ex-smokers who vape: smoking lapses and relapse

Small study; interesting findings. A new article published in Drug and Alcohol Review details how vaping (using e-cigarettes) helps some people avoid relapsing back to smoking. The authors, Caitlin Notley, Emma Ward, Lynne Dawkins, Richard Holland, and Sarah Jakes, have made a clear-headed and nuanced contribution to this controversial field.

The paper is especially interesting to me because it explores the often-rocky path toward smoking cessation. For ex-smokers who quit by switching to vaping, social cues and “trigger events”—like seeing someone smoke or being forced to vape “tobacco flavor” because your favorite fruit flavor was just banned—may lead to relapse. Which is bad.

A “lapse” is a one-off thing, from one puff to several cigarettes after a smoker has quit. A “relapse” is defined as five lapses within 50 weeks after a quit attempt or as a full return to regular smoking. Past research has shown that even one lapse increases the risk of a full relapse. But most of that research was conducted prior to the advent of vaping.

This new study revisits the question and suggests that vapers who lapse may be less likely to relapse than smokers who quit by other means. Let’s explore the findings.

The researchers conducted semistructured qualitative interviews with 40 vaping ex-smokers in the United Kingdom. Interviews elicited information about their lapse and relapse experiences as well as attitudes toward combustible tobacco and vaping. One participant, for example, regarded an occasional cigarette as a “slippery slope.” Another called vaping a “perfect replication of smoking.”

The authors noted that past research found that full relapse, after a lapse, may be due to “cognitive dissonance” caused by internalized pressure for total abstinence. One lapse creates a sense of failure, which then weakens future resolve, resulting in a relapse to smoking.

The good news is that vaping seems to disrupt that chain of reasoning. It seems to give ex-smokers leeway to see one cigarette in a different way. For vapers who lapse—either intentionally or unintentionally—the pressure for total abstinence is either absent or substantially reduced because they have an intermediate option that is not available to non-vapers.

Having the pleasurable alternative of vaping meant that full relapse to smoking was not inevitable. Instead, lapses were perceived as ‘permissive’ or ‘purposive,’ intentional and contextualised, or for some as unintentional, with the resulting emotional response negatively reinforcing ongoing tobacco smoking abstinence.1

The researchers also found that vaping seems to change ex-smokers’ sense of identity. They may stumble but they still regard themselves as being on the path to quitting. One interviewee noted that her cravings had subsided and said, “this is gradually; it wasn’t a conscious effort, it was more a by-product of having a vape that I stopped smoking because I wasn’t planning on stopping, it just happened.”

For those of us who listen to ex-smokers who now vape, this story is very familiar: “I quit by accident.” No other smoking cessation option elicits this response from ex-smokers.

It is also interesting to note how vapers describe their lapse. Many noted the unpleasant taste or smell of smoking. Some found it “sickening.” Vapers who had previously expressed strong positive feelings toward e-liquid flavors were the most likely to experience disgust at the smell and taste of smoking. This aversion may be a further incentive for vapers to continue their “smoker’s journey” toward cessation. And it hints at the potential consequence of flavor bans in the United States.

As a scientist, I can’t help noting that “more research is necessary” to verify and understand how vaping may help ex-smokers avoid relapse. I will also note that this study is another nail in the coffin for two cherished myths of tobacco harm reduction deniers: “it normalizes smoking,” and “it’s a gateway to smoking.” Ex-smokers and current vapers like me, feel markedly healthier, always saw such claims as the blinkered assumptions of never-smokers.

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