Since the 2007 release of electronic or e-cigarettes and vaporizers as an alternative to smoking traditional cigarettes, the sale and use of these products have increased drastically each year. Both devices deliver nicotine by heating up a flavored substance called “e-liquid” to create an aerosol vapor that looks similar to smoke [1]. This vapor is inhaled in a similar fashion to cigarettes. Unlike e-cigarettes, vaporizers (typically called “vapes”) do not use disposable cartridges but utilize a reservoir or tank that can be refilled and holds more liquid at one time. Vapes or e-cigs can look like a variety of items; some resemble traditional cigarettes, while others look like pens, USB storage drives, or cigars. Larger devices called “mods” often look like a battery with a clear acrylic tank attached to the top [2]. Some users are also mixing or utilizing liquid cannabis in modified devices as well, which produces a mind-altering effect due to its concentrated nature. As of 2018, more high school students than adults are vaping—A Centers for Disease Control report indicated that 1 in 5 students in high school, and 1 in 20 in middle school, use e-cigarettes or vapes regularly [3]. Many vaping users are not aware that the vapor contains nicotine when they begin use, believing that the liquid contains only flavoring.

Abuse Signs and Symptoms

Nicotine from either traditional cigarettes or vapes is delivered from the lungs into the bloodstream, where it travels to the adrenal glands. The glands release epinephrine, which acts in the body as a stimulant, increasing blood pressure, heart rate, and alertness. Nicotine also activates the body’s “reward system,” where natural feel-good chemicals are released into the body [3]. Indications that an individual may be addicted to nicotine are:
  • Continuing to vape when it is harmful or no longer pleasant
  • Anxiety or irritability when unable to vape
  • Thoughts of using or vaping interrupting other activities
  • Vaping even after negative consequences have occurred
  • Feeling unable to cut down or stop use
  • The individual feeling as if they do not have control over their use
Nicotine use in teenagers impacts the development of the brain, and can have permanent effects on learning, attention, memory, and impulse control [2].

Withdrawal and Detox

As a person continues to vape regularly, over time the body becomes used to the levels of nicotine present, and when one stops, unpleasant (but generally not life-threatening) withdrawal symptoms begin to occur and can last for several weeks. Common withdrawal side effects are:
  • Headaches
  • Feeling jittery, restless and irritable
  • Increased sweating
  • Anxiousness
  • Sadness or depression
  • Trouble thinking clearly/ concentrating
  • Lack of energy/ feeling tired
  • Increase in appetite
  • Intense cravings for nicotine
Frequently, the cravings for nicotine and vaping last longer than other withdrawal symptoms, and can be triggered by people, places, and things that remind the person of vaping, though they can occur without a specific reminder. Monitoring symptoms, especially sadness and depressive thoughts, is important in managing nicotine withdrawal to ensure the individual’s safety and well-being.

Treatment and Rehab

Treatment for quitting vaping may require a stay in a residential facility. Seeking assistance from a therapist and support from a medical professional to monitor your withdrawal symptoms is important. Additionally, developing a plan to work through any difficult cravings or stresses that may come up during your early recovery is critical. The longer one is able to remain nicotine-free, the less severe the withdrawal symptoms will be and the easier to challenge the cravings will be. As a result, it is recommended that all tobacco/nicotine product use is stopped at the same time. Setting up a plan for healthy habits, such as drinking plenty of water, improving sleep quality, and keeping healthy snacks nearby to curb hunger during withdrawal can also lessen the intensity of unpleasant symptoms during withdrawal.

Aftercare

Creating and updating a recovery plan is key in successfully remaining vape free long-term. Having a list of activities to keep your mind occupied and knowing who in your friends and family groups are supportive and there to listen when you are struggling can be the difference between staying clean or vaping. Recognizing what triggers your cravings to use and how to handle them before they happen is important for ensuring that you know what to do before a stressful or triggering event surprises you. Attending support groups can also be beneficial, as an outlet for processing your struggles and victories with others who are going through similar situations. References: [1] Food and Drug Administration, 2020, https://www.fda.gov/tobacco-products/products-ingredients-components/vaporizers-e-cigarettes-and-other-electronic-nicotine-delivery-systems-ends {2} National Institute on Drug Abuse (NIDA), 2020, https://www.drugabuse.gov/publications/drugfacts/vaping-devices-electronic-cigarettes [3] Centers for Disease Control (CDC), 2018, https://www.cdc.gov/mmwr/volumes/67/wr/mm6745a5.htm