Models of Addiction

The Disease Model of Addiction

The definition of addiction varies among individuals, organizations, and medical

professionals, and society’s viewpoints about addiction are ever-evolving. The National
Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services
Administration (SAMHSA), and the National Institutes of Health (NIH) all similarly
describe addiction as a long-term and relapsing condition characterized by the
individual compulsively seeking and using drugs despite adverse consequences.1

These organizations call addiction a disorder or a disease because:1

● Addiction changes how the brain responds in situations involving rewards, stress,
and self-control.
● These changes are long-term and can persist well after the person has stopped
using drugs.

Comparing substance addiction to heart disease may help illustrate why it is defined as
a disease by so many:1

● Both addiction and heart disease disturb the regular functioning of an organ in
the body – the heart for heart disease and the brain for addiction.
● They both can lead to a decreased quality of life and increased risk of premature
death.
● Addiction and many types of heart disease are largely preventable by engaging in
a healthy lifestyle and avoiding poor choices.
 ● They are both treatable to prevent further damage.

Furthermore, since addiction is marked by periods of recovery and symptom recurrence

(relapse), it resembles other diseases like hypertension and type-2 diabetes.3 These
diseases are lifelong conditions that require continual effort to manage. Symptoms will
likely return during periods where treatment compliance is low or absent, and symptoms
will likely diminish when compliance to treatment begins again in earnest. 3

Is Addiction a Choice?: Opponents of the Disease Model

The idea that substance addiction is a disease is not, however, universal. Some would
argue that addiction is not a disease because:4

● Addiction is not transmissible or contagious.

 ● Addiction is not autoimmune, hereditary, or degenerative.
● Addiction is self-acquired, implying the person gives the condition to himself.

Proponents of this way of thinking put much more emphasis on the social and
environmental factors of addiction—one proponent claims that addictions may be
“cured” by locking addicts in a cell where there is no access to substances—instead of
on the brain changes that occur as a result of substance abuse.4

Some schools of thought view treatment for addiction as little more than the individual
making the decision to stop using.5

Specific aspects of these opinions are hard to refute. For example, it is true that most
substance abuse begins with a decision (although in many cases substance use began
with a prescription from a doctor for a real medical problem and evolved into abuse).

But while no one forced an addicted person to begin misusing a substance, it’s hard to
imagine someone would willingly ruin their health, relationships, and other major areas
of their lives. Surely, if overcoming addiction were as easy as simply choosing to stop,
the problem of addiction would be much easier to address and relapse would not be as
common.

It should be noted that the “addiction is a choice” view is largely relegated to individuals
and small groups. There are few, if any, nationally recognized substance abuse-focused
organizations whose views have not evolved to understanding addiction as a disorder or
disease. In fact, the NIH views the idea that addiction is a moral failing as an outdated,
ill-informed relic of the past.6

The American Psychiatric Association (APA) no longer uses “addiction” as a term or

diagnosis. Instead, the APA adopted the phrase “substance use disorder” as a way to
describe problems related to “compulsive and habitual” substance use.7 The change
was made specifically to avoid confusion surrounding the term addiction and it’s
“uncertain” definition, as well as the negative stigma attached to the word. 7

No matter how one defines addiction or what term is used, what is clear is that
addiction is an enormous problem in the U.S. that affects millions. Another irrefutable
fact is that many drugs—both illicit and prescription—are quite addictive.

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Why Are Drugs Addictive?

People get addicted to drugs for many reasons, but one of the major factors behind why
drugs are so addictive is the rewarding, euphoric high they bring about. Drugs have the
potential to significantly impact the systems in the brain relating to pleasure and
motivation and make it difficult for other natural pleasures to compare.1

Every person experiences natural rewards in their life like a delicious meal, a favorite
song, the pleasant feeling following exercise, or the happiness after sex, but drugs offer
something more. The high that comes from abusing drugs is bigger, brighter, louder, and
more gratifying than any natural reward, and it can make natural rewards seem small,
dim, and quiet by comparison.

When drugs enter the brain, they can:1

● Mimic naturally occurring brain chemicals.

● Trigger the release of brain chemicals in large amounts.
● Prevent brain chemicals from being recycled and reabsorbed into the brain.

One of the brain chemicals often discussed in the addictive power of substances is
dopamine.1 Scientists believe, when a rewarding event occurs, the brain releases
dopamine to signal the experience and encourage repetition.1 In terms of natural
rewards, this is healthy and keeps life going; consider the pleasure derived from sex: it
encourages repetition, thus perpetuating the reproduction of the species.

