen-rich nutrients and removing waste from all areas in the body. In a healthy body, the process of circulation is effortless. Smoking interferes with that process. Cardiovascular disease Heart disease is the leading cause of death for men and women in the United States. About 20 percent of all deaths from heart disease can be directly attributed to smoking. In addition, smokers who have heart disease are more likely to die younger than nonsmokers. Every single cigarette a smoker consumes increases the risk of heart disease. In other words, the more you smoke, the more likely you’ll die of heart disease. What does smoking do to the cardiovascular system? If your health care provider tells you that you suffer from one of the following health issues, you can bet that smoking has contributed to these interrelated diseases: Hypertension (high blood pressure): Smoking increases blood pressure immediately and over the long term. Hypertension causes the heart to pump harder. It damages blood vessels, causing them to narrow, weaken, or rupture. That damage, in turn, can lead to stroke or heart attack. Arteriosclerosis: This disease involves plaque buildup in the arteries which can result in a serious blockage resulting in stroke or heart attack. Heart disease: When the plaque buildup affects the blood supply to the heart or the coronary arteries, it can cause chest pain, shortness of breath, or a heart attack. When a heart is weakened, it can lead to what’s known as heart failure. Heart failure occurs gradually, and symptoms include shortness of breath, weakness, fatigue, wheezing, and retention of fluids, resulting in swollen feet and ankles. Although many pipe and cigar smokers claim that they don’t inhale, some do, and all of them ingest secondhand smoke close up. Smoking cigars and pipes increases both the risk of heart disease and stroke. Cerebrovascular disease Strokes occur when the blood supply to the brain is impeded by a blockage or leakage. The more you smoke, the higher your risk for stroke. In fact, strokes are the top cause of serious long-term disability in the United States. The acronym FAST can help you remember the symptoms of a stroke. Here’s what the acronym stands for: Face: Numbness or weakness as evidenced by a droopy or asymmetrical smile. Arms: Weakness or paralysis on one side of the body, which can be determined by trying to raise both arms at the same time. With a stroke, one arm may not function the way the other one does. Speech: Confusion or difficulty speaking, or understanding may show themselves. Time: If these symptoms appear, call a doctor immediately. Urgent, prompt attention can improve the outcome greatly. Smoking leads to a host of cerebrovascular problems. It also hijacks the mind, body, and soul. Ted’s story, in the nearby sidebar, “Dying for a smoke,” shows how powerfully addiction leads to deterioration in health, but also impedes recovery. Checking for peripheral artery disease With peripheral artery disease (PAD), plaque builds up in the arteries of the outer (or peripheral) part of the body, most commonly the legs. PAD results in pain, cramping, weakness, and numbness in the extremities. If the blood flow is sufficiently restricted, it can also lead to a high risk of infection, which is difficult to treat. Those with severe PAD, can develop gangrene in the affected tissues, which can lead to amputation or even death. Smoking and diabetes are both risk factors for PAD. How smoking affects lungs From the moment a smoker inhales for the first time, the lungs rebel. Most first-timers choke and cough as part of this rebellion. But the lungs adapt after a while and seem just fine again — until they’re not so fine. In addition to lung problems directly caused by smoking, smoking exacerbates preexisting asthma, makes recovery from colds or flu slower, and can increase the risk of pneumonia. See your doctor for any cough that lasts for three weeks or more or immediately if you’re coughing up blood. Confronting coughs Most smokers develop a smokers’ cough. It’s caused by toxins setting up shop in your lungs, which the body tries to eliminate by coughing. In the beginning, it’s a dry, unproductive cough without phlegm. As time passes, it becomes more frequent, gets worse in the morning, and starts producing phlegm. Treatments designed for typical coughs are not particularly effective for smoker’s cough. Eventually, smoker’s cough often leads to more serious conditions. Taking a turn for the worse Many people fear lung cancer as the worst outcome of long-term smoking, and for good reason. However, chronic obstructive pulmonary disease (COPD) ranks pretty high on the list, too. In fact, the U.S. Centers for Disease Control and Prevention (CDC) ranks COPD the fourth leading cause of death in the United States. As COPD progresses, the lungs struggle to function properly. The lung tissues thicken, which makes it more difficult to inhale and exhale. More mucus is also produced as the disease progresses. Again, our intention is not to scare you, but people with end-stage COPD have great difficult breathing and become cognitively impaired due to the lack of oxygen. Most experience substantial anxiety because of being unable to catch their breath, which can turn into feelings of drowning. Although there are medications for easing symptoms for a while, there is no cure for COPD. Smoking causes at least 75 percent of all cases of COPD. COPD is often used as an umbrella term encompassing both chronic bronchitis and emphysema. Chronic bronchitis is bronchitis that persists for months, often recurring over years. Symptoms of chronic bronchitis include Shortness of breath Unusually low energy Cough Overproduction of mucus or phlegm Sometimes fever The most severe symptom of emphysema is shortness of breath. That shortness of breath may appear when going for a long walk at first. However, as the disease progresses, shortness of breath becomes much worse and can be evoked