Vaping's Mental Health Link Complicates Quitting

Vaping is in your news feed for its regulation, impact on public health and effects on young people.

So with growing awareness of the effects of vaping on health plus recent reforms to limit availability of vapes to pharmacies in Australia, many people will be thinking about quitting. They will also need support to do so.

That's partly because so many vapes contain nicotine. Some 73% of Australians who currently vape said their last vape contained nicotine. This tends to be high-strength nicotine.

Mental health is another factor closely linked to vaping - whether people with mental health symptoms are likely to start vaping in the first place, how they fare when vaping, and whether they need additional support when trying to quit.

Here's what we know about how mental health is connected to vaping and where to go for support to quit.

How are mental health and vaping linked?

An estimated 4.3 million Australians reported a mental health problem in the past 12 months. This includes anxiety and mood disorders (such as depression), which typically begin in adolescence to early adulthood.

We know vaping and mental health (including anxiety and depression) are linked. People who vape frequently are twice as likely to have a depression diagnosis compared with people who have never vaped.

Australia's National Drug Strategy Household Survey also shows people with more mental distress related to anxiety and depression were four times as likely to have vaped than were those with low distress.

And for those already with a mental health problem, vaping is related to worse depression symptoms and physical health.

The relationship between nicotine-containing vapes and mental health is complicated. People in mental distress can be more likely to start vaping and people who vape are more likely to have mental health problems. What this doesn't tell us is which comes first. So we need longer-term studies to find out more.

What about self-medicating with vapes?

Some people link using nicotine-containing vapes with managing mental health or stress. For instance, in an Australian survey including questions about the expected benefits of vaping:

• 61% of young adults who vaped feel it helps people calm down when tense or stressed

• 57% said it cheers people up when in a bad mood

• 50% said it helps people feel better if they've been feeling down.

In other studies, people who vape say it can be a way to address anxiety, depression or stress.

But rather than addressing these symptoms, vaping can increase them.

For instance, a study in the United States found vaping dependence was linked with increased symptoms of depression. We also know from smoking research that quitting can improve mental health.

Does mental health affect quitting?

The evidence related to mental health outcomes from vaping is in its early stages. And if people have a mental health condition, what this means for quitting is under-researched.

But we know stigma plays a role in both experiences of mental health and addiction, which may make asking for help to quit even more difficult.

We also know having a mental health condition can increase the odds of relapsing after trying to quit vaping.

So what works to quit?

We have little evidence and guidance for the best way to support people who vape to quit, generally. There's even less evidence on how to support people with mental health conditions to quit.

There are quit vaping programs for people with mental health conditions. And as receiving mental health support does boost the odds of success in quitting tobacco smoking, this may also hold promise for quitting vaping.

Although the evidence is still growing, experts recommend quit plans consider someone's severity of mental illness, the impact of nicotine use and withdrawal, and whether medications for their mental illness interact with ones used to help them quit vaping.

Cognitive behavioural therapy is a type of psychological therapy that looks at how thoughts, behaviours and emotions are connected. This is an effective approach to support people to quit smoking and its principles can be combined with quit medications to help people quit vaping. People with a mental health condition who vape can be offered cognitive behavioural therapy to help them quit, though specific evidence is still needed to show how well this works.

Psychologists and counsellors can also use motivational interviewing to highlight discrepancies between someone's actions and values. For instance, this might be used to highlight the discrepancy between someone who wants to be healthy for their family (their value) but who vapes regularly (their action). This, combined with education, may motivate people to act and see a future without vaping.

Health providers and counsellors can offer brief advice on how to quit, extrapolating from what works for quitting smoking. Services such as Quitline can also help mental health providers deliver quit support.

How do I find out more?

If you or someone you know wants to quit vaping, whether or not there are mental health concerns, resources include:

• My QuitBuddy app
• Quitline or 13 7848
• Kids Helpline or 1800 55 1800
• 13YARN or 13 92 76
• Headspace or 1800 650 890
• ReachOut
• Beyond Blue or 1300 22 4636
• Head to Health or 1800 595 212.

More reading on the impact of vaping on adolescent mental health is also available.

If this article has raised issues for you, or if you're concerned about someone you know, call Lifeline on 13 11 14.

Joshua Trigg is supported by funding from the National Health and Medical Research Council, the Medical Research Future Fund, and the Flinders Foundation. He has previously received funding support from The Australian Prevention Partnership, SA Health, Cancer Council SA and Cancer Council NT. No other funding sources or consultancy are declared, including from tobacco, e-cigarette or pharmaceutical companies.

Lavender Otieno is supported by funding from the Medical Research Future Fund and partially from the National Health and Medical Research Council. No other funding sources or consultancy are declared, including from tobacco, e-cigarette or pharmaceutical companies.

Anthony Venning does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.