By definition, e-cigarette use is dual-use; only a small proportion of smokers cease smoking the moment they begin using e-cigarettes.
There would be very little e-cig usage without dual-use. As a consequence, dual-use cannot be judged as overall bad since it is the road to complete substitution (a vaporizer being used to replace cigarettes) or, in some cases, total cessation.
The majority of e-cig use is dual-purpose, as the median time to quit smoking is measured in months rather than minutes. (Because little genuine research is done, the average period to quit smoking is unknown because much of the ‘research’ produced on vaping is junk science intended to limit access to vaping devices.)
Dual-use, therefore, appears to be the most effective approach for reducing smoking prevalence in the United Kingdom.
It may be questioned whether extended dual-use is a negative development. To assess this validity, we must first consider what any drawbacks might be, and if any are discovered, how long is ‘too long.’
The three dual-use outcomes
When you use e-cigarettes alongside smoking, there are three potential outcomes:
- Smoking cessation
- Reduction in smoking
- Failure and relapse to smoking
1. Smoking cessation
The use of a vaporizer to aid in the quitting process has the potential to benefit individuals and public health. In practical terms, the two outcomes are nearly identical because:
- There is no cap on how long you can use a vaporizer. Currently, there is no evidence that using a vaporizer is more dangerous than drinking coffee. There is no such thing as “too long.”
- If some people are concerned about their nicotine intake for any reason, there would need to be scientific evidence that prolonged pure nicotine use has an average health effect other than benefits; none exists.
- Vapers can reduce the amount of nicotine ingested over time in any case.
Vaping does not lead to any illness or raise the risk of disease. There is no measurable increase in risk at this time. On the other side, the quantifiable advantage comes in the form of (a) removal of risk from smoking, (b) improvement of quality of life as a vaper is happier than if they were not to smoke or vape, and (c) supplementation with dietary nicotine has clear benefits for many people while having no negative clinical significance.
2. Reduction in smoking
Unless there is no difference in health outcomes between smoking one cigarette per day and smoking 40 cigarettes per day, a decrease in smoking must provide benefits.
There has been a lot of debate about this, yet common sense suggests that the less you smoke, the better.
Suppose the benefit is difficult to quantify statistically. In that case, it may be more of a problem with the statistics than with the basic issue: otherwise, there would be no purpose in smoking less, and smokers might as well smoke 60 cigarettes per day. This is patently absurd.
In the case of dual-use, any vaping must lead to less smoking—the more vaping and the less smoking, the better.
This is further compounded by the fact that vaporizer usage differs from other smoking cessation products (including NRTs) in that there is a non-motivated vaping-increase / smoking-decrease effect seen nowhere else: people inadvertently vape more and smoke less, which has the potential to result in unintentional quitting.
It appears that vapes are preferred unconsciously by some smokers, at least in the short term. They replace smoking when access to proper items is unrestricted, and expert mentoring is available.
- Vaping (and, by extension, dual-use) can cause unintended smoking cessation.
- There is a strong inclination to vape more and smoke less, which even in experienced smokers appears to be unintentional and necessitates dual-use by definition.
A significant percentage of vapers will eventually quit (quitting smoking with the aid of vaping, then quitting vaping), and this is due to dual-use by definition – since few smokers give up on their first day of using e-cigarettes.
Furthermore, as previously stated, the shift may be involuntary: smokers vape more and then quit.
On the other hand, dual use helps smokers quit and may help them achieve total abstinence.
3. Relapse to smoking
Some people who start e-cigarettes relapse and resume smoking. It can happen at any time, even during the first or tenth week.
The longer someone vapes, the more likely they will be successful: a graph may probably be made showing relapse rates decreasing over time, with high numbers at first and low rates after six months.
This is in line with typical smoking cessation quit rates, although the mechanism may differ.
Dual-use potential drawbacks
It has been claimed that dual-purpose may lead to failure to quit:
a. Continuation of smoking
b. Failure to quit and relapse to exclusive smoking
a. Continuation
Is it a negative in any way if a smoker continues to dual-use but never transitions to exclusive vaping or relapses to exclusive smoking? And, on a larger scale, are these sorts of occurrences common?
Each e-cig session probably replaces a tobacco cigarette. A statistic has been offered that each cigarette reduces longevity by 11 minutes, but it is difficult to make a comparable statement about e-cig usage; thus there appears to be a benefit to extended usage per se.
At the moment, we are unaware of a large number of dual-users who have remained for several years; surveys do not presently appear to be capable of detecting them.
It’s worth stating that switching to all-e-liquid vaping might take up to a year, especially if you’re a smoker who doesn’t want to stop.
Extended dual-use is the road to smoking cessation for people who do not want to quit. They may have intended to use an e-cigarette in places where smoking was not possible; nevertheless, the vaporizer ‘grows on you,’ and users who are exposed to the correct product choice for their condition may find themselves stopping completely.
b. Relapse to smoking and a failure to ever quit
It is unavoidable that someone will relapse. Some vapers will ultimately relapse and return to smoking alone.
In reality, the vast majority of people will be unable to quit smoking on their own. This is due in part to the fact that it takes excellent coaching (mentoring) to achieve good quitting success rates, as anyone familiar with traditional smoking cessation techniques would know.
E-cigs are not a mythical wonder drug that solves all problems and outperforms every other solution: it’s simply the greatest answer so far, but nothing more.
Vaping is not a panacea, and suggesting that the simple availability of a substitute will cure addiction is unrealistic – especially where the solution is complex and highly dependent on free consumer choice and sound guidance (or luck) for it to succeed as with smoking.
There are hundreds of alternatives, but only a few will suit your needs. There is simply no such thing as a one-size-fits-all solution.
The critical factor is always mentoring, that is to say, sound advice available on an ongoing basis.
Dual use, therefore, is a tremendous benefit: it leads to a drop in smoking, smoking cessation, and total quitting. All of these are beneficial for the individual since (a) they all have health advantages, and (b) they are voluntary and self-motivated good decisions regardless of which option is chosen.