by almost doing nothing, even when sitting. Also, people with advanced emphysema suffer chronic fatigue, poor alertness, and blue or gray fingernails. Confronting lung cancer Eighty percent to 90 percent of all lung cancers appear to be caused by smoking. Most lung cancers are not diagnosed in the early stages, which is why about half of all patients die in the first year following diagnosis. The five-year survival rate is just under 20 percent. We should note that a few new, targeted medications and immunotherapy hold some promise for future improvements in these outcomes. Smoking light or menthol cigarettes does not reduce a smoker’s risk of lung cancer compared to regular cigarettes. However, smoking unfiltered cigarettes doubles the risk of lung cancer for smokers. Filters do not make cigarettes safe in any way, shape, or form. But if you’re going to smoke something, come hell or high water, at least consider avoiding unfiltered cigarettes. Early detection greatly improves survival rates. If you’re a smoker, consider going to www.lung.org for a free quiz that you can use to determine if you’re eligible for a low-dose CT screening exam that could save your life. Normally, the first sign of lung cancer is a cough that doesn’t go away. Hoarseness, shortness of breath, chest pain, coughing up blood, weight loss, and frequent lung infections represent more concerning symptoms. Don’t wait; if you think you’re at high risk or you have some of these symptoms, see your healthcare professional right away. When it comes to your risk of heart disease, stroke, and especially COPD and lung cancer, you may think you’ve succeeded at dodging the bullet if you use smokeless tobacco. Although your risk of lung cancer and COPD may be lower as a smokeless tobacco user, that’s not necessarily the case for many other forms of cancer. In the next section, we look at some of the health risks faced by smokeless tobacco users. HTPs have not yet been linked to lung cancer. And tobacco companies claim that they’re safer than cigarettes. We have two problems with this claim: There have not been any long-term studies of the safety of HTPs compared to cigarettes. You’re inhaling the vapor of the entire tobacco product. Indeed, HTPs don’t involve the range of carcinogenic materials and chemicals of burned tobacco, but they do contain some of the same toxins. Other cancers caused by smoking Smoking not only devastates the lungs and circulatory system but also is responsible for many otherwise preventable cancers. Cancer involves cells going wild dividing and invading healthy tissue. Cancer cells move stealthily through the blood and lymphatic system. Toxic chemicals from tobacco make emerging cancer cells more likely and stopping cancer cells more difficult. Warning signs of cancer include Unexplained weight loss Persistent cough or hoarseness Sores that take too long to heal Unexplained lumps that appear anywhere on the body Bleeding or discharge Fatigue If you have any of the troubling signs above, or significant changes in appetite, bowel or bladder routine, or unexplained pain, see your healthcare provider for a checkup. The more cigarettes you smoke and the more years you smoke them, the greater your risk of cancer of most types. Sending toxic chemicals throughout your body has consequences including a higher risk of the following: Mouth and throat cancer Esophageal cancer Cancer of the larynx Cancer of the trachea Pancreatic cancer Stomach cancer Bladder cancer Kidney cancer Liver cancer Cervical cancer Colon and rectum cancer Leukemia Whether smoky or smokeless, using tobacco causes cancer. For those who smoke pipes or cigars, chew tobacco, or use snuff, the resulting cancer is mainly found in areas that have been directly exposed to the tobacco, such as the mouth, throat, nose, and sinuses. In addition, smokeless tobacco is associated with a higher risk of pancreatic cancer. How smoking erodes overall health Ingesting poison into your body day after day, not only causes cancer, heart disease, and stroke, but a whole lot of other heartache. Smoking negatively impacts every part of your body. Smoking increases the risk for a variety of disorders, from loss of hearing to loss of bone mass. The following problems have been linked to smoking: Hearing loss: Smoking decreases oxygen levels, which negatively effects the blood vessels that keep the critical hair cells in the inner ear healthy. Cataracts and macular degeneration: Smoking tobacco substantially increases the risk of eye problems. Some studies have found that smokeless tobacco also increases risk. Crohn’s disease: Crohn’s disease is a type of inflammatory bowel disease that causes pain, diarrhea, weight loss, and malnutrition. Smoking is a risk factor, and it can lead to more disease. Periodontal disease: This disease involves chronic infections of the gums around the teeth. Tobacco use makes it worse, and chewing tobacco is a particular risk. Type 2 diabetes: This chronic disease impacts health negatively across a variety of domains and is 30 percent to 40 percent more likely to occur for smokers as compared to nonsmokers. Rheumatoid arthritis (RA): RA is a chronic, autoimmune disease, and smoking has been shown to increase its risk and severity. Osteoarthritis: It’s unknown exactly why, but smoking actually seems to confer some small benefit for reducing this disease of the cartilage that protects the ends of bones. Given all the other problems smoking causes, it hardly seems worth going for this mild benefit. Osteoporosis: This disease involves a deterioration of bone density. The more cigarettes you smoke, the more likely you’ll have osteoporosis and break bones. And if you do break a few bones, they’ll heal more slowly. Ulcers: Evidence suggests that ingesting tobacco increases the risk of stomach ulcers and slows healing. You could almost get the impression that the human body just isn’t designed to handle cigarette smoke or tobacco products.

