Friday 15 June 2018
Sarah Jakes spoke at the opening plenary at the GFN earlier today. Here is the text for Sarah's presentation, "Rethinking why people like nicotine":
In his talk there, Joe mentioned the scream test. I have a test of my own, I call it the ‘glaze test’.
It’s not always easy, especially when talking to a large group of people, to tell whether they’re really with me.
They tell me they’re passionate about helping people stop smoking and I don’t doubt them. They say they support e-cigarettes and I don’t doubt that either, but do they really understand?
So my test is to throw in a slide about Pleasure. Normally it will include a photo of Vapefest – happy people at an open air festival, celebrating nothing more than the one thing they have in common – their love of vaping.
I tell them about the colourful tents, the thousands of different devices and liquids for sale, the camping, the barbecues, the music and the friends who wait all year for this event just to see each other in person.
And as I look around the room I often see amusement or surprise. The fact that thousands of people come together to celebrate vaping is a revelation.
But in others I see eyes glazing over. It’s as if they’re saying ‘look, I’ve reluctantly come to the conclusion that vaping might be helpful, but enjoyable? Gimme a break’.
Often people are so fixated on the concept that smokers are nothing more than the pitiful victims of an evil industry, that they cannot process the idea that people can enjoy the use of nicotine.
I’ve lost count of the times that I’m told (by people who don’t use nicotine) that the only thing I enjoy is the relief from cravings. Well no, actually I enjoy the taste of my mango cloud, the feeling of the vapour as I inhale it and the sight of it as I exhale.
I value the friends I’ve made through vaping, and the knowledge that we’re a part of something important. Oh and the mild effect of nicotine of course.
Physical cravings are not the only thing that lead people back to smoking. Much more powerful for many people is the feeling of missing something, even decades after stopping smoking.
To understand this better, I’d like to read you something written by Liz Hilton. Liz is in her 70s, smoked for 50 years and has been a vaper for 7.
She started a YouTube channel called ‘vaping for the over 60’s’ and through her channel and blogs has helped many hundreds of smokers switch to vaping.
In her latest video, which she also says is her last, she describes her relationship with smoking and this is what she says:
“Smoking is deeply rooted in my psyche. And I believe it is rooted that way for many people. Smoking is a comfort for me. A way to fill a hole. A pleasurable activity, meaningful.
It is the marker of peak experiences, deep lows, celebrations, triumphs, a friend that accompanies me through my life. My best friend. How thoughtless it is for someone to tell me I must simply ‘quit’.”
I expect by now, that some of your eyes are glazing over. Some are probably making a mental note to ask whether I would agree that this friendship is an abusive relationship. In many ways I do agree.
But just as we would hope that anyone in an abusive relationship can find a new and better friend, so too can smokers.
Smoking is a personal journey which most smokers consider to be no one else’s business. Quitting smoking is also a part of that journey and can be a deeply personal act. It is unfortunate then, that at this crucial point, everyone seems to want to butt in and take over.
No doubt, some people who want to stop smoking appreciate help from a health practitioner. But for many others the medicalisation of cessation is in itself a barrier.
Asking for help, or being told you must seek it can be seen as a weakness, and addiction as a personal or moral failure. It doesn’t have to be that way.
Nicotine itself is a mild stimulant and also relaxant. Nicotine withdrawal is unpleasant, slightly uncomfortable, but not painful or sickness inducing. It is everything around smoking that is so captivating.
So when you offer me a patch you are offering a solution to what for me is the easy part. I’m expected to go cold turkey on the rest.
I choose not to.
My own relationship with smoking was similar to Liz’s, though maybe less intense. My relationship with vaping is somewhat different. If smoking is James Dean, vaping’s more like the Fonz: more fun and pretty harmless. Probably not quite as cool though.
What we’re seeing now is a revolution. People can take control of their own smoking without feeling ashamed, replace it with something equally pleasurable but less risky and be satisfied in the knowledge that they did it for themselves.
It’s empowering and it works.
So why does pleasure seem to be such an issue? I’ve seen many suggested explanations, all may play a role, some more than others.
There are fears that it might attract non nicotine consumers into regular use. We’d be burying our heads in the sand if we denied this could happen. It is almost inevitable.
But so far at least, the numbers are tiny and the minimal risk of harm is dwarfed by benefits gained by the people attracted to switch from smoking. Somehow that side of the equation often seems to be forgotten.
There are fears that vaping could be the ‘training wheels’ for future smoking. The mechanism for this isn’t clear. Nicotine isn’t like some other drugs, where users become habituated and seek ever larger doses. It baffles me what the attraction of smoking would be for anyone who wouldn’t have been attracted to it anyway.
For me, the most likely explanation is that pleasure plus minimal risk of harm equals zero incentive to stop.
Public Health England’s message is that it is better not to smoke or vape, but if that’s not an option – vape. I would argue that for me, the benefits of vaping outweigh the risks and so that statement isn’t true -and I think PHE understand that.
They may not endorse it, but they get it.
For others long term nicotine use in any form is a problem. If it’s not a problem for me I don’t see why it should be for them.
As Joe said earlier, Mike Russell’s words were prophetic. He understood that there was a potential for new nicotine products to become a long term replacement for smoking tobacco, and that for that to happen they must be, in his words, “as palatable and acceptable as possible”. Another word for that is ‘pleasant’.
Mike said that 27 years ago and yet vapers still today find themselves faced with moralistic opposition to their ongoing use of a mildly addictive, approximately harmless and ultimately enjoyable product.
A product which for many if not most has improved their health and extended their lives.
No doubt snus users will tell you the same story, and the heat not burn fans still have it to come.
It’s time that stopped.