Falling into addiction

“Everybody was caught off guard with how quickly this epidemic started,” Executive Director of Shrewsbury Youth and Family Services Christine Mowry, who created the vaping cessation treatment program offered at Algonquin, said. “This is the single fastest growing epidemic ever recorded since data around substance use has been recorded.” 

With 2,409 cases and counting of lung injury associated with e-cigarette product use reported to the Centers for Disease Control and Prevention (CDC), the vaping epidemic and related health concerns have swept the country. As of Dec. 17, 54 deaths have been confirmed by the CDC in connection with e-cigarette use, three of those in Massachusetts.

The rapid increase in vaping-related illness prompted Gov. Charlie Baker to declare a public health emergency and enact a temporary ban on the sale of all vaping products from Sept. 24 to Dec. 11. On Nov. 27, Baker signed a law that will prohibit the sale of all flavored tobacco and vaping products and place a 75 percent excise tax on vaping products once it goes into effect on June 1, 2020.

Despite these alarming facts, a Harbinger survey of 265 students conducted from Nov. 11 to Nov. 20 through Google Forms revealed that 27 percent of students have vaped, with 7 percent vaping on a regular basis.

The risk

Though the CDC, U.S. Food and Drug Administration (FDA) and state and local health departments continue to investigate the multi-state outbreak of lung injury associated with e-cigarette product use, several health risks are now known to be associated with vaping, a practice that has risen dramatically in popularity in recent years.

“When this all started, nobody had any idea [about the risks],” Mowry said. “It was so misrepresented in the media as a safe alternative to combustible cigarettes.”

According to Health and Fitness teacher Melissa Arvanigian, vaping leads to high incidence of pneumonia, bronchitis and other lung diseases.

“[Vaping is] weakening the lungs and the airways,” Arvanigian said. “…We only have one body and we should really use it in a way that is going to be beneficial and not have any long term effects such as possibly asthma or breathing issues.”

Though there are serious long-term consequences to vaping, which could result in hospitalization or even death,  school district physician Safdar Medina believes most teenagers who vape will see negative effects on a daily basis.

“They’ll see reduced exercise endurance simply because their airways are inflamed from vaping,” Medina said. “Day-to-day shortness of breath, day-to-day cough which may not be so serious that they may go to the hospital, but they will see [these negative effects].

These health risks do not necessarily deter teenagers like senior Caleb* (name changed to maintain anonymity), who vapes on a daily basis.

“[Vaping] relaxes me,” Caleb said. “It’s a fun thing to do. Sure, it’s harmful, obviously. It’s not healthy, but I chose what I want to do with my life.”

Medina notes that one key danger of vaping is how easy it is for teens to get addicted.

“When we look at how addictive [vaping] is, it takes literally a few weeks [of vaping daily] to become addicted to nicotine for the adolescent brain,” Medina said. “That’s how serious of a health risk it poses.”

According to Mowry, nicotine addiction may make someone more susceptible to other addictions.

“Nicotine addiction really does prime the brain for addiction to other substances,” Mowry said. “That’s the scary part of this, too.”

Junior Elissa* (name changed to maintain anonymity) has vaped since freshman year and has struggled to quit vaping in the past.

“You don’t actually know how difficult it is [to quit vaping] until you try to quit and you’re like, ‘Okay, I’m done for good,’ and then you see someone has something and you’re like, ‘Oh, can I just get a hit of that?’ and then you start vaping again even though you said you weren’t going to,” Elissa said. “You’re not mad at yourself either because you’re addicted and you don’t really care.”

Recent news of vaping-related illness and death is one of the reasons that prompted Elissa to cut back on vaping, yet she continues to vape occasionally. She is one of 20 percent of survey respondents who say they are vaping less in light of this news.

“If I’m not vaping 24/7 like I used to be and like a lot of the people who have died or gotten really ill, it probably, hopefully won’t affect me as much, and I won’t die like them,” Elissa said.

Caleb has also been vaping less, but thinks that, overall, vaping is not as dangerous as many other substances.

“I have been [vaping less because of the news], but I think it’s all blown out of proportion,” Caleb said. “I understand that… we don’t know a lot about it, but there’s been low double-digit number for deaths [due to vaping], meanwhile 500,000 a year for cigarettes and so much unbelievable amount of family disruption due to alcohol and all that other stuff. I just genuinely don’t understand why everyone’s like, ‘crack down on vaping.’”

Although vaping may not cause as many deaths per year as smoking cigarettes, Medina still cautions students against using e-cigarettes.