Cheat Sheet / Updated 05-15-2023

To overcome an addiction, first you need to recognize addiction in yourself or a loved one. Then, explore addiction recovery programs and treatment methods and decide how to deal with your addictive behavior, or that of a family member or friend.

Article / Updated 05-03-2023

Gambling involves the betting or wagering of valuables on uncertain outcomes and takes many forms — from games of chance to skill-based activities. People have many motivations for gambling, but all involve the hope of gaining more. Gambling is sometimes a rite of passage by which people discover more about themselves and how to compete with others. It is sometimes a way of life (for people such as casino pros and escape gamblers). It can be, in its healthiest form, a way of socializing and having fun. Pathological gambling is a progressive disorder that involves impulse-control problems. The consequences of pathological gambling are severe and may be devastating to the addicted person's family and career, but the disorder can be treated. As with all addictions, pathological gambling has personal, familial, and neurochemical aspects. Pathological gamblers may even have a genetic vulnerability, although such complex behaviors are unlikely to be traced to one specific gene in the same way some medical conditions, like cystic fibrosis, have been. Problem gambling pioneer Dr. Robert Custer identified three phases to a progressive gambling problem: a winning phase, a losing phase, and a desperation phase. Winning phase In the winning phase, you may experience a "big win" or a series of smaller wins that result in excess optimism. You may feel an unrealistic sense of power and control and you're excited by the prospect of more wins. ("Hey Doc, this is a sure thing. I'm betting the farm.") At the same time, you can't maintain the excitement unless you're continually involved in high-risk bets. Your bets increase, and ultimately, the increased risk puts you in a vulnerable situation where you can't afford to lose . . . and then, sure as the sun rises, you do lose. Losing phase In the losing phase, you may brag about past wins; how you had the casino or track or bookie on the ropes. But in the immediate situation, you're losing more than winning. You're more likely to gamble alone, and when not gambling, you're more likely to spend time thinking about how and when you'll gamble next. Most importantly, you're concerned with how you'll raise more money, legally or illegally. You may have a few wins that fuel the size of your bets. But the dominant pattern is that of losing. Moreover, making the next bet becomes more important than the winning of any previous bet. As the losing continues, you start lying to family and friends and feeling more irritable, restless, and emotionally isolated. You start borrowing money that you're unsure about being able to repay. As your life becomes unmanageable, you may be developing some serious financial problems. Your denial of the huge financial pressures that are building may seem unbelievable to some people: You're also likely to start chasing your losses, trying to win back what you lost. ("Doc, I'll stop, but first I've got to get back to even.") If you don't change your pattern, however, you'll be engaging in more and more self-destructive behavior. Desperation phase The next phase, the desperation phase, involves still another marked change in your gambling behavior. You may now make bets more often than is normal, in more desperate attempts to catch up and "get even." The behavior that's now out of control is associated with deep remorse, with blaming others, and with the alienation of family and friends. You may engage in illegal activities to finance your gambling. You may experience a sense of hopelessness and think about suicide and divorce. Other addictions and emotional problems may also intensify during this phase and drag you down.

Article / Updated 04-17-2023

Direct from the Age of Aquarius, with a history going back thousands of years, hallucinogens take people on far-ranging trips inside their own minds. Hallucinogens (also called psychedelics) cause your brain to generate experiences that are profound distortions of reality. We have five senses: seeing, hearing, tasting, touching, and smelling. Hallucinogens distort these senses, and particularly change your impressions of time and space. Hallucinogens specifically disrupt the neurotransmitter serotonin and interfere with the way your neural cells interact. Serotonin can be found in many places in the central nervous system (your brain and spinal cord) and assists in the functions controlling mood, hunger, body temperature, sexual behavior, muscle control, and sensory perception. The trips caused by hallucinogens can last for as long as 6 to 12 hours. Some trips are good, some are bad. A good trip is dependent on your mindset when you take the drug. Your reaction may differ from time to time, even though you take the same amount of a drug. A good trip often involves visual hallucinations (seeing things that aren't really there or that are distorted). These images may be seen as funny or inspiring, or just odd. Colors may be especially intense and intriguing patterns may emerge on surfaces, like tables or ceilings. Distortions of objects, faces, and other body parts may be experienced. A heightened sexual drive — an aphrodisiac effect — has also been reported. A bad trip on the other hand, may be set off by similar doses of drug that in the past provided a good trip. A bad trip is a frightening experience with surging anxiety and fears of being out of control and vulnerable. Terrifying images and hallucinations have been reported. At different times, under controlled conditions, hallucinogens have been used in experimental forms of psychotherapy, because they seem to bring underlying conflicts to the surface. The bad trips may be linked to these conflicts surfacing, especially when they take symbolic forms and distort reality (these distorted thoughts and images are like a very bad nightmare). Some hallucinogens come from plants but most are synthesized and manufactured. Mescaline comes from the cactus plant called peyote. Psilocybin comes from certain mushrooms often referred to as magic mushrooms or shrooms (for short). LSD (lysergic acid diethylamide, also known as acid) and a dissociative anaesthetic, PCP, (phencyclidine or angel dust) are widely available synthetic hallucinogens. Taking LSD may make you feel several emotions simultaneously and may merge senses so that you see sounds and hear colors. LSD itself, is a clear or white, odorless, water-soluble material synthesized from lysergic acid, a compound rye fungus. The potential of LSD for abuse is fairly high because the experiences are exciting to some people and they want to re-experience their excitement until, of course, they have a bad trip. If you value self-control, it's unlikely that you'll want to gamble in this way about having a good versus a bad trip. If you use LSD, you may experience flashbacks — a repetition of earlier LSD experiences. A flashback often has an unsettling effect, because it is something that is frequently beyond your control. Flashbacks can occur later in your life and seem to be set off by past associations. People with post-traumatic stress have reported similar experiences as they relive their trauma. In a flashback you have to redirect your attention to the present and get out of your head. Flashbacks are a significant concern if they occur when you're driving or in other situations where distractions can result in elevated risks.

