In this guest blog, Louise Ross – a pioneer of applied tobacco harm reduction – asks what it means to run e-cig friendly support services for smokers. Update 4 September 2015: French language article about Louise and translation of this blog on Vapoliique: Stop-tabac de Leicester (UK): l’expérience ecig friendly
—————— Guest blog – Louise Ross ——————
This month has seen more stop smoking services than ever declaring themselves ‘ecig-friendly’, including all of the services in the north-east of England – see Fresh North East: Stop smoking services go ecig friendly – quit and save.
This makes me really proud; I coined the term back in January 2014, when our team was trying to work out how to embrace this new technology while avoiding censure from critics who may have thought we were stepping way over the line.
Over a year later, I’ve come across quite a few different interpretations of the term, and I thought it might be useful to reflect on what it means to me.
What it definitely isn’t…
In my opinion – let’s not forget, we’re working in uncharted territory here, without any Standard Operating System – it is not an attempt to get vapers to stop vaping. I’ve come across a number of healthcare professionals, stop smoking service providers, commissioners in Public Health, and the general public too, asking how soon people should come off their vaporisers, and suggesting that ecig users could use the stop smoking services for support to do just that.
It’s understandable, given a long-standing antipathy towards nicotine, commonly described as more addictive than heroin or cocaine. However, let’s remind ourselves that this does not seem to hold true for nicotine once it is separated from the cigarette smoke. In both nicotine replacement therapy and in ecigs, it seems to be far less dependency-creating, and users seem to manage to either titrate down or go for reasonable periods without any nicotine at all, once the actual smoking stops.
When stop smoking advisors ask what to say to people wanting to ‘come off ecigs’, I say just advise that this can be managed adequately by reducing the dose at a pace the person feels comfortable with. This is about self-management, and the anxiety about reducing to zero vaping as soon as possible often seems to have been fuelled by negative comments from a GP, or a friend who’s read scare-story in the papers. Once people are reassured that there is no rush to stop using their vaporiser, they tend to relax about it – some may stop soon because they want to, some may gradually reduce their use because they want to, and some may continue indefinitely, again, because they want to. My aim is to help people be smoke-free, not nicotine-free, and I’m coming around to thinking that longer-term (clean) nicotine use could well provide a protective element that stops people relapsing to smoking when they have a crisis.
So having dealt with what it’s not, what does ecig-friendly really mean…?
For me, it is welcoming people who want to stop smoking, and who might want to use an ecig to do that. They may have lots of questions, and we shouldn’t pretend to know anything that we really don’t, so being ecig-friendly can mean admitting your limits and signposting people to other sources of information, like vaping groups, sympathetic retailers who want to help, or the New Nicotine Alliance, a charity that educates and advocates for vapers: the New Nicotine Alliance.
It’s also being prepared to seek help ourselves, and educating ourselves, with a sense of diligent enquiry, about issues that are at times incredibly complex and confusing, but being prepared to put some work in and remain open-minded.
It means having the courage to take some risks, to stand up for the rights of people to be heard and to have their experiences accepted as valid, despite the crushing weight of disapproval from a hostile sector of ‘experts’.
It means developing a team of people who chat to vapers in social settings, always keen to learn more about choices, flavours, health changes, problem-solving. (The picture is our Tina, chatting to the gas-men digging a trench outside our office – every one of them had a vaporiser!)
It means remembering that as stop smoking teams, we have heaps of experience helping people to stop smoking – we know how to make it more likely they will succeed, by changing routines, by building motivation, and by showing that we really care about the outcome. We’ve made this same journey with so many diverse people who aspire to no longer smoke, and we often know many more choices than people are aware of, such as different ways of using nicotine replacement therapy, which appears to work rather well with ecigs..
Recently I’ve thought of the advisor/service user relationship more like a coach with a sportsman or woman in training – the coach is there to help set goals, to improve performance, to urge on, to get the person back on track when they despair. Mostly though, a coach can see the desire for success in their trainee’s eyes, and they don’t deter them or send them away saying they can’t help them.
An ecig-friendly stop smoking team will welcome anyone who wants to stop smoking, and they will work with them, listen to them, encourage them, and respect them. It’s the way of the future.
Stop Smoking Service Manager, Leicester City
Associate of the New Nicotine Alliance
Follow Louise on Twitter: @grannylouisa