Dopamine tells the brain that the experience of using a drug is important and should be
repeated. The brain is programmed to remember the people, places, and things
associated with the use, so it will be easier for the person to repeat the situation.

With repetition, these bursts of dopamine tell the brain to value drugs more than natural
rewards, and the brain adjusts so that the reward circuit becomes less sensitive to
natural rewards. This can make a person feel depressed or emotionally “flat” at times
they aren’t using drugs.1 If natural rewards are a plate of broccoli, drugs are a huge bowl
of ice cream, and broccoli is even less appetizing after ice cream.
Over time, the desire for drugs becomes a learned reflex—a person can be triggered to
use by the people, places, and things that are linked to their drug use, just as someone
might get hungry driving by their favorite restaurant, only the desire is likely to be much
more overwhelming. Cravings can feel uncontrollable even years after a person gets
sober.1

At the same time the drug is producing these changes in the brain that are associated
with the development of addiction, the individual may also come to tolerate higher
doses and even depend on the drug to feel well. 3 Tolerance and dependence develop
because of adjustments the brain makes to manage the alterations that come from the
repeated presence of a drug. Tolerance and dependence are two signs of a substance
use disorder but may also develop to some extent in the absence of addiction. 3 So what
are they?
 ● Tolerance is a state where the body’s reaction to the presence of a given amount
of drug becomes diminished over time. To compensate, the person will consume
a higher dose or consume it more often (or both).1 A growing tolerance to a
substance’s effect and the ensuing increase in substance use may hasten the
development of an addiction and increase the risk of overdose.
● Physical dependence is the state of needing alcohol or other drugs just to feel
normal. 3 Without these substances in the system, withdrawal will arise, and
depending on the substance, symptoms could range from irritating to
life-threatening.7

Addiction and physical dependence are often talked about as though they are
interchangeable; however, they are separate phenomena that can exist without the other.
3
Someone using their opioid pain medications as prescribed can develop some
physiological dependence but may not exhibit the compulsive behaviors of addiction.
Conversely, some drugs may be used in a compulsive manner that indicates an
addiction without physically relying on it to feel well.

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Symptoms of Addiction

The DSM-5 Criteria for Substance Use Disorders includes:

● Taking the substance for long periods of time or in larger amounts than intended.
● Being unable to cut down or stop substance use.
● Spending a lot of time obtaining, using, and recovering from the effects of the
substance.
● Experiencing cravings, or intense desires or urges for the substance.
● Failing to fulfill obligations at home, work, or school due to substance use.
● Continuing substance use despite having interpersonal or social problems that
are caused or worsened by substance use.
● Giving up social, recreational, or occupational activities due to substance use.
● Using the substance in risky or dangerous situations.
● Continuing substance use despite having a physical or mental problem that is
probably due to substance use.
● Tolerance, or needing more of the substance to achieve previous effects.
● Withdrawal, meaning that unpleasant symptoms occur when you stop using your
substance of choice.

Causes & Risk Factors of Addiction

There is no single cause of addiction; people begin using substances for many reasons
and one person’s path to addiction may look drastically different from that of another.

Apart from the case of beginning drug use via a prescription from a doctor, there are 4
main reasons people may try substances, according to NIDA:1
 ● To feel good. Drugs may lure people with the appeal of:
○ A euphoric high.
○ Feelings of power.
○ Increased confidence.
○ Energy.
○ Relaxation.
● To feel better. Someone with anxiety, high stress, or depression might turn to
drugs to try and manage distressing symptoms.
● To do better. Some drugs have the reputation of improving athletic or academic
performance, so people may see them as a way of getting ahead or even just
keeping up.
● To fit in or experiment. People, adolescents especially, may use out of sheer
curiosity or to try and impress their peers.

People who have an intensely good experience their first time using begin to learn that
drugs can make them feel great, and the foundations of addiction are set. Not everyone
responds the same way to drugs and alcohol, however.

For years, experts have debated if it was nature (biology/ genes) or nurture (upbringing/
environment) that determined whether someone will become addicted. Now, the
prevailing view is that there is no one thing we can look at to predict someone’s risk of
developing an SUD—rather, the interaction of the person’s unique biology and
environment BOTH influence how the drug will impact a person’s susceptibility to
becoming addicted.1
Biological factors impacting addiction account for between 40% and 60% of someone’s
risk for addiction.1Possible biological factors include:1

● Genes and epigenetics (the way environment impacts gene expression).

