New Study Suggests that Electronic Cigarettes are Much Less Addictive than Real Ones

A new study published this week in the journal Drug and Alcohol Dependence suggests that electronic cigarettes are far less addictive than tobacco cigarettes, and that their addiction potential is probably closer to that of nicotine gum.

(See: Etter JF, Eissenberg T. Dependence levels in users of electronic cigarettes, nicotine gums, and tobacco cigarettes. Drug and Alcohol Dependence 2015; 147:68-75.)

The researchers surveyed: "(a) 766 daily users of nicotine-containing e-cigarettes with 30 daily users of nicotine-free e-cigarettes; (b) 911 former smokers who used the e-cigarette daily with 451 former smokers who used the nicotine gum daily (but no e-cigarette); (c) 125 daily e-cigarette users who smoked daily (dual users) with two samples of daily smokers who did not use e-cigarettes."

The major findings were as follows: "Dependence ratings were slightly higher in users of nicotine-containing e-cigarettes than in users of nicotine-free e-cigarettes. In former smokers, long-term (>3 months) users of e-cigarettes were less dependent on e-cigarettes than long-term users of the nicotine gum were dependent on the gum. There were few differences in dependence ratings between short-term (≤3 months) users of gums or e-cigarettes. Dependence on e-cigarettes was generally lower in dual users than dependence on tobacco cigarettes in the two other samples of daily smokers."

The authors concluded that: "Some e-cigarette users were dependent on nicotine-containing e-cigarettes, but these products were less addictive than tobacco cigarettes. E-cigarettes may be as or less addictive than nicotine gums, which themselves are not very addictive."

The Rest of the Story

In contrast to the statements of many anti-smoking groups, which have been claiming that electronic cigarettes are as addictive as real cigarettes because they contain nicotine, the rest of the story is that electronic cigarettes do not appear to be anywhere close to cigarettes in terms of their addictive potential, and in fact, they are probably much closer to nicotine gums, which are not particularly addictive.

The primary reason for this is probably the inferior of delivery via electronic cigarettes compared to real cigarettes, a phenomenon that Dr. Eissenberg demonstrated in one of his previous studies.

While use of electronic cigarettes by youth remains an important concern, it does not appear that there is major potential for huge numbers of youth to become quickly addicted to these products, despite the fact that they contain nicotine. Even among formers smokers who "relapse" to nicotine use by using e-cigarettes, their level of dependence on electronic cigarettes appears to be less that the level of dependence that nicotine gum users display for the gum.

Interestingly, users of nicotine-containing e-cigarettes were only slightly more dependent than users of nicotine-free e-cigarettes, suggesting that the nicotine in e-cigarettes is not powerfully addictive as it is in cigarettes.

Let's face it. The cigarette companies have perfected the method to most efficiently and consistently deliver nicotine to the user in a way that maximizes addictive potential. The e-cigarette cannot come close. And it is not designed to come close. A huge part of the action of the e-cigarette is the simulation of smoking. The delivery of nicotine is only one component of the effectiveness of these products. In fact, in the clinical trial by Bullen et al., electronic cigarettes were not substantially different in their effectiveness whether they delivered nicotine or not.

This study should help allay the fears of electronic cigarette opponents who are claiming that huge populations of youth are going to quickly become addicted to nicotine via electronic cigarettes and then transition to active smoking. This does not appear to be the case, based either on conceptual grounds or actual observation.