Cheat Sheet / Updated 02-28-2023

Internet addiction involves excessive, and at times compulsive, overuse of Internet screen devices. Typically, some types of content are potentially more addictive, including social media, pornography, video games, binge TV watching, shopping, and gambling. The Internet delivers desirable content unpredictably, and the reward center of the brain loves the unpredictable experience of maybe. Addiction is about maybe finding the pleasure you once experienced, and you thinking that maybe it will be fun again. This is the neurobiological chase for the previous pleasurable dopamine hit.

Cheat Sheet / Updated 10-05-2021

Quitting smoking or vaping may be one of the hardest things you’ll ever do, but the rewards will last you a lifetime. In order to succeed at quitting, you need to learn how to deal with your cravings (because you know they’ll hit). You also need the motivation to keep going when the going gets tough. One way to stick with your effort to quit smoking or vaping is to find something healthy to do instead. Many people worry that when they quit, they’ll gain weight, so it helps to find ways to boost your metabolism so you can focus on quitting, not on the number on the scale. Finally, as you’re quitting, you may have trouble sleeping, so knowing how to get a good night’s sleep is key.

Article / Updated 03-27-2020

Quitting smoking is one of the toughest challenges a person can face. It takes the ability to handle frustration, manage intense cravings, break strong associations, and ignore frequent temptations. Having support from family members and friends can improve a person’s chances of success. Being around someone who’s trying to quit smoking presents its own challenges. The smoker may start showing disagreeable behaviors, reactions, and emotions that you’ve rarely seen before. This article helps you anticipate these possibilities and deal with the person you care about during an especially difficult time. Although this article describes helping someone you care about stop smoking, the advice applies equally to those trying to stop vaping, chewing, or other related addictions. Make your home a no-smoking zone The fewer places a smoker has available to smoke in, the better. For smokers, part of the problem is the numerous associations they have between certain environments and their smoking habits. For example, if they always smoke at the dining room table, that location in and of itself tends to trigger strong urges and cravings to smoke. Make your house a no-smoking zone. While you’re at it, make your car a no-smoking zone, too. Eliminating the opportunity to smoke in the house or the car cuts down on the number of available triggers. By doing this, realize that you’re not telling the smoker that he or she can never smoke again (which could lead to unproductive rebellion). Mutually agreeing to a no-smoking zone merely sets the stage for quitting. This action can happen prior to actually setting a quit date. You can help make the case for declaring your home and car smoke-free by explaining that you’re also trying to improve your own health by reducing the amount of secondhand smoke you and your family are exposed to. Clean up the smokey mess Over time, your home has no doubt taken a hit from all the tobacco exhaled into the air over years of smoking by the person you’re helping. Tobacco smell, as well as toxins, permeate the carpet, walls, curtains, furniture, bedding, and clothes throughout the home. Consider the quit date a time for massive spring cleaning, no matter what time of year it is. Removing the odors will also cut down on the associations that trigger smoking. Smokers will hesitate before lighting up in a newly decontaminated environment. Consider opening all the windows and doors in the house to a day or two of completely fresh air. And if you want to really go all out, have your duct work cleaned as well. Don’t forget to thoroughly clean the car. This is a great time to get your car professionally detailed. Remove all ashtrays, lighters, and other paraphernalia from the home. If you can’t stand to throw away your great-great-grandfather’s ashtray, clean it up and store it in a drawer out of sight for a while. Maybe someday, you can use it as a place to put paper clips. But that’ll come well down the road, after months of smoke-free living. Remain positive Helping someone quit smoking, chewing, or vaping can feel like a burden. Plus, when you’re around someone who’s unusually irritable, it’s easy to become crabby yourself. It’s important to work at staying as upbeat as you can. Think about a future when cigarettes and such are no longer a part of your lives. Remaining positive doesn’t mean you put on a sickeningly sweet persona. It doesn’t mean you give in or capitulate to honest disagreements. However, this probably isn’t such a great time to have deep talks about long-term relationship issues or chronically difficult subjects. Postpone arguments if possible. Be sincere in your effort to stay positive. Depersonalize crabbiness It’s hard not to take irritability and cantankerousness personally. But when someone is trying to quit smoking, his or her crabbiness is not about you. Withdrawal from tobacco sets off moodiness and discomfort in most quitters. The person you’re helping probably feels like lashing out at the world and you’re the part of the world that’s most available. This isn’t fair, but the withdrawal symptoms — including the crabbiness — won’t last forever. When