Another way to look at dual use, harm reduction, and support for people who smoke.
When I first started vaping, it wasn’t about quitting smoking. I believed I’d never be able to stop, so there was no point in trying anymore. After failing so many times, I wasn’t willing to risk feeling like a failure again. Internalizing failure can be deeply damaging to one’s well-being.
The only reason I picked up a vape was because I needed something for places where I couldn’t smoke. I was what people call a “dual user.” To my surprise, a few months later, I realized I couldn’t even remember my last cigarette. I had quit smoking without meaning to.
There has been much concern over dual or poly-use. For transparency: I am still technically a poly-user, even though I quit smoking more than 10 years ago. For years, I only vaped. Now, depending on circumstances, I sometimes rotate among different nicotine products. I’ll share that story before circling back to why “dual use” is often misunderstood.
Sometimes, I struggle to sleep. My brain doesn’t “turn off,” even when I’m exhausted. That’s one of the challenges of living with ADHD. I’ve often wished for an on/off switch in my head. I found that using a higher-nicotine vape before bedtime helps me fall asleep faster. At especially restless times, I’ll use a nicotine patch at night, which helps me sleep longer. For most people, nicotine is a stimulant, but in ADHD brains, stimulants can paradoxically calm the mind.
Travel has also made me a poly-user. On airplanes, vaping isn’t allowed. At conferences, I often don’t want to miss conversations by stepping outside to vape. That’s why I carry mint nicotine lozenges in my backpack. They’re my stand-in for when I can’t vape, though they take longer to work, so I have to plan ahead.
I’ve also experimented with nicotine pouches. I keep a couple of coffee-flavored brands in my bag. I used to vape coffee flavors, but those are no longer available; now I begrudgingly vape menthol. Flavor restrictions have made vaping less satisfying. When I miss coffee flavor, I’ll use a pouch, although I dislike its texture and peppery burn, especially as someone with sensory sensitivities due to being autistic. Of all products, vaping is still the most satisfying and the closest substitute for smoking for me.
Many people assume that dual use means someone smokes just as much as before and adds another nicotine product. Most of the time, that isn’t true. Alternatives usually act as substitutes. Gradually, cigarettes decline while other products increase. For some people, the switch is immediate. For others, it takes months (or even years).
One of my vape shop customers took three years to switch entirely. After I trained as a Tobacco Treatment Specialist, I suggested he try nicotine gum in addition to vaping. That combination worked to help him completly stop smoking. Even now, though he hasn’t smoked in two years, he still vapes and chews nicotine gum, so technically he’s a dual user.
Not everyone completes the switch. I’d like to see the research community focus more on why. Clarity in definitions would help: What exactly counts as dual or poly-use? Which products are being used, how often, and how do patterns change over time? How does this compare with people who quit cold turkey or who return to smoking? Without context, the term “dual use” risks being misleading.
I sometimes wonder if the bigger problem is perception. We hear mixed messages: every cigarette takes seven minutes off your life, but also, cutting down smoking doesn’t help. Too often, vaping is portrayed as just as harmful as smoking. Doesn’t that strip away motivation for people trying to transition? Instead of seeing dual use as a step forward, the world often frames it as a failure, contributing to the stigma.
That stigma seeps inward. While dual-using, many people see each cigarette as a personal failure. In my peer support group, I urge people to reframe: celebrate the cigarettes not smoked. Progress matters!
I also suggest practical strategies: make smoking less convenient. Put cigarettes in the garage, basement, or glove box. Keep alternatives like vapes, lozenges, or gum where cigarettes used to be. That way, habits shift because it’s become easier to use the alternative than to smoke. No more absent-mindedly lighting up a cigarette without thinking about it.
Yes, the ideal plan is to quit smoking entirely on day one. But many people need steps. Meeting them where they are is more effective than condemning them.
I wish more people would congratulate each cigarette not smoked. Instead of branding people as failures for dual use, let’s recognize them as the winners they are, people reducing harm, one step at a time.
Until next time…
P.S.: The Blog Directory has been updated.
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A full guide to vape aerosols: Post 9, environmental aerosols (part 2). “This 9th Substack post expands the previous 8th post by reviewing the results of two studies: one looking at the chemical composition of exhaled vape aerosol, the other discussing biomarkers of exposed bystanders. So far, all studies (even those methodologically questionable) do not provide robust evidence of concerning aerosol toxicity or health effects from bystander exposure to aerosol exhaled by vapers.”
E-cigarettes for Smoking Cessation: The Courage to Embrace the Science Around Nicotine Addiction. “We advocate for taking the hard road and facing these moral dilemmas. Based on data provided by Fillion et al and other researchers, guideline writers and clinicians should acknowledge the potential benefits of e-cigarettes for smoking cessation, and advocate against their uptake in populations likely to suffer more harms than benefits.”