● Gender.
● Ethnicity.
● Stage of development.

The person’s developmental stage is particularly important, since teens who use drugs
are much more likely to become addicted and remain addicted into adulthood.1
Environmental factors include all situations and experiences a person lives through. The
most significant environmental influences include: 1

● Home environment.
● Family dynamics.
● Friends.
● School.

Each person will have a number of biological and environmental risk and protective
factors.1 A risk factor is something that puts the individual in more danger of becoming
addicted, while a protective factor is something that minimizes that danger.

Possible biological and environmental risk factors include:1

● Family history of addiction.

● Family history of mental illness.
● Chaotic home life.
● Adverse childhood experiences (ACE) like neglect or physical, mental, or sexual
abuse.
● Negative attitudes of parents and friends.
● Unsupportive community.
● Poor school achievement.
● Easy access to drugs and alcohol.

Possible biological and environmental protective factors are:1

● No family history of addiction or mental illness.

● Good physical health.
● Supportive, involved family.
 ● Healthy relationships at home and in the community.
● Access to positive resources in the neighborhood like community groups, safe
playgrounds, recreation centers, etc.
● Academic success.
● Strong impulse control.

Finally, the risk of addiction may be strongly impacted by the route of administration of
the abused substance. Certain routes will produce stronger highs. For example,
injecting opioids will produce a rapid intense euphoria that snorting or swallowing
opioids can’t match.1

Intense highs that come on rapidly also tend to dissipate quickly,1 and the quicker
comedown may further encourage drug abuse.

Addiction Treatment Process & Options

If you or your loved ones are abusing alcohol or other drugs, it is never too early or too
late to ask for help. Professional treatment for addiction is an effective way to address
both your physical dependence and addiction. These programs don’t view the people
who ask for help as “addicts” but as individuals struggling with a chronic condition
affecting every aspect of their lives.

At the earliest stages of addiction treatment, a professional will conduct a thorough

assessment to identify your current status, symptoms, and the most appropriate course
of action to manage your recovery. An evaluation includes:8

● A complete physical health and mental health history.

● Information regarding the drug(s) being used, such as:
○ The specific substance used.
○ The duration, rate, and dose of use.
○ If other drugs are used concurrently.
● Previous treatment attempts.
 ● Current stressors like:
○ Financial problems.
○ Legal issues.
○ Risk for violence or suicide.
○ Living situation.

Based on the information gathered during this assessment, you will be referred to a
level of addiction treatment that best fits your condition.8

At the outset of addiction treatment, many people require a period of professional

detoxification to allow the body to readjust to the lack of the drug (go through
withdrawal) while under supervision.8 Professional detox is a necessary first step in
treatment for many people getting sober, because quitting certain substances will bring
about a range of distressing withdrawal symptoms that may venture into life-threatening
territory.8

During medical detox, medications are used to manage withdrawal. Other detoxes,
called “social” or clinically managed detox, emphasize the support and encouragement
of staff in a safe environment to facilitate recovery but do not offer prescription
medications for symptoms. These detoxes may not be safe for managing withdrawal
from alcohol or sedatives and are usually not recommended in cases of opioid
dependence due to the severe discomfort associated with withdrawal from these
drugs.8

Detox, and the treatments that follow, can occur in inpatient or outpatient settings:8

● Inpatient treatment is any treatment requiring the individual to live at the facility
while receiving services. Inpatient programs are often housed in hospitals or
standalone treatment centers and vary in duration, with longer inpatient
 treatment often referred to as residential treatment. Inpatient treatments offer
more intense services for people with greater symptoms and a lack of healthy
support at home.
● Outpatient treatments permit the individual to attend services during the day and
sleep in their own bed at night. Outpatient is usually a better fit for people with
less severe addictions and/or strong social networks. Outpatient treatments may
continue for years and levels of care include:
○ Partial hospitalization programs (PHPs). This highest level of outpatient
that includes many hours of services each day, 5 days per week.
○ Intensive outpatient programs (IOPs). Slightly less intensive than PHPs,
IOPs provide between 6 and 9 hours of treatment each week.
○ Standard outpatient. This is the least time intensive outlet for outpatient
care, offering hour-long sessions weekly or monthly.