you feel like striking back, take a deep breath. Ask yourself what your goal is. Will you really achieve something useful by counterattacking? Probably not. And you’re only likely to make things worse. What you really want, down deep, is a nonsmoker. Play the game for the long haul. Keep judgment at bay Look for ways to express empathy with your family member or friend who’s trying to quit smoking, chewing, or vaping. Empathy is all about putting yourself in someone else’s shoes. If you’re a smoker or a former smoker, that’s probably pretty easy to do — you’ve likely had the same struggle with trying to quit. But if you have never smoked or struggled with an addiction, it can be more difficult to feel empathy. Imagine a time in your life when you were especially hungry, yet you were hours from being able to eat. That’s the kind of feeling quitters face every day. The difference is that you were ultimately able to satisfy your hunger. If a quitter tries to satisfy his or her hunger by smoking or vaping, the battle could be lost — or at least made more difficult. Also, we’ll go out on a limb here and suggest that, because you’re human, you probably have a few of your own flaws. Maybe you eat too much, spend too much, have a quick temper, forget birthdays and anniversaries, leave your house a mess, are late to pay bills — you get the idea. No one’s perfect. So, try to avoid nagging and criticizing. Instead, try empathizing by saying something like the following: I know this is a really hard time for you. Let me know if I can help. I get it that you’re crabby. I would be, too. Quitting is probably the hardest thing you’ve ever done, isn’t it? You look like you’re struggling. How about we go over our list of positive actions? It probably feels like things will never get easier, but from everything I know and have read, you’ll likely feel better in a couple of weeks. Thanks for working so hard at this! Plan distractions It’s likely that your friend or loved one has a list of things to do instead of smoking. That may include chewing hard candy, going to the gym, riding a bike, or going for a walk instead of heading into the breakroom at work, among other things. But it’s also good to develop a list of alternative distractions that the two of you can do together. These could include going to a movie, going to the beach, taking a hike, playing fetch with your dog, or eating out. Get creative! Plan your list together, and make sure to identify distractions that don’t serve as triggers for the person trying to quit. If eating out makes him or her want to reach for a cigarette, skip that and throw a ball for the dog instead. Reduce stress Hopefully, your friend or loved one who’s quitting hasn’t chosen a highly stressful quit date — you know, like the week before income tax forms are due or when you’re putting your house on the market. But no time is stress-free — and you can help. Offer to take on a bit more responsibility for a few weeks. For example, you can help with childcare, meal prep, or the laundry. We’re not giving the quitter an excuse to be lazy, but it takes a lot of energy to stay focused on quitting. Give your friend or loved one all the support you can. This is not a free ride. After a month or so, things should gradually go back to normal. Be clear about what you’re willing to do and for how long. Encourage all attempts Slips or lapses are normal and expected. Try not to catastrophize if your partner slips and has one or more cigarettes. We’re not saying that slipping is good — slips pretty much always make things tougher. But they don’t mean that failure looms on the immediate horizon. So, if the person you’re helping slips, remind him or her that slips can serve as learning opportunities. If he or she wants to talk about why the slip happened, by all means talk and search for reasons together. You can talk about how long he or she was able to go without smoking and all the good reasons for quitting. But don’t criticize, blame, induce guilt, nag, shame, or harass! Even if the slip turns into a total relapse, it’s still important to encourage more attempts when the time seems right. Remind your friend or loved one that most smokers try to quit as many as 30 or more times before finally succeeding. You both need to be patient and positive. Repeated runs at it still have a good chance of working eventually. Check in Some people trying to quit think they should go it alone. They don’t talk about what they’re doing or how they’re feeling. Generally, that’s not such a good idea. Check in regularly with your friend or loved one. Ask about how it’s going. Encourage a discussion about what’s working and what’s not, as well as how you can help. In other words, ask questions about how you can help make quitting easier. Be sure to stay positive and encouraging when discussing the struggles of quitting. Checking in lets the person know that you appreciate what he or she is going through and that you care. Celebrate success Whether the smoker has gone for one hour, one day, one week, or one year, celebrate every successful day without smoking. Here are some ideas: Plan fun activities. Bake a cake. Give a small gift. Send a congratulatory card. Go to a movie. Recognize success even if your smoker relapses. Each smoke-free day benefits health, and getting back on a successful track is always possible. Sometimes after quitting, even after quite a while, cravings come up. So, be sure to continue to notice and celebrate regularly!