“[Vaping] is harmful,” Medina said. “It is going to cause cancer. There’s nothing safe about it. That should be the bottom line.”

Fighting the epidemic

This year, Algonquin is offering Shrewsbury Youth and Family Services’ vaping cessation treatment program to students who have been suspended for vaping.

Mowry helped start the program as an effective way to address vaping addiction among teens. 

“Punitive response to substance use does not stop people from using the substance if there’s an addiction,” Mowry said. “…Suspending kids we felt was not an appropriate response to a brain disease, which we know addiction is.”

The program runs for six consecutive weeks for an hour each week. An alcohol and drug abuse counselor works one-on-one with students to help them understand why they were vaping and build the motivation to quit. The program then focuses on building coping and refusal skills, dealing with cravings, personal stress management and relapse prevention.

“Right now, there is no other treatment program like this in the state of Massachusetts,” Mowry said.

According to Mowry, Algonquin signed a contract for five students to receive treatment through this program, which costs $500 per student.

“If we see a student who’s self-injuring, maybe somebody who’s cutting, are we going to suspend them and punish them?” Mowry said. “Put it on their college record? No, we’re going to try to get them help. Same idea [with vaping].”

Beginning last year, the required freshman Health and Fitness course began to cover vaping in an effort to educate students about the risk at a younger age.

“If you can catch them before they start, that’s huge, because once they get addicted, it can be tough to become unaddicted,” Health and Fitness teacher Melissa Fustino said.

The dangers of vaping are covered again in the sophomore Health and Fitness curriculum. 

According to Arvanigian, who teaches sophomore Health and Fitness, educating her students on the dangers of vaping gives them the power to take better care of themselves. 

“It allows them to make a more educated decision about what they’re going to do with their bodies,” Arvanigian said. “At the end of the day, they’re the ones who make the decision [to vape or not].”

Caleb says he was not influenced by what he learned about vaping in sophomore health class.

“I understand there’s a certain core curriculum that has to be covered throughout sophomore health, but I feel like drugs, vaping and alcohol should be really at the forefront because those and STDs are the things that teenagers are discovering and that we know the least about,” Caleb said.

MA legislation

On Sept. 24, the Department of Public Health enacted a temporary, state-wide ban on the sale of all vaping products in response to the confirmed and suspected cases of severe lung disease associated with the use of e-cigarettes.

According to the Harbinger survey, 42 percent of Algonquin students who vaped regularly have stopped vaping because of the ban and another 18 percent have vaped less..

Finding it difficult to get access to vaping products during the ban, Elissa has vaped less However, she has started to smoke cigarettes instead.

“[Smoking] is just a nice feeling,” Elissa said. “A lot of my other friends started smoking cigarettes too because they said, ‘Oh, Juuling is bad for you so I should stop,’ but then there’s something else available that’s the same.”

The health risks associated with smoking cigarettes don’t concern Elissa as much as those associated with vaping; she knows that if she stops smoking within the next few years, she is much less likely to see negative health effects than someone who has been a smoker their whole life. Elissa also smokes cigarettes less often than she used to vape.

“I used to vape almost every single day,” Elissa said. “At school, too. In the bathrooms. Freshman year, I used to vape in class. But now, I’ll smoke cigarettes on the weekends and not every weekend.”

On June 1, 2020, a new MA law will take effect that restricts the sale of all flavored tobacco and vaping products to licensed smoking bars where they may only be consumed on-site. The law will also place a 75 percent excise tax on vaping products, which is meant to make the products too expensive for minors and reduce their appeal. Massachusetts is the first state to enact such stringent controls.

Medina believes a flavor ban is important because flavors are often used to target teenagers.

“If you ban flavors, then you ban the appeal of it,” Medina said.

Recovery

According to Medina, realizing that you are addicted to nicotine in the first step in overcoming it.

“The first thing they need to do is come to the realization that they are addicted and realize that their brain is going to crave nicotine now and they should try to seek help immediately,” Medina said. “There are different apps out there that they can use or different websites they can go to, different helplines they can call.”

Mowry believes that early identification and early intervention are key to overcoming addiction.

“Treatment works and the earlier we get engaged in treatment, the better the outcomes,” Mowry said.

Though school nurse Justine Fishman acknowledges that quitting an addiction is challenging, she urges students to put in the effort.

“You may or may not be successful the first or fifteenth time you try,” Fishman said. “It’s harder to quit something than it is to become addicted, but that doesn’t mean you give up.”