For many, addiction treatment is a lifelong process with ongoing professional treatment
and aftercare options to maintain recovery. Since longer periods of treatment are linked
to longer periods of recovery, staying in treatment for an adequate amount of time (as
recommended by your treatment staff), engaging in aftercare, and participating in
recovery groups can be extremely beneficial.3

Whether you think addiction is a disease or not, everyone can agree that addiction is a
serious problem that adversely affects the lives of the people using substances as well
as the people in their lives. The suffering that comes along with addiction can be
immense, but treatment offers a ray of hope for the future.
Why is smoking so addictive?

When a person smokes, nicotine reaches the brain within about ten seconds. At first,
nicotine improves mood and concentration, decreases anger and stress, relaxes
muscles and reduces appetite.

Regular doses of nicotine lead to changes in the brain, which then lead to nicotine
withdrawal symptoms when the supply of nicotine decreases. Smoking temporarily
reduces these withdrawal symptoms and can therefore reinforce the habit. This cycle is
how most smokers become nicotine dependent.

Smoking and stress

Some people smoke as ‘self-medication’ to ease feelings of stress. However, research

has shown that smoking actually increases anxiety and tension. Nicotine creates an
immediate sense of relaxation, so people smoke in the belief it reduces stress and
anxiety. This feeling is temporary and soon gives way to withdrawal symptoms and
increased cravings. Smoking reduces withdrawal symptoms but doesn’t reduce anxiety
or deal with the reasons someone may feel that way.

Smoking and depression

Adults with depression are twice as likely to smoke as adults without depression. Most
people start to smoke before showing signs of depression, so it’s unclear whether
smoking leads to depression or depression encourages people to start smoking. It’s
most likely that there is a complex relationship between the two.

Nicotine stimulates the release of the chemical dopamine in the brain. Dopamine is
involved in triggering positive feelings. It is often found to be low in people with
depression, who may then use cigarettes to temporarily increase their dopamine supply.
However, smoking encourages the brain to switch off its mechanism for making
dopamine, so in the long term, the supply decreases, which in turn prompts people to
smoke more.

People with depression can have particular difficulty when they try to stop smoking and
have more severe withdrawal symptoms. Remember, there’s lots of support available if
you decide to quit. However – you don’t have to go through it alone.
Smoking and schizophrenia

People with schizophrenia are three times more likely to smoke than other people and
tend to smoke more heavily. It’s likely this is because people with schizophrenia use
smoking to control or manage some of the symptoms associated with their illness and
reduce some of the side effects of their medication.

A recent study has shown smoking may increase the risk of developing schizophrenia.
However, further research is needed to fully understand how the two are linked.

Ways to help you quit

Stopping smoking suddenly through willpower alone is the least effective way to quit. If
you plan, have support and choose the right time to try, you’re more likely to be
successful. If you’re feeling unstable, experiencing a crisis or undergoing significant
changes in your life, you’re less likely to quit.

If you take antidepressants or antipsychotic medicines, talk to your GP or psychiatrist

before you stop smoking. The dosage you take may need to be monitored, and the
amount you need to take could be reduced. This is because smoking can reduce the
levels of some medications in the blood, so you may need a lower dose when you quit.

Prepare for change

Think about your relationship with smoking. Write down what you will gain by not
smoking, such as better physical health, fresher breath, improved concentration and
more money to spend on other things.

Get support from family and friends

Stopping smoking can be easier with the support of family and friends. If you live with
people who smoke, or have friends who smoke, suggest to them that you give up
together. If other household members smoke, encourage them not to smoke around you
or leave their cigarettes, ashtrays or lighters where you will see them.

Find other ways to cope with stress

If you use smoking to cope with stress, you’ll need to find other ways to deal with it.
Some things people find helpful are meditation and breathing exercises, regular
exercise, cutting down on alcohol, eating a well-balanced diet, acupuncture and
hypnosis. Counselling or simply talking to a supportive friend, family member or
religious or spiritual leader can also help.

Find a local stop-smoking service

You’re three times as likely to stop smoking successfully if you use a stop smoking
service. They offer free one-to-one or group support along with stop-smoking
medicines. You usually go for a few weeks before you quit, then once a week for four
weeks after your last cigarette.

Talk to your GP

Many people don’t realise their GP can help them stop smoking. They may enrol you in
a stop smoking clinic, prescribe nicotine replacement therapy, or stop smoking
medicine.