Article / Updated 03-13-2020

If you do decide to take up vaping, whether as an aid to quitting smoking or as a hobby or recreational activity, you should at least be aware of what’s currently known about the risks. Again, our advice is to refrain from another, potentially addictive habit — a habit that will cost you time, money, and possibly your health. Ultimately, the choice of whether to vape is yours. The discussion that follows lays out the major, known risks of vaping. Time will no doubt reveal more. When people smoked cigarettes during the Roaring Twenties, they had little concern about the health consequences of their new habit. Serious warnings didn’t start appearing until around 1950. In part, that’s because many of the diseases associated with cigarette smoking take decades to develop. Vaping today is much like smoking cigarettes in the 1920s. Yes, there are far fewer “known” toxins in e-cigarettes, but we just don’t have long-term data to know for sure what the risks are over time. Can you become addicted to vaping? Every morning we drink coffee. And we enjoy coffee. Any morning that our coffee routine is interrupted, we crave coffee. We both consider ourselves “mildly addicted” to caffeine. Not a big deal unless coffee is not available. And we have both had periods of time without caffeine. However, not all addictive drugs are as cheap and readily available and have as relatively high health/safety profile as caffeine. In addition, caffeine’s downside risks are minimal. Nicotine has many similar effects on the body as caffeine. So, why is it such a serious issue to be addicted to nicotine? Part of the concern has to do with the way nicotine is consumed. With cigarettes and vaping, people become enslaved by the routine of having to take numerous puffs all day long. Most people generally drink coffee one, two, or at most, three times per day. That’s partly because caffeine has a much longer half-life than nicotine, meaning that nicotine remains in the body a much shorter time than caffeine does. Thus, to maintain the good feeling, you must replenish nicotine much more frequently. Then, of course, there’s also the hassle factor of nicotine addiction. You don’t see too many “no-coffee” zones out there, and no one else unwillingly consumes your coffee when you drink it. With smoking and vaping, severe limits are placed on where you can consume, and everyone around you inhales some of your nicotine, whether they want to or not. One of the highest risks associated with vaping nicotine is that you’ll become addicted to the substance. Nicotine is one of the most addictive drugs out there (and more so than caffeine). A major characteristic of becoming addicted is that you continue to seek out your drug of choice despite negative consequences. Negative consequences of a nicotine addiction may include significant risks to health. Do you really want your life and the lives around you controlled so much by a drug? Chemical concerns of vaping If you visit a local vape shop and ask what chemicals are in the e-liquid, they’re likely to tell you it comes down to just vegetable glycerin, propylene glycol, and whatever substance you’re wanting added such as nicotine, CBD, or THC. They may inform you that various flavors are in the liquid, too. They’ll likely assure you that the flavors are all safe and that many are FDA approved. (See Chapter 5 for more information about e-liquids or, as they’re also called, e-juices.) What they won’t tell you is that these substances are mainly approved for human ingestion, not inhalation. For example, consider pepperoni pizza. It tastes great, and it’s relatively safe. But what would happen if you liquified the pizza, heated it, and inhaled the vapor? We don’t know the answer to that question, but just intuitively, it seems like it wouldn’t be a good thing to do to your lungs. In other words, most chemicals used in vaping have never been subjected to scrutiny for safety when inhaled. Because literally thousands of chemicals are used for flavoring in e-liquids, that leaves you quite uncertain as to the safety and nature of e-liquids used for vaping. Furthermore, the chemicals that are put into e-liquids can break down and change when heated and vaporized. Just a few of the chemicals and toxicants your body may encounter when vaping include Acetaldehyde Acrolein Acrylamide Benzene Diacetyl Formaldehyde Furfural Nitrosamine Phthalates Various volatile organic compounds And, as we said, these aren’t the only chemicals you could be exposed to when vaping. Some of them are known carcinogens. Sometimes there are chemicals that are not listed on the labels of the e-liquids. Furthermore, toxic substances emitted from e-cigarettes vary with the device used and the contents of the specific e-liquid. At the same time, to be fair, you should know that your exposure to toxins from e-cigarettes is substantially lower than what you inhale from regular cigarettes. Metals in e-liquid Your local vape shop manager probably won’t mention this, but there are studies indicating that e-cigarette aerosol contains metals. Metals are highly toxic and can affect multiple organs. However, this issue is still waiting for answers from good studies to address specific long-term health effects (or lack thereof) from vaping. The levels of metals vary with the type of device in question. Most studies to date have focused on cig-a-like products and vape pens. It’s believed that heated coils and other components of the vaping device are the primary source of these metals, which are thought to leak into the aerosol. A few of the metals that have been found include Aluminum Chromium Iron Lead Manganese Nickel Tin The exact levels and concentrations vary among devices and, thus, long-term health effects are more difficult to definitively ascertain or predict. Cadmium is also found in e-cigarettes; however, at much lower levels than it’s found in combustible cigarettes. Cadmium has high toxicity and causes lung and kidney disease. Getting to the heart of the matter Like combustible cigarettes, e-cigarettes carry nicotine into the lungs and circulate through the cardiovascular system. The nicotine is carried by microscopic particles in the aerosol. These ultra-fine pollutants have been linked to high blood pressure, coronary artery disease, and heart attacks. In a large survey of close to 100,000 participants, researchers found that e-cigarette users had significantly higher risks of heart attack and coronary artery disease than non-smokers or non-vapers. The risk suggested a 34 percent increased chance of having a heart attack for e-cigarette users. This type of study demonstrates a possible association, but it can’t truly establish a causal relationship between vaping and heart disease. Furthermore, the authors acknowledged that regular smoking confers a much higher risk of cardiovascular disease than vaping. One preliminary study indicated an improvement in heart function when combustible cigarette smokers switched to vaping for a month. Once again, more data over long periods of time is needed. Lungs irritated by vaping E-cigarettes have been associated with increased risk of asthma, chronic bronchitis, and pulmonary inflammation. In addition, people who vape have decreased immunity and increased mucus secretion. There is concern that e-cigarette