Nicotine Addiction Research May Never Catch Up To E-Cigs

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IMG_1931-580x386Research into addiction has long had some pretty steep ethical barriers.  These barriers have dramatically limited our understanding of how addiction forms, what can prevent it, and how we can remove it.  This means that our understanding of the addictiveness of electronic cigarettes may never be more than an educated guess with a bit of supporting evidence.

There’s a few reasons for this.  Most science — particularly that involving humans and the human brain — requires rigorous measures designed to make sure nothing unethical is going on.  Participants need to give voluntary and informed consent (which is hard to claim with addicts).  There should be some evidence or proof that the research being done is not more detrimental than beneficial to the participant.  As well, use of children and teens — often the formative times of addiction — can be hairy at the least.

Here’s a bit more on the issues that are likely to prevent addiction research from providing much help with the electronic cigarette debate anytime soon.

t1larg.drug.addictions.earlyYou can’t really witness addiction start.  In order to study the onset of addiction in humans, you need to get humans addicted to something in front of you.  There is no level on which intentionally getting a subject addicted to a substance (no matter how benign) would be ethical.  Addiction can certainly be studied in non-human animals, but that will never tell us what we could learn from witnessing the onset of addiction in humans.

Many researchers actually believe that electronic cigarettes may not initiate the level of addiction in new users as traditional cigarettes.  It appears that without the additives and delivery via smoke, e-cigs may be easier to quit after addiction occurs.  Unfortunately, this isn’t really ethically testable in a controlled environment — especially given that most smokers get their start before age 20.

brain-gearsResearch aimed at changing behavior undermines individual autonomy.  Although many smokers want to quit smoking, research designed explicitly to control, change, and undermine behavior patterns is problematic.  For some, it just exhibits a creepy factor that can’t really be described.  Even if research found ways of fundamentally changing behavior despite the individual, we wouldn’t often want to do this, and so the value of the research seems very limited.

With electronic cigarettes, this means research into their use as a cessation alternative tends to be as hands free as possible.  Researchers will give smokers e-cigs — sometimes even without instruction on basic safe and effective use — and just hope results happen.  Results have been happening, but it seems likely that with supportive therapy and coaching, the success rate could be much, much higher.

MP900438811-2jnm8xqResearch that narrows the “open future” of the individual should be avoided.  This is not entirely dissimilar to the previous point.  Essentially, research (particularly that involving young individuals) that restricts behavioral options can have long reaching effects on an individual’s future.  This is hard to quantify.  Let’s say a smoking cessation therapy is heavily tied to keeping an individual indoors where smoking bans are more common.  That individual may manage to quit smoking, but may develop a long-term aversion to going outside.

One thing electronic cigarettes have going for them is that they very closely resemble smoking — both in effect and ritual.  Research into the use of e-cigs for cessation may not need to worry about controlling behavior, but many researchers have expressed concern that a cessation method so close to the original addiction may only reinforce other aspects of the addiction and prevent an open future in which the individuals manages to obtain total abstinence.  Thus far, this appears to be of little concern — as the ability to quit e-cigs appears far easier than conventional cigarettes — but it still creates research barriers.

addictive_drugsResearch into use of an addictive or harmful substance should be careful about encouraging use of that substance.  Even with smokers, it is of questionable ethics to tell them to sit in a room and do something that will eventually kill them so you can research it.  Even if the study asks them to do an amount of smoking moderate to them, often there is still a paid incentive or a note of encouragement to smoke.  It’s not far from giving an alcoholic a few beers to see the effect.  Would they be doing it anyway?  Probably.  Does that excuse encouraging it further?  Probably not.

For e-cigs, this is a particularly pertinent issue as they offer nicotine without 99% of the harmful constituents of smoking.  Experts have said that nicotine itself can be used for a lifetime without significant damage to an individual’s long-term health (similar to caffeine).  Still, nicotine is highly addictive, and finding ethical ways to study it without accidentally encouraging or reinforcing its use should be a high concern for researchers.

Research into electronic cigarettes will certainly continue to further nail down just what effects they have and the promise they may offer to current smokers to escape the habit.  But research into addiction can be a treacherous field and may prevent a profound understanding of what the devices can really do for some time.

This article draws much of its underlining information from materials created by Dr. Tom Walker with the Centre for Professional Ethics at Keele University in the United Kingdom.

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