Nicotine replacement therapy and medication

Nicotine replacement therapy (NRT), anti-depressants and other medication have all
been shown to help smokers without mental health problems stop smoking. They may
also be helpful for people with depression or schizophrenia. NRT appears to be more
effective when combined with talking therapy.

You could also consider e-cigarettes. They’re much safer than cigarettes and can help
people stop smoking.

Talk to your doctor, a pharmacist or a health visitor about which treatments might be
suitable for you.

Talking therapies

Individual, group or telephone counselling can help people to stop smoking. Talking
therapies can help people change their behaviour by thinking and acting more
positively. Many counselling programmes use the techniques of cognitive behavioural
therapy (CBT) and social skills development. Research has shown that CBT may be
particularly effective in smokers with or without mental health problems.

Avoid triggers linked to smoking

Removing all tobacco products from your home can help lessen some of the cravings
for nicotine withdrawal.

Learn to recognise your smoking triggers. Identify when you crave cigarettes, such as at
a party or after a meal. Try to avoid those situations where possible, or plan ways to
resist triggers you can’t avoid. Most cravings only last a few minutes. If you can ride
them out, you’ll be closer to quitting for good.

Be prepared for withdrawal symptoms

You may experience headaches, nausea, irritability, anxiety, craving cigarettes, feeling
miserable, difficulty concentrating, increased appetite and drowsiness. Drinking more
fresh fruit juice or water, eating more high-fibre foods and reducing caffeine and refined
sugar in your diet can all help you cope with withdrawal symptoms.

Don’t give up if you relapse

Many people who quit smoking will relapse at some point. Don’t be put off trying again.
Use it as an opportunity to reflect on what went wrong, learn about yourself and figure
out what will help you be more successful in future.

Further help and support

Call the National Smokefree Helpline in England on 0300 123 1044 or visit the NHS
website. If English isn’t your first language, you can call the helpline and ask to speak
to an interpreter for the language you need.

​ In Wales, call 0808 250 2157 or visit Help Me Quit.

​ In Northern Ireland, visit Stop Smoking NI.
​ In Scotland, call 0800 84 84 84 or visit Quit Your Way Scotland.
​ ASH (Action on Smoking and Health) - Campaigns to reduce the health problems
caused by tobacco.
References:

Live Well, Quit Smoking - NHS

Live Well, Stopping Smoking for your Mental Health - NHS

How to resist the toughest cigarette cravings - Patient Info

Smoking ‘may play schizophrenia role’ - BBC News

* Last updated: 9 Mar

Smoking and vaping - how to

discourage your children
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Summary
Read the full fact sheet
● Include smoking and vaping in conversations with your child about risky
behaviours.
● Plan ahead: know the facts. Talk about the short-term and long-term risks of
smoking and vaping.
● Stay calm, ask open-ended questions. Keep conversations positive.
● You are a role model for your child: what you do can influence your child,
including if you quit smoking or vaping.
● Talk with your general practitioner (GP) and get advice from Quitline on 13 7848
about smoking or vaping.
On this page
● What is vaping?
● What is the link between vaping and smoking?
● Why some children vape or smoke
● Be a good role model by not vaping or smoking
● Take a stand against vaping and smoking
 ● Educate your child about vaping and smoking
● What to do if your child already vapes or smokes
● Children and vaping or smoking
● Where to get help

The average age that young people in Australia start smoking is around 16 years.
Experts are concerned that young people are experimenting with vaping at an even
earlier age. When people smoke a cigarette, they inhale chemicals and fine particles,
and this causes or contributes to a wide range of diseases including cancers, heart
disease and emphysema. When people vape an e-cigarette, they inhale chemicals,
heavy metals and fine particles, which poses risks to lung health and poisoning.
Explosions and fires from e-cigarette devices are also a risk. People who smoke
frequently become addicted to nicotine, and e-cigarettes that contain nicotine are also
addictive. Children who vape nicotine are much more likely to start smoking.

The best protection against addiction, illnesses and injuries is never to vape or smoke in
the first place. However, children entering their teenage years are experimental, curious
and vulnerable to peer pressure and online promotions. Whether your child chooses to
vape or smoke regularly or not is influenced by a range of factors. It is not always
possible for parents to prevent their child from trying e-cigarettes or cigarettes, but the
use of various strategies can reduce the likelihood of a child wanting to vape or smoke
and doing so regularly.