users may be predisposed to respiratory infections. Healthy adults and teenagers have been taken to emergency rooms with shortness of breath, chest pain, and fatigue. Some of them have ended up in intensive care with severe lung damage, and some have died. They all reported vaping prior to their illnesses. People have been vaping in large numbers for over a decade, and these cases have only recently emerged, so it seems likely that new contaminants have gotten into the supply chain. Nonetheless, as of this writing, it appears that the only apparent common denominator for these lung damage cases is vaping. Those stricken reported using various devices with different e-liquids. A substantial majority (over 75 percent) admitted to vaping THC, some obtained legally and many others not. Vitamin E acetate is often used with THC to make a proper vaping consistency. Vitamin E, when inhaled, appears to cause a severe inflammatory reaction. Another possible culprit is contamination from using devices with bad e-liquid mixes and/or problematic flavorings of unknown toxicity. Careful reporting and study will be needed to track down the true source(s) of the problem. The bottom line is that the vaping industry is in dire need of robust study and regulation. While investigating a recent spike in pulmonary illnesses related to vaping, the CDC recently recommended the following: Never buy e-cigarettes or e-liquids off the street. Do not modify e-cigarette products on your own. E-cigarettes should not be used by teens, young adults, pregnant women, or adults who do not currently use tobacco products. If you vape and have concerns about your health, such as shortness of breath, cough, or chest pain, seek immediate medical care. Getting burned Are you someone whose money burns a hole in your pocket? We hope not. But we also hope that you’re not someone whose vaping device burns a hole in your pocket or blows up in your face, hands, or groin. People have shown up at emergency rooms, after vaping devices have blown up, with broken facial bones, severe burns, and extensive lacerations. Vaping devices exploding and burning is not a frequent occurrence, but it happens. In fact, there were over 2,000 emergency room visits due to vaping devices catching fire or exploding in the period from 2015 to 2017. It’s believed that this statistic is an underestimate and that better surveillance procedures should be implemented to track this problem more accurately. You can see the whole exploding vaping device thing on YouTube. Just search for vaping explosions. Not a pretty sight. Most vaping explosions happen due to problems with the lithium ion batteries and mechanical mod systems lacking regulators. In the event that you do experience a vaping fire or explosion, you should seek immediate medical attention if the burn is more than 3 inches in diameter. Do so also if the burn affects your face, genitals, hands, feet, elbows, or knees and the skin is blackened or severely blistered. If your clothes catch fire when your vaping device explodes, stop, drop, and roll. And cover your face. For minor burns, keep the area clean and cover it with a cool compress. Always watch for increasing symptoms of infection, such as redness, swelling, discharge, or fever, and seek medical attention if they occur. Pregnancy and vaping If you’re planning on having a baby soon, our strong advice is to stay away from all nicotine products and vaping of any type. Although vaping may have a somewhat safer profile than smoking regular cigarettes, that does not make it safe — especially when you’re pregnant. Preliminary research on animals links the possibility of e-cigarette use as a cause of birth defects, especially to craniofacial development. It appears that flavors, especially complex mixtures of flavors, have the largest effect on this anomaly. Early research suggests that fetuses exposed to nicotine and/or e-cigarette flavors, have a greater risk of brain or lung damage. Like other risk factors, much needs to be determined through further research. In the meantime, keep your baby safe and avoid all vaping. Seizures caused by vaping A seizure occurs when there is a sudden surge of electrical activity in the brain, which can cause disturbances in movement, behavior, and consciousness. Signs of a seizure may include staring, confusion, or uncontrolled, jerking movements, as well as memory lapses. Most seizures last from a few seconds to minutes. Some reports indicate the possibility of seizures having occurred after vaping with e-cigarettes. The FDA has had reports of seizures from people who just started to vape and regular users of vaping devices. It has been postulated that high doses of nicotine could be responsible for these seizures. And seizures are, indeed, one of the known side effects of nicotine poisoning. This effect would, thus, be in response to having overdosed on vaping if, indeed, vaping was the cause of the seizures. However, a causal link has not yet been established. Some e-cigarettes have very high levels of nicotine. In fact, one e-cigarette, Juul, popular with teenagers has as much nicotine as an entire pack of cigarettes in a single device. Nicotine poisoning Nicotine poisoning is relatively uncommon because most smokers and vapers self-regulate their consumption based in part on how they’re feeling. However, emergency rooms and poison control centers have seen an uptick in nicotine poisoning over the past few years with the advent of vaping devices. E-liquids can contain enough nicotine to kill a small child or pet. Many vapers refill their own devices and maintain a supply of premixed e-liquid formulations or the pure chemicals (including nicotine) that go into mixing the refills. Since 2016, nicotine bottles have been required to come in childproof containers. You can get nicotine poisoning simply by spilling or touching it while refilling your vaping devices. Always wear protective gloves when handling. It should also go without saying that nicotine products should be kept well out of the reach of children and pets. Secondhand vapor What about exposing other people to your vapor? Or what are the risks of being in a room with someone else who’s vaping? The good news is that secondhand vapor is far less toxic than smoke from combustible cigarettes. The bad news is that vaping appears to make the air inside a room lower quality, with small amounts of nicotine and other particles. The health implications of this indoor pollution are unknown. Regulatory guidelines and vaping E-cigarettes first became commercially available in the United States in 2006. That’s a short time span, and the FDA has been slow to catch up in terms of oversight and regulations. In other words, the industry has been largely on its own until quite recently. That means you don’t have great assurances that products contain what they say and in the amounts that are stated. Furthermore, consumers can’t assume that devices have been made with safe, reliable materials and designs. New regulatory guidelines are set to come out soon and should provide consumers with more confidence in what they’re purchasing. These directives should help reduce illegal, online sales of fake products as well. You can’t fully assess a product’s safety without knowing exactly what it contains or how it’s manufactured.

