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Can E-Cigarettes Reduce Smoking Among the Mentally Ill?

Vaping is the new replacement for cigarette smoking. Is it a better choice?

Two young men were walking toward me, their faces obscured by clouds of vapor coming from tubes stuck in their mouths. They appeared to be in a fog bank of their own making.  As they walked past, I realized that they were smoking, or rather vaping, e-cigarettes.

This relatively new form of sending nicotine into the blood differs considerably from conventional cigarettes that depend on the combustion of tobacco, paper, and miscellaneous substances.  

E-cigarettes are powered by a battery and look like a real cigarette (or a pacifier for grown-ups.)  Inside the device is a cartridge filled with a liquid containing nicotine, flavorings like candy, and other chemicals. The liquid is heated to a vapor, which is inhaled like a cigarette, and called vaping.

The smoker of e-cigarettes can determine the amount of nicotine he or she will be inhaling by purchasing a specific amount to be added to the heated liquid. Traditional cigarettes contain about 4mg-14mg of nicotine, depending on the brand.  According to the CDC, the average smoker absorbs about 1mg of nicotine from smoking one cigarette, but of course this varies depending on the amount of nicotine in the brand and how deeply the smoke is inhaled. People switching to an e-cigarette can turn to charts that show the amount of nicotine to use to equal the amount they used to get from a traditional cigarette. Hopefully, they will use the e-cigarettes to consume less nicotine.

Many people still smoke because nicotine seems to improve their mood and cognition.  Indeed, smoking has been described as a means of self-medication used to diminish depression, anxiety and even distractibility.  Perhaps because of this, those suffering from mental disorders comprise one of the largest subgroups of people who are still smoking.  According to the Substance Abuse and Mental Health Services Administration, about 18 percent of the U.S. population as a whole smoke.

However, the rate is much higher among those who are mentally ill.  NAMI, The National Alliance on Mental Illness, reported that 60 percent of those with depression smoke, and the number increases to 90 percent among those with schizophrenia.

Nicotine’s positive effect on mood is measurable, although not everyone may benefit. Brain cells containing neurotransmitters involved in our behavior and emotional state contain sites or receptors sensitive to the presence of nicotine. These nicotine receptors may strengthen the effect of dopamine, serotonin and other neurotransmitters on mood, thus making the smoker feel less anxious and depressed. People who suffer from ADHD also may use nicotine to enhance attentiveness and concentration, as it is thought to have an effect on the brain similar to that of drugs used for this disorder.

Regardless of the benefits on mood and cognition, one cannot minimize or ignore the negative consequences of bringing nicotine into the body. In a conventional cigarette, the tar, and a multitude of other substances involved in its combustion, may be the villains in the cancer-producing effects of smoking on the individual, alongside the respiratory and other problems suffered by those exposed to second-hand smoke. E-cigarettes have not been used for long enough to detect the health consequences of habitual use, but nicotine is a drug and thus has the potential for harm, regardless of how it is administered.  And the sad fact is that someone who begins to smoke as a way of lessening the pain of depression and anxiety, may remain addicted to cigarettes long after the mental illness has been helped by medication and therapy.

Might “vaping” e-cigarettes be the solution to breaking the addiction, or at the very least decreasing the health risk? The nicotine delivered in the heated liquid inhaled and puffed out by the smoker is not in a matrix of cancer-causing substances, but added in a measured form to a liquid in the cigarette’s receptacle. The amount of nicotine in the e-cigarette can be slowly reduced to wean the smoker gradually from dependence, and ultimately be removed altogether so that all that is left is the oral gratification of sucking on a tube and emitting vapor.

In a May 13, 2014 issue of Tobacco Control, Sharon Cummings, PhD, reported that smokers with mental health problems are more likely to use e-cigarettes to reduce the hazards of smoking than the general population. She found that 60 percent of smokers with mental illness indicated that they were somewhat likely or very likely to try e-cigarettes in the future for this reason, compared with 45.3 percent of smokers without mental health conditions.

But should people who dose themselves with nicotine to help their mental health withdraw from this drug without medical supervision? Anyone who has tried to stop smoking knows that the craving for nicotine takes a long time (or never) to disappear, and the early weeks of abstinence are accompanied by side effects such as disruptive sleep, distractibility, excessive eating, depression, anxiety and anger.  How much more vulnerable must people be who are already suffering from some of these symptoms before nicotine withdrawal? What if the smoker who suddenly decreases the nicotine in the e-cigarette experiences a flare up of anxiety, panic attacks or depression?

The use of vaping, which allows the smoker to inhale smaller and smaller doses of nicotine, may be an effective way of eradicating the addiction.  But if this is done by those who have used nicotine as an adjunct to their medication, or as a way of preventing themselves from needing medication, the medical community should supervise and support them as they would with any other type of drug withdrawal.  


Effect of nicotine and nicotinic receptors on anxiety and depression. Picciotto MR1, Brunzell DH, Caldarone BJ) Neuroreport. 2002 Jul 2;13(9):1097-106

(S. E. Cummins, S.-H. Zhu, G. J. Tedeschi, A. C. Gamst, M. G. Myers. Use of e-cigarettes by individuals with mental health conditions. Tobacco Control, 2014; 10:1136 )