One of my 18-year-old patients beseeched me to write a blog about vaping. He told me that he has tried to quit vaping nicotine on a few occasions and was dismayed to find that his addiction to nicotine was harder to break than his use of weed. He explained that his nicotine withdrawal symptoms made him very irritable, and that he felt that he had to inhale some more nicotine to prevent himself from lashing out. He said that he thought he was so hooked on nicotine because it was so easy to inhale high doses through his vape pen.
Vaping involves using a device that heats a liquid that produces an aerosol that can be inhaled into the lungs. Vaping devices (also known as e-cigarettes) can appear like a pen, USB flash drive, a small tank, or cigarettes. It is estimated that 20% of US high school students have vaped nicotine. Most of them start vaping because they were encouraged to do so by a friend. They continue vaping because it helps with stress, anxiety, or depression. Marijuana is another substance that is commonly vaped (Yingst, 2019).
Many teens assume that vaping is safe because it is not associated with inhaling carcinogens from smoking cigarettes. However, dangerous chemicals are aerosolized by vaping including formaldehyde, which can injure the lungs. Further, some teens start smoking cigarettes after becoming addicted to nicotine through vaping.
Signs that someone is addicted to nicotine include that they are unable to stop despite serious attempts. When they stop temporarily, they might develop physical or emotional symptoms such as strong nicotine cravings, anxiety, depression, irritability, restlessness, difficulty concentrating, increased appetite, insomnia, and even gastrointestinal issues such as constipation or diarrhea. Such withdrawal symptoms typically are most intense for the first week, and then improve over the subsequent few weeks (Taylor, 2014).
In thinking about how to overcome a nicotine addiction it is useful to identify situations in which someone is triggered to use nicotine, such as boredom, stressful times, while driving, or social factors. Also, it is important to think about whether and why the affected person wants to quit vaping.
Treatment for a nicotine addiction can include use of a nicotine replacement therapy (e.g., patch, gum, lozenge, or nasal spray), or oral medications to reduce nicotine craving under supervision by a medical professional, and behavioral approaches such as cognitive behavioral therapy, motivational interviewing, meditation, and hypnosis. There is some on-going promising research regarding use of transcranial magnetic stimulation (TMS) as an aid for smoking cessation. Often, patients benefit from a combination of medication and behavioral approaches.
It should be noted that nicotine withdrawal symptoms may be less of an issue in adolescents as compared to adults, and therefore nicotine replacement therapy is less appropriate in this age group. Further, such therapy can cause the developing adolescent mind to become more dependent on nicotine (Arain, 2013).
When behavioral approaches are used in the treatment of nicotine addiction, an initial discussion can focus on the reasons they want to quit including their interest in being healthy while avoiding dependence on a substance to help them feel good. Patients are taught to avoid triggers of their nicotine use.
In hypnosis, patients can be prompted to imagine two futures: One in which they have become seriously ill because of their on-going dependence on nicotine, and another in which they are healthy because of their success with overcoming their addiction. They can be guided to make the best choice for themselves, and then congratulated for becoming free of nicotine.
Coping with Nicotine Withdrawal
Exercise can be a fantastic way of boosting mood in dealing with nicotine withdrawal symptoms. It can be extremely healthy to substitute an exercise addiction (if exercise is not overdone) for a nicotine addiction. As appetite improves once nicotine use is stopped it is important to eat a healthy diet, rather than eating comfort foods that can cause undesired weight gain. Hypnotic imagery can be helpful in maintaining a good exercise routine and a healthy diet.
Periods of nicotine craving often last for 5-7 minutes. One way to cope with such feelings is to recognize that they last only a few moments, and that they can become tolerable with employment of hypnosis relaxation techniques. I emphasize that in this way my patients can learn to be comfortable with being uncomfortable, which is a skill that can be useful in many life arenas.
Hypnosis, meditation, and yoga can all be used to relieve stress associated with nicotine withdrawal.
Hypnosis can be used to help overcome vaping and nicotine addiction including through its use to reinforce the reasons for quitting, and as a method to enhance coping with nicotine withdrawal symptoms.
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Arain, Mariam, et al. 2013. “Maturation of the adolescent brain.” Neuropsychiatric Disease and Treatment. 9:449–461.
Taylor, Gemma, et al. 2014. “Change in mental health after smkoing cessation: a systemic review and meta-analysis.” British Medical Journal. 348:g1151.
Yingst, Jessica, M., et al. 2019. “Nicotine absorption during electronic cigarette use among regular users.” PLoS One. 14:e0220300.