What is vaping?
An e-cigarette is a battery-powered device that heats a liquid into an aerosol which is
inhaled into the lungs. This aerosol contains many different chemicals. At least 20 of the
chemicals found in e-cigarette aerosols have been shown to cause damage to the lungs
or other organs. The aerosol might or might not contain nicotine.

E-cigarettes come in many shapes and colours: they can look like cigarettes or cigars or
other everyday items such as pens, memory sticks or highlighters. E-cigarettes may
also be called vapes, JUULs, hookah-pens, or other names.

In Australia, you can only legally buy vaping products that contain nicotine with a
doctor’s prescription. However, testing shows that most e-cigarettes bought from shops
or online in Australia contain nicotine and this is commonly not stated on the label.

In Victoria, it is not legal for anyone to sell e-cigarettes, whether or not they contain
nicotine, to a person aged under 18 years.

Links to more information on vaping:

 ● Quit Victoria’s video: E-cigarettes and young people: what you need to know
● Quit resources for parents and teachers about teen vaping
● Australia National University’s e-cigarette infographic.

What is the link between vaping and smoking?

There is a strong link between smoking and vaping for children because:

● Tobacco and many e-cigarettes contain nicotine, an addictive substance.

● In young people, vaping tends to lead to or reinforce smoking.
● Non-smoking children who vape nicotine are three times more likely than
non-users to start smoking.
● Both smoking and vaping (whether the e-cigarette contains nicotine or not) are
harmful to health.

Why some children vape or smoke

Some of the reasons why your child may try e-cigarettes or cigarettes include:

● peer bonding and the desire to fit in with friends

● copying parents or older brothers or sisters who smoke
● the wish to assert their growing independence
● the desire to appear more grown up and sophisticated
● curiosity
● flavours (e-cigarettes)
● to imitate actors, models or influencers in movies, video games or social media.

While older forms of cigarette and e-cigarette advertising have been banned, children
are increasingly exposed to cigarette and e-cigarette advertising and branding through
the internet and social media, including Tik Tok, Instagram, Facebook and YouTube,
among others.

E-cigarettes have a wide range of sweet flavours that appeal to children. Child-friendly
packaging that have cartoons or look like juice boxes, lollies or biscuits are common.
Some products make it easier for children to hide their vaping from their parents and
teachers, such as attachments that reduce the aerosol, or e-cigarettes concealed in
clothing, toys and smart watches. Together, e-cigarette advertising and features give
children the sense that they are fun, cool, lower risk and can be used to get around
smokefree policies.
Some groups of children are more at risk of smoking than others. These groups include
children:

● who start vaping

● who experience depression, anxiety or emotional distress,
● with mental health or behavioural problems, and
● who have certain temperaments including poor self-control, children who tend to
rebel, or who are prone to sensation seeking and risk taking.

Be a good role model by not vaping or smoking

If you don’t want your child to vape or smoke, set a good example by not smoking
yourself. Similarly, only vape if it has been prescribed to you by a doctor to help you
stop smoking. Research shows that children are less likely to smoke if their parents stop
smoking or have never smoked.

If you smoke or vape and have found quitting difficult, share your experiences with your
child. For example, tell them how it feels to be hooked on doing something you don’t
want to do, or how much money you wish you hadn’t wasted on cigarettes or
e-cigarettes over the years. Let them see they can learn a valuable lesson from your
experiences.

If you see vaping as a way of reducing your risk from smoking, try not to let this be the
main message to your child. Vaping is harmful and has extra health risks for children.

Ask your children for their support during your next quit attempt. If your child can
witness how tough quitting cigarettes or e-cigarettes can be, they may want to steer
clear of addiction completely.

Take a stand against vaping and smoking

Other suggestions to reinforce the non-vaping and non-smoking message include:

● Don’t permit anyone to vape or smoke in your home.

● Discuss the issue of vaping and smoking with your child when you see other
people vape or smoke.
● Don’t let your child light a cigarette for you or anyone else or try your or anybody
else’s e-cigarette.
● Don’t let your children buy e-cigarettes or cigarettes for you or anyone else.
● If there are adults who smoke or vape in the house, make sure they keep their
vaping products or cigarettes where your child cannot access them.
Educate your child about vaping and smoking
Symptoms of many smoking-related illnesses tend to develop in middle or later life. The
long-term health effects of vaping products are unknown because they have only been
widely used for about a decade.

Trying to explain the long-term risks of smoking to a child or teenager may not have
much of an impact, as 20 or 30 years or more into the future is an unimaginable time to
them. Mention these long-term risks but try to talk more about the risks to their health
and wellbeing right now.

