Interview with Dr. Mark Ackerman, MARR Newsletter, April 2020
Psychologist and Addiction Specialist
Click here for the podcast version of this article
At MARR, we do not specifically address nicotine dependence as part of our program of treatment, and clients are permitted to smoke cigarettes, though they are not permitted to use e-cigarettes (also referred to as vaping). To get a clinical perspective on the issues of smoking and vaping as they relate to long-term health and recovery, MARR spoke with a psychologist from the community, Dr. Mark Ackerman, who has expertise in treating addictions, including recreational drugs, alcohol, compulsive behavior and nicotine dependence.
We have all seen commercials that try to scare people into quitting smoking, or maybe we have even tried to scare somebody we love into quitting ourselves. Is trying to scare people into quitting effective?
Research on what works for overcoming addiction, in particular, smoking and nicotine addiction/tobacco use, indicates that scare tactics are not effective for bringing about change. I have learned through my work with individuals that this is correct. Individuals who are nicotine dependent often become resistant when they feel like they’re being pushed too hard. Addiction counselors are most effective when they strive to meet the individual where they’re at and provide information if they’re asking for it. There’s a technique called “motivational interviewing” that can be very effective in assisting people who are ambivalent or resistant to giving up an unhealthful habit.
There are 3 key components for success with nicotine addiction and addiction in general:
- Motivation: You have to want to change. When you have that element of motivation and commitment to change, then you can go to the next level.
- Technique: Behavior change strategies, attitude changes, and environmental modifications play a significant role in overcoming nicotine dependence.
- Medication: The medication component can help people feel less uncomfortable while they’re going through the process of giving up tobacco-related products. There are several FDA-approved medication choices that are available which have been very helpful. Speaking with a health care provider is recommended.
How do you address nicotine addiction when you are working with patients who are also trying to stop using alcohol and other drugs of abuse?
We know that people often have the thought that tobacco is less harmful than other drugs, but in fact, tobacco contains nicotine which is a highly addictive drug of abuse. Studies on addictive behavior show tobacco at the top of the list of what leads to chronic disease including lung and cardiovascular disease. There seems to be a myth that says “If you smoke, but you don’t do anything else…well, it’s not a great thing. But you know, if that’s the thing that keeps you away from using other drugs of abuse, well, we’ll kind of accept that.” We’re learning now that’s not the case, and that it is probably best to give up all products that are addictive. If someone continues to smoke, even though they may overcome other addictions, it can lead back to prior addictive behaviors by keeping the pleasure center in the brain responsive to certain chemicals.
Do you typically introduce the idea of quitting smoking to somebody who is in early recovery?
I usually want to hear what they have to say and what their motivations are. If someone is motivated to overcome an addiction other than smoking, I might say to them, “Well, we’re going to work on that, and how do you feel about giving up tobacco? I might suggest that they consider quitting nicotine products, and I let them know that there is help for that as well. Ultimately, being fully successful at overcoming addictive behavior usually means giving up smoking and vaping.
Vaping has been in the news though most people might not know much about it. Could you give us a brief overview of what vaping is and some of the risks associated with it?
Use of e-cigarettes, also called vaping, produces an aerosol by heating a liquid that contains flavorings, chemicals, and quite frequently nicotine and sometimes THC. The user inhales that aerosolized vapor into their lungs. The idea behind e-cigarettes, which became available about 14 years ago, was to help people quit smoking. One of the problems that subsequently developed is that younger people, who often were not smokers beforehand, began vaping and using e-cigarettes because they thought it was “cool”. Vaping was marketed as being a cool sort of a thing to do that was safe. Because it has different kinds of flavorings like mint and strawberry, it became very appealing to young people. Vaping and e-cigarette use have been shown to be potentially helpful for adults who are trying to transition away from more traditional tobacco products like smoking and chewing tobacco. The problem is that it’s turned into a harmful habit for some young people who were not smokers and may lead them down the path into becoming smokers.
Also, there are many different forms of electronic cigarettes with different components to them that are unknown and potentially unhealthy. Most electronic devices are produced overseas thus there is no control over what contaminants may be used in their production.
A couple of months ago there was an outbreak of pneumonia and acute respiratory distress among some people who were using electronic vaping devices. This was well-publicized and is cautionary. Not only is there a risk to breathing in aerosolized chemicals which contain nicotine, but by breathing in chemicals that are harmful, there is also a risk of developing a lung infection.
How would you summarize the public misconception about vaping?
Using electronic cigarettes with the goal of quitting tobacco products and overcoming dependence on nicotine and staying with that goal can be helpful for some people. However, the caution is that use of e-cigarettes and vaping are not approved successful treatments for overcoming nicotine dependence or quitting smoking and also incur health and addiction risk. My recommendation would be to use a combination of FDA-approved medications such as Chantix or nicotine replacement (e.g nicotine patch or nicotine gum) combined with behavior change counseling.
What would you suggest for parents who just found out their 16-year-old son or daughter is vaping? What approach would you pass on to them?
I would recommend sitting down with the young adult or teen to find out what’s going on rather than blaming or making accusations or threatening them about consequences. I might want to ask: “How did you get started with this? And why do you think you are using e-cigarettes?”
And then if there’s a good opportunity, providing helpful information. I would advise to be careful about overly aggressive approaches such as scare tactics which we discussed earlier, that are not usually effective as they tend to get tuned out by teens.
If you have one thing to pass on to people who are reading this, what would it be?
There is an enormous amount of evidence showing that tobacco use in any form is highly addictive and extremely harmful to the human body. Second hand smoke is harmful to those who live with or share space with smokers. Pet health is negatively impacted by the chemicals found in tobacco smoke. Life is short and the human body is very delicate. I would advise avoidance of all tobacco and nicotine products. If you use, get help to assist you with quitting. Find alternative ways to manage the stress in your life and find other forms of pleasure that would lead to the same sense of relief and enjoyment that nicotine products provide. The majority of people in the U.S., 85%, do not smoke. It is therefore easy to find a friend or neighbor or co-worker who does not smoke and spend time with them. Avoid places where people smoke, as visual and olfactory cues can be a trigger to use, just like in other addictions. If you are having difficulty quitting, establish some new relationships with non-smokers and consider obtaining some professional counseling. Join a support group. Millions of Americans have quit smoking over the past several decades and you can, too. It requires motivation and willingness to make change.