What a Breakthrough E-Cigarette Study Illustrates About Addiction

The first large, systematic study of whether e-cigarettes help people to quit smoking was published January 30 in the New England Journal of Medicine, and covered by the New York Times, the BBC and many other major outlets.

The study, conducted among almost 900 smokers in England, compared e-cigs and nicotine replacement therapy (patches, gum, etc.) to discover whether vaping is helpful for cigarette cessation. The answer, unequivocally, was yes. The study found e-cigs to be rough twice as likely to help cigarette smokers to quit as NRT.

The figures were still relatively low—with 18 percent of smokers who switched to e-cigs remaining smoke-free after one year, versus 10 percent for NRT. But, given that 18 percent would extrapolate to almost 7 million people if applied across the population of US smokers, that is not something to sneeze at.

These results actually affirm everything we know or should know, about addiction. (In this article, I’ll use the term “addiction” in the popular sense, to describe compulsive use, with or without harms—although there are persuasive arguments to define addiction as necessarily including serious negative consequences, which align with current American Psychiatric Association criteria for diagnosing substance use disorders.)

Inhalation and involving your hands are crucial elements in cigarette addiction for some.

E-cigs work better than NRT for preventing cigarette smoking because smokers can still follow familiar and pleasurable patterns of behavior. A crucial ingredient in the overall drug experience to which a person becomes addicted are the favored rituals involved in administering a drug. Thus some people addicted to injecting heroin don’t accept non-injectable opioid replacements (like methadone and buprenorphine), which is one rationale for heroin-assisted treatment.