Article / Updated 03-13-2020

Yes, probably — but with numerous caveats. In a head-to-head contest, smoking appears more dangerous than vaping. Think of smoking like playing professional football without a helmet or protective gear. Chances are, you’re going to get hurt. Badly. You may even die. Half of all chronic smokers will eventually die from illness directly linked to smoking. However, if you suit up in appropriate protective clothing and a helmet, you’ll have a much better chance of surviving that football game. Nonetheless, you’ll still be running substantial risks of getting hurt, especially over time. Consider all the serious brain injuries increasingly reported among former professional football players, even though they used helmets. For that matter, even in the short run, it’s a rare NFL game that you don’t see at least one player carried off on a stretcher. So, let’s say that vaping is more like playing football for years with protective gear: safer but far from safe. Yet, many in the public don’t realize that vaping is probably safer than smoking. Surveys have found that increasingly, the public views e-cigarettes as equally, if not more, dangerous than regular, tobacco cigarettes. That may be because of frequent news articles about the dangers of vaping. Relatively few news articles appear that detail the dangers of cigarette smoking. That’s because those dangers have been well known for decades and the topic is neither newsworthy nor controversial. Scientists know that cigarette smoking kills, and the risks are well established. A lot of the damage from regular smoking is caused by the combustion of tobacco, which produces toxins that damage the cell linings of the lungs. That damage makes the cells more vulnerable to the effects of cancer-causing chemicals (some caused by the combustion itself) found in regular cigarettes. Vaping appears safer, but many of the risks associated with vaping are not yet fully known. Long-term studies are sorely lacking because vaping is a relatively new phenomenon. Nevertheless, scientists have reached a reasonable consensus that vaping is safer than regular cigarettes. Although vaping potentially exposes vapers to an array of toxic chemicals, there are fewer chemicals and the levels of those chemicals are much less toxic than those found in regular, combustible cigarettes. You should know that conclusions about the safety of vaping are complicated because of the variety of devices and substances. In fact, there are literally hundreds of different types of vaping devices that produce variable levels of heat and amounts of vapor. There are almost an infinite variety of e-juice combinations. And the concentrations of these substances also fluctuate widely. For example, some e-liquid contains exceptionally high levels of nicotine. Other formulations contain no nicotine whatsoever. Still others deliver various flavors, tetrahydrocannabinol (THC), cannabidiol (CBD), and so on. Different risks likely depend on the actual device and specific ingredients in the e-liquid. Although most forms of vaping appear generally safer than smoking cigarettes, we want to be clear that we do not advocate starting vaping if you’re not a smoker. Using vaping as one means of either quitting smoking or reducing overall harm from smoking is only recommended for the small percentage of people who smoke heavily, have tried quitting by a number of other means, and are either unable or unwilling to quit smoking entirely. Because vaping in the United States is still lightly regulated, using e-cigarettes may confer greater risks than if purchased in the United Kingdom, where there are strict controls over the industry. So, for now, the U.S. Centers for Disease Control and Prevention (CDC) recommends against using vaping to quit smoking. The U.S. Food and Drug Administration (FDA) is often cited as having not found e-cigarettes to be a safe and effective method for smoking cessation efforts. One reason it hasn’t reached this conclusion is that it hasn’t yet studied e-cigarettes for this purpose. In the United Kingdom, the National Health Service (NHS) has assessed the issue and recommends e-cigarettes for the purpose of quitting smoking. More research is badly needed on vaping as a smoking cessation strategy because what we have now is both conflicting and controversial.