Some risks to teenagers include:

● reduced fitness levels (smoking or vaping)

● stained teeth and fingers, nasty smelling breath (smoking)
● dental problems (smoking or vaping)
● coughing, wheezing and for children who have asthma, worse symptoms
(smoking or vaping)
● pre-diabetes (metabolic syndrome) (smoking)
● being unattractive to non-vaping/smoking peers (smoking or vaping)
● wasting money that could be used for clothes, music or other items (smoking or
vaping)
● the difficulty of stopping use once symptoms of addiction to nicotine appear
(smoking or vaping).

Many young people develop symptoms of addiction even if they don’t vape or smoke
every day, and for some, symptoms can develop within days to weeks of starting to
vape or smoke.

A person’s brain is still developing up to the age of about 25 years old. Smoking or
vaping while their body and brain is still growing can have long-lasting effects.
These include:

● poorer lung growth and weaker lungs (smoking)

● poorer bone growth leading to lower bone mass as adults (smoking)
● effects on brain development, which are related to poorer attention, learning,
memory, concentration and control of emotions (smoking or vaping)

Less common but very serious risks of vaping include:

 ● Serious lung injury that can lead to hospital or death, including for teenagers and
young adults. These cases are known as EVALI or e-cigarette or vaping
associated lung injury and can happen to users of e-cigarettes containing
nicotine or substances from cannabis.
● Burns and injuries from faulty e-cigarettes exploding.
● Nicotine poisoning can occur if a child or adult swallows or spills vaping liquid on
their skin. They may need to go to hospital, and in severe cases they can die.
Very young children are most at risk. If you suspect nicotine poisoning, call the
Poisons Information Centre on Tel. 13 11 26.

Cigarettes and e-cigarettes harm the environment and contribute to climate change.
E-cigarettes are both e-waste and a biohazard, meaning they contain single use plastics
and lithium batteries, metals, nicotine and other chemicals that can leach into the
environment and are poisonous to animals. There is not yet a system to dispose of
e-cigarettes safely. A lot of forest is cleared to grow tobacco for both cigarettes and to
produce nicotine for e-cigarettes. Cigarettes butts make their way into our coastal
oceans where they stay for many years and leach nicotine (which is also a pesticide)
into the environment.

What to do if your child already vapes or smokes

If your child is already vaping or smoking, or if you suspect they may be, try to avoid
getting angry at them or making threats. Instead, stay calm and try having a
conversation with them using a reasonable ‘adult-to-adult’ tone. Use open-ended
questions.

Find out what they find appealing about the products. For example, it may be fitting in
with their peers is important. Don’t try to force your child to stop seeing their friends who
vape or smoke.

You could try saying you disapprove of vaping and smoking, but let your child try to fit in
with their peers in other ways such as buying the same style of clothes as their friends.
Or you could help your child to question the value of always following the crowd. It can
be an opportunity to encourage your child to think and act independently. Teens with
disposable income are more at risk of trying vaping out of curiosity. Having a
conversation with them about their spending and saving habits and what other interests
or hobbies they would like to spend their money on may help.

As teens experiencing stress, anxiety and depression are more at risk of smoking,
encouraging a more holistic approach to health and wellbeing may also help. For
example, having a good sleep routine, a healthy diet, doing exercise they enjoy,
engaging in programs that support mental health such as mindfulness meditation, and
other strategies that reduce anxiety and depression may help.

Read more about general issues facing teenagers and teenage health.

If your child wants to stop vaping or smoking, but is finding it hard, help is available.
Quitline counsellors know how to talk about vaping or smoking with young people and
support them to quit.

Children aged 12 to 17 years may use nicotine replacement therapy like the patch or
lozenges to help them quit smoking, but it’s strongly recommended that they speak to
their doctor or other trained health professional about it first.

Children and vaping or smoking

Vaping and smoking become more common as students progress through school. One
in twenty school students (about 5 per cent) have tried smoking by age 12, and this
rises to one in eight by age 14 (about 12 per cent). In 2017, similar percentages of
children these ages had tried e-cigarettes.

By the time they are 17 years old, around 35 per cent of school students have tried
smoking and 11 per cent are ‘current smokers’ (defined as having smoked in the week
before the survey). In 2017, one in five 17 year old students had tried e-cigarettes and
11 per cent had used them on three or more days in the past month.