September 2019 Newsletter
In just two months, more than 400 cases of severe pulmonary disease among users of electronic cigarette products have been reported in no fewer than 25 states.
According to the Centers for Disease Control and Prevention (CDC), the cases, which have been primarily among adolescents, are currently under investigation and may be related to high levels of vitamin E in cartridges of cannabis vaping products. Amid this vaping investigation, Michigan became the first state to ban the sale of flavored e-cigarettes.
1. Most E-Cigarette Solutions Contain Nicotine
Electronic cigarettes, or e-cigarettes, have many names, including e-cigs, vape pens, e-hookahs and e-cigars. Using an e-cigarette is often called ‘vaping’, but the ubiquity of one e-cigarette company has given rise to another brand-centric term for use, JUULing.
E-cigarettes come in many shapes and sizes. Some, like JUULs, resemble USB flash drives or pens while others are larger tank systems or ‘mods’. In any form, e-cigarettes work by heating a liquid solution, which usually contains nicotine and flavoring, to a high enough temperature that it produces an inhalable aerosol.
While nicotine levels in e-cigarettes are highly variable, one pod from the top-selling e-cigarette brand, JUUL, contains as much nicotine as a pack of 20 regular cigarettes.
2. E-Cigarettes Are Not Smoking Cessation Devices
Although there has been some debate as to whether e-cigarettes may be used by adult smokers to transition away from combustible cigarettes, e-cigarettes have not received Food and Drug Administration approval as smoking cessation devices and even JUUL’s CEO has warned against their use.
Among adolescent never-smokers, there is evidence that e-cigarette use increases the frequency and amount of cigarette smoking in the future. Even if young adults do not progress to future cigarette smoking, vaping is unsafe and addictive.
3. Youth Vaping Is a Public Health Crisis
Although smoking rates among adults reached an all-time low in 2017, there has been a dramatic rise in youth vaping.
From 2017 to 2018, the National Youth Tobacco Survey results confirm that there was a 78% increase in e-cigarette use among high school students and a 48% increase among middle school students. By 2018, the total number of middle and high school students currently vaping rose to 3.6 million.
4. Youth E-Cigarette Cessation Treatments Are Emerging
Although there is a large body of research on adult smoking cessation methods, there is little information about how drug or behavioral interventions may support youth e-cigarette cessation.
Among adolescents, motivational interviewing and face-to-face cessation counseling appear to increase quit attempts and cessation.
While nicotine replacement therapies (NRTs) have been shown to increase quit attempts in youth, they have not been shown to have long-term improvements on cessation. Moreover, NRTs have not been approved for use in youth under the age of 18.
Transcranial magnetic stimulation (TMS), a noninvasive neuro-modulatory therapy, has emerged as a promising therapeutic treatment for addiction. In adults with nicotine use disorder, TMS treatment has been shown to be highly effective in reducing craving and increasing cessation of tobacco use.
As vaping-linked respiratory illnesses surge among school-aged youth, parents, clinicians and policy makers are desperate for adolescent e-cigarette addiction treatments. In an attempt to close this treatment gap, the Truth Initiative launched a text-based e-cigarette quit program. Additionally, the FDA has begun to investigate ways to help young adults who are addicted to vaping.
5. Vaping Related Pulmonary Illness Research is Ongoing
When other causes of pulmonary disease are not identified, the CDC urges clinicians to consider the possibility of vaping in patients who report e-cigarette use within the past 90 days. Although there is insufficient understanding of vaping-related pulmonary disease to provide clinical recommendations, a recent study concluded that patients have improved with prolonged courses of glucocorticoid therapy.
In the late 1800s, scientists hypothesized that vaccines might have the potential to cure alcoholism.
To test this hypothesis, scientists in San Francisco vaccinated horses with alcohol in an attempt to create alcohol antibodies which could be used treat ‘chronic inebriation’ in humans. An 1898 article from the New York Medical Journal described the ‘equisine’ treatment “sterilized [horse blood], mixed with chloral, and frozen [then] applied once a week for eight or nine weeks”.
Thankfully, there have been significant advancements in addiction treatment since then!
Tell us a bit about your choice to specialize in addiction treatment.
Thank you for the opportunity to speak about teen addiction and the recovery services available at Recovery NOW, Inc. and Positive Counseling Center.
Treating substance abuse has been a specialty of mine since 1992. While training to be a substance abuse specialist, I heard over and over that addiction is a family disease. Interestingly enough, treatment models are often individually focused, not family focused. I started my group practice to help whole families recover.
As a group of 20 mental health providers, we provide mental health and substance abuse services for people of all ages and their families. To recover family stability, we work as a team to treat multiple family members while helping individuals remain clean and sober. Our services include psychotherapy, interventions, treatment evaluation, hypnotherapy and medication management for children and adults. Currently, we have 3 locations of San Pedro, Hermosa Beach and Long Beach.
Which treatment approach(es) have you found to be most successful in youth e-cigarette cessation?
I am a firm advocate for prevention. Stress and mental health problems, such as ADHD, are significant risk factors for nicotine use. To inform prevention, we have a stress test on our Positive Counseling website. Also, our Recovery NOW website has quite a bit of information on mental health and substance abuse.
Poor family communication is both a risk factor for and a consequence of youth nicotine use. For youth who have already started using e-cigarettes, communication with parents is often difficult, so improving family communication is a strong treatment approach. Additionally, therapy that addresses family communication breakdowns can also prevent e-cigarette and other substance use.
Parents should also know that our children are always watching us. We are their role models, so if we smoke and/or use drugs and alcohol, then we are sending a message to them that nicotine, drugs and alcohol are okay.
How to do you counsel young adult clients about vaping?
It is important to educate our youth that, contrary to what they might think, the nicotine content of e-cigarettes is often very high. The use of cigarettes, whether they are electronic or not, increases the risk of marijuana use. Many parents are not aware that marijuana can be vaped. We know that youth marijuana use is a significant problem for brain development because in these formative years, the brain is still maturing. Providing psychoeducation, encouraging physical exercise, helping youth assess whether their peers are positive influences or not are all important aspects of treating and preventing e-cigarette use.
Palos Verdes Breakfast Club
When : September 21, 2019
Where : Palos Verdes, CA
What : Dr. Martha Koo, M.D. is presenting on advancements in neuroscience and technology: transcranial magnetic stimulation and photobiomodulation.
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