Fighting E-Cigarette Addiction: Zach Arledge's Experience (USA)
By his junior year of college, Zach Arledge had already tried to quit vaping half a dozen times. Each attempt ended in failure, with him returning almost instantly to his Juul.
Determined to succeed this time, Mr. Arledge chose a more auspicious time: winter break, with more free time and a week off. To prepare, he bought sugary cereal to calm his cravings and melatonin to help him sleep.
He drew 72 boxes on a piece of paper, each representing an hour of his first three days without nicotine. He checked them off as the hours passed, marking each time slot as soon as he woke up. During those early days, Mr. Arledge felt disconnected from his body, unable to concentrate. He chewed chopsticks and sat in front of the television to distract himself.
The nicotine in e-cigarettes can be highly addictive and increase blood sugar, heart rate, and blood pressure, among other health risks. While some people turn to vaping as a way to quit smoking, e-cigarettes contain substances that also pose health risks.
Despite the popularity of vaping — more than 8 million Americans used e-cigarettes in 2018, according to federal health data — there are few established guidelines to help people like Arledge quit. Many of the current recommendations come from smoking cessation efforts, not from research specific to vaping.
"The health care system has not yet fully caught up," said Suchitra Krishnan-Sarin, a professor of psychiatry at Yale University School of Medicine who specializes in adolescent tobacco use.
Often, doctors say patients don't realize they're becoming dependent on their vapes and are deeply addicted before they even think about quitting.
"You can easily increase the amount of nicotine you consume, almost without realizing it," said Dr. Pamela Ling, director of the UCSF Center for Tobacco Control Research and Education.
A single Juul pod can contain as much nicotine as a pack of cigarettes. Within a year of switching to vaping, Arledge was consuming one a day. He had known for a while that it was time to quit. But each attempt failed because of withdrawal symptoms.
Doctors say there are strategies to help people overcome these symptoms and quit vaping for good.
How to quit vaping
Make a plan
Planning to quit involves understanding your triggers: what motivates you to vape, and what people or environments to avoid while quitting. “The more you understand yourself, the better you can prepare,” said Dr. Panagis Galiatsatos, director of the Tobacco Treatment Clinic at Johns Hopkins Medicine.
Some people choose to quit abruptly, but experts say others do better by gradually reducing the amount they vape over several weeks. Setting a complete quit date can also help.
Preparing for withdrawal symptoms
People who are addicted to nicotine may experience withdrawal symptoms when they quit. They may feel anxiety, nausea and tremors, Dr. Krishnan-Sarin explained. “It’s like the system is rebalancing itself,” she added.
These symptoms are usually most intense during the first three days and usually fade over time. To manage them, it helps to have water, gum, and snacks on hand to relieve the oral fixation felt when the urge to vape strikes.
Seek help
While there are no medications specifically approved to help people quit vaping, some smoking cessation treatments may be beneficial, according to Dr. Galiatsatos. Non-nicotine quit smoking medications approved by the FDA for adults, such as bupropion, which reduces cravings, and varenicline, which makes nicotine less enjoyable, may help.
Nicotine replacement therapies, such as patches, gum, and lozenges, can also help people quit vaping. The National Quitline can provide advice and support, as can text messaging services like the National Texting Portal, This is Quitting, My Life My Quit, and SmokefreeTXT. Quit the Hit, a five-week program using group direct messages on Instagram, can also help support people who want to quit vaping.
Arledge’s last attempt to quit was successful. It took three days for the worst of his cravings to disappear. Now, he often reflects on how hard it was to quit vaping when he faces a challenge, like enrolling in a demanding master’s program or sticking with his weight training.
It usually takes several attempts for someone to quit e-cigarettes for good, said Bonnie Halpern-Felsher, a Stanford professor and developmental psychologist who studies teen behaviors around tobacco products. It's important to remember that attempts are part of the process, and if the first attempt fails, "you're not a failure."
