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Clinical Therapist Brian Leidal (young adults and adolescent boys) addresses the topic of vaping, a form of substance use that has surged amongst teens and young adults in recent years. With four years at Open Sky, previous work experience in inpatient drug and alcohol rehab, and a Master’s degree in Community Counseling with an emphasis on addiction counseling, Brian is well-positioned to support students and families on a variety of substance-related issues, including vaping.

A New Era of Youth-Targeted Substance Campaigns

As a teenager back in the 1999s, I clearly remember the presence of Joe Camel increasing in the world as I aged: billboards, magazines, and eventually, playing cards. Joe Camel was the mascot for Camel cigarettes and was prevalent in cigarette marketing campaigns throughout the 90s. I remember when my friends in school began collecting the cards and I noticed my friends’ older siblings smoking Camel cigarettes. This marketing presence came to an abrupt end in 1997, when the Federal Trade Commission banned the character because Camel cigarettes was targeting its marketing campaign towards minors. I reflect on Joe Camel today as I notice the increasing prevalence of e-cigarettes and vaping in the students that I work with at Open Sky.

Juul is one of the most prevalent players in the vaping market. They state that their products are oriented towards adult smokers who want to quit by completely switching to vaping. Their social media marketing campaign tells another story. A study conducted by the CDC showed that seven in ten middles school and high school students in the U.S. were exposed to e-cigarette (vaping) advertisements.

The number of teens who have reported using e-cigarettes at least once has been on the rise. In 2019, a poll conducted by the New England Journal of Medicine found that 25% of 12th graders had vaped in the last 30 days, and 11.7% vaped daily (defined as at least 20 days out of the last 30 days). The chart below depicts the poll’s findings for the rise in the number of students who had vaped at least once in the last 30 days.

The National Institute on Drug Abuse states that “the easy availability of these devices, alluring advertisements, various e-liquid flavors, and the belief that they’re safer than cigarettes have helped make them appealing to this age group. In addition, they are easy to hide from teachers and parents because they do not leave behind the stench of tobacco cigarettes, and are often disguised as flash drives.”

The Effects of Vaping

Vaping devices, or e-cigarettes, work by vaporizing a liquid solution typically containing nicotine and/or THC, flavorings, and other chemicals. The nicotine is absorbed into the bloodstream from the lungs. It causes a release of the hormone epinephrine, which stimulates the central nervous system. This increases blood pressure, breathing, and heart rate.

A common perception of vaping is that it is less harmful than cigarette smoking. While vaping exposes the user to fewer toxic chemicals than regular cigarettes, they still can contain harmful components such as lead, volatile organic compounds, and cancer-causing agents.

Nicotine, which is a common component of vaping devices, is a highly addictive substance. Interestingly, a national survey on drug use found that approximately only 18% of high school users knew of inhaling nicotine from their vape device, compared with 65% who believed the vapor contained “just flavoring”. While nicotine doesn’t have as many negative side effects as other common substances of abuse, nicotine reinforces our dopamine reward system in our brains to a greater degree than many other substances. Nicotine causes other dopamine-rewarding behaviors to become even more rewarding which is partially why quitting nicotine is so difficult: other activities don’t seem that great anymore without it. It also impacts the brain’s control of attention, impulse, learning, and mood. All of these effects are especially significant for adolescents and young adults, whose brains are still developing until about age 25. It’s also important to note that vape/e-cigarette users are much more likely to start smoking cigarettes.

While research on the overall health effects of vaping is limited due to the relative novelty of the devices, studies suggest it causes inflammation in the lungs and airways. This is particularly concerning during the time of COVID-19. Smokers and vapers who contract the virus are more likely to have more severe side effects because of compromised lungs. If you vape, “you’re going to make lungs more vulnerable to severe infection,” said Dr. Panagis Galiatsatos, an American Lung Association spokesman and a clinic director at Johns Hopkins Hospital. What we need, especially now, is clean air and healthy respiratory systems.

Treatment Approach

One of the most normal human traits is our desire to change how we feel when we are uncomfortable. Throughout the human lifespan, we encounter challenging events and situations as well as various coping strategies to deal with those stressors. Substances, both legal and illegal, provide short-term relief of emotional and physical pain that lasts anywhere from seconds to hours. When substance use (or any other non-substance coping strategy, like food, sex, gambling, exercise, work, video games, etc.) occurs repeatedly in correlation with discomfort, that pattern can lead to abuse. Our brains are pattern-making organs—the behavior or substance that provides the greatest relief with the smallest effort is normally our go-to.

In his book, “Age of Opportunity: Lessons from the New Science of Adolescence,” Laurence Steinberg discusses brain development in adolescents and why this may leave many parents frustrated or confused about the choices their children make. One of the metaphors from the book that I appreciate most is when Steinberg compares the adolescent brain to a car. Adolescents have excellent acceleration and driving speed! The average adolescent brain can make decisions quickly and their ability to reason (when calm) is on par with a fully formed adult brain. Adolescent brains, however, have an underdeveloped braking system! Their ability to think through the possible consequences of their actions isn’t quite there yet. It is also developmentally appropriate for adolescents to value the opinions of their peer group over those of their parents, teachers, or elders. The combination of an underdeveloped braking system in the adolescent brain and greater value on a peer group should tell us why “JUST SAY NO” from the D.A.R.E. era of drug education didn’t work well.

At Open Sky, we treat substance use in a number of ways simultaneously.

  • Open Sky is a controlled environment where devices like e-cigarettes and vapes aren’t present. Many substance use treatment programs advocate that the first 90 days are the most crucial in the recovery process. By the time an Open Sky student graduates, much of that 90-day period has been completed.
  • The wilderness presents an untold number of challenges that cause students to work with their emotions and relate to each other in healthier ways than in the past.
  • With a clearer head and holistic lifestyle, students reflect on their relationship with substances. One of the most common areas that students come to understand is how they didn’t have full control of their substance use, but rather their substance use had control over them in some manner that they didn’t realize.
  • All students analyze their substance use patterns through working on a ‘relapse awareness plan’ that asks them to consider cues, triggers, warning signs, replacement behaviors, and many more variables in order to understand what a roadmap to relapse might look like.

As I carry out the above approaches, I always individualize treatment to the unique needs and circumstances of each student. I come alongside them in digging beneath the surface of any emotion or behavior, including vaping, and developing skills and strategies for choosing a healthy path.

April 23rd, 2020

Brian Leidal, MA, LPC | Clinical Therapist | Adolescent Boys & Young Adults