Electronic-cigarette use by individuals in treatment for substance abuse: A survey of 24 treatment centers in the United States

Abstract

Prevalence and reasons for using electronic cigarettes (e-cigarettes) was examined among patients enrolled in 24 substance abuse treatment centers in the United States (N=1,113). Prevalence of e-cigarette use was assessed for the full sample. Bivariate analyses and multivariate logistic regression were used to identify characteristics associated with e-cigarette use among current cigarette smokers (the majority of e-cigarette users). Overall 55.5% of the sample reported lifetime use of e-cigarettes, and 30.5% reported using e-cigarettes in the past 30 days (current users). The main reasons for using e-cigarettes were (a) at times/places when smoking was prohibited (53.5%), and (b) as a way to quit/reduce cigarette smoking (50.3%). Daily vs non-daily e-cigarette users were more likely to use e-cigarettes both as a way to reduce health risks, and as a way to quit/reduce cigarette smoking. A majority of e-cigarette users (87.1%) reported dual use of e-cigarettes and tobacco cigarettes during the past month. Among current cigarette smokers, those that also used e-cigarettes smoked more cigarettes per day, were more likely to have made a past year cigarette quit attempt, and to have tried nicotine replacement therapy compared to cigarette only smokers. There was a high rate of dual e-cigarette and cigarette use by persons enrolled in addiction treatment. E-cigarette users may be heavier cigarette smokers trying to quit or reduce their cigarette smoking. However, e-cigarettes were also used at times when individuals could not smoke cigarettes. Substance abuse treatment centers developing tobacco policies need to consider these potentially conflicting reasons for using e-cigarettes.

Electronic cigarette and tobacco use in individuals entering methadone or buprenorphine treatment

“…These latter results were similar to those from a prior study of 1127 individuals from 24 substance abuse treatment centers that daily EC users were more likely to be on methadone maintenance and to be former cigarette smokers, and the majority of daily EC users were current cigarette smokers. 16 Both the results of this earlier study and the current analysis suggest that some individuals successfully switched from combustible cigarette use to EC use, but that switching might require daily EC use (i.e., persistent nicotine use) to maintain smoking abstinence. Alternatively, these individuals might reflect a subpopulation with a particularly strong motivation to stop smoking or who have lower nicotine dependence Third, we found that past-30-day EC users were more likely to report psychiatric symptoms compared with non-users.…”

“…Nonetheless, we note similarities between our patient population and others with OUD that have been previously studied. 16,23,25 Second, the cross-sectional data in the current analysis prevented examination of daily changes in smoking and EC use over time. Additional investigations utilizing longitudinal and experimental designs are needed to evaluate the impact of ECbased interventions on smoking cessation in people with OUD.…”

“Essentially, All Models Are Wrong, but Some Are Useful”: A Preliminary Conceptual Model of Co-occurring E-cig and Alcohol Use

“…Additionally problematic, approximately 30% of individuals in substance use treatment report current use of e-cigs [41]. Research indicates that targeting both smoking cessation and alcohol use in treatment results in better substance use outcomes [42] likely as a result of the mutually reinforcing properties of alcohol use and nicotine.…”

Commentary on Nardone et al. (2016): Satisfaction, dissatisfaction and complicating the nicotine‐reduction strategy with more nicotine

“…Patterns of use of other nicotine products with VLNC in an open market, including by individuals abusing other substances [8] or challenged by mental illness, could help to assess what might be wrought by a mandatory VLNC policy [18]. Applying simplified models of what will happen in complex systems often goes wrong [19].…”

“…Compliance with VLNC by healthy, well-paid volunteers sheds light upon challenges smokers might face, even if greater challenges could befall mentally ill, alcohol-abusing smokers [6,8].…”