AI in Behavioral and Social Research: Ethical Considerations, Challenges and Opportunities. “The application of Artificial Intelligence (AI) in behavioral and social research can have significant benefits, including increased productivity. However, its use also presents ethical risks, for example relating to bias and fairness, transparency and trust, and consent and privacy. Addressing these issues requires a multi-faceted approach, involving the development of adaptive protocols, technical solutions, human oversight, and public education. Responsible use of AI requires a values-driven approach, accountability, and collaborative efforts within the research community.”
Nicotine pouch, cannabis, vaping, psychedelic use on the rise among US adults. “Alcohol continues to be the most commonly used substance across age groups, followed by cannabis and nicotine.” Monitoring the Future Panel Study annual report: National data on substance use among adults ages 19 to 65, 1976-2024.
“Mother of Methadone”—Trailblazing and Stigma in Addiction Medicine. “I did not want to squander my opportunity to advocate from within the house of medicine, as my professional credentials gave me access and credibility in a way that many people who use drugs did not have. But, to appropriately steer my actions, I had to keep one foot planted in the grass roots of harm reduction, listening to users’ priorities and paying attention to their solutions.”
Trust Me, I'm Sorry - On 'partisan admissions of guilt' “Whenever I mention I work on echo chambers, people always smile and say “oh yeah, like Elon’s far-right twitter” or “oh yeah, like those lefty activists you see on campus”. What they almost never say is “oh, you mean us.”
Public health errors 101: the basics. “Studying them helps us understand how and why errors happen, improve responses when they occur, and strengthen prevention. For these reasons, examining public health errors is not only necessary but also a promising and exciting field of research.”
The Ongoing Exclusion of People with Lived Experience. “Public health organizations within Canada have choices to make: continue on the path of stigmatization, fear-based narratives, and cling to outdated ideologies, or choose to rebuild public trust by including the very people who are affected by policies (average consumers).”
Paulo Freire can redefine Tobacco Control. “In the logic of harm reduction, the first step is not to forbid—it's to listen. To listen as an ethical gesture…What does smoking mean to you? A companion against loneliness? A fleeting pause in a routine of exploitation? A trace of class? A family inheritance? An improvised strategy against anxiety? This gesture is ethical because it breaks the silence of stigma…Care, within this horizon, does not prescribe: it welcomes. It does not command: it asks. Because dialogue opens the possibility of another path.”
How harmful are nicotine pouches?
SHIFTING FIREPOWER - Tobacco Control’s Self-Serving Reinvention.
When Foreign Influence Clouds Local Voices.
SWEDEN’S SECRET - Nicotine Innovation Challenging the Norms.
Derek Yach - “The Lancet Group is correct. The dialogue arounds NCDs must change. But not in the way they recommend. The popularism of demonization of industry started with tobacco and infant formula companies and is being expanded without thought to working with companies that contribute to public health through innovative technologies created through multibillion $ investments in science, and whose products are approved or authorized by major national regulatory science agencies…”
Media, Researchers Fuel More Vape Misperceptions. “Selya explained that the study showed that personal and situational risk factors correlated with cigarette smoking since 1974—such as alcohol use, parental smoking and sociodemographics—were more common among youth who vaped in 2018 than among the youth who didn’t. She suggested that a “neutral” headline would center on how youth who vaped in 2018 were similar to youth who smoked in 1974, in terms of those risk factors.”
Gibraltar debates tobacco ban with vaping also in firing line. “The draft bill, spearheaded by Minister for Health, Care and Business Gemma Arias-Vasquez, would prohibit the sale of tobacco products to anyone born on or after January 1, 2009. If approved, the law would take effect in January 2027, when the first of that group turns 18. The proposals also ban the sale and advertising of single-use vapes to all ages.”
Indonesia Keeps Vapes Legal as Singapore Treats Them as Narcotics. “The National Narcotics Agency (BNN) said it recently foiled attempts to bring in synthetic marijuana and ketamine intended for use in vape cartridges…Despite the alarming trend, Marthinus stressed that the government does not intend to impose a blanket ban on vaping. “It’s not about prohibition. What we must do is differentiate between vapes used for smoking and those exploited by certain groups for crime,” he said.”
More News: Vapers Digest: Aug 25, Aug 27, Aug 29.
FDA Sued Over Years-Long Internal Review of Flavored ENDS MDO. “This litigation implicates an important aspect of FDA’s failure to timely authorize new products—the indefinite limbo of supervisory review. Should NJOY prevail, its victory may establish a model for other applicants that would seek to compel a resolution of supervisory review of their PMTAs. Even if FDA were to deny the supervisory appeal, the final agency decision would allow NJOY to bring its arguments on the merits to federal court.”
Iowa E-Cigarette Law Challenged: Industry Claims New Rules Will Destroy the Industry and Violate FDA Enforcement Discretion. “In the complaint filed on August 26, e-cigarette stakeholders also defended their standing to sue, arguing that the state government incorrectly likened the nature of their actual harm to drug traffickers and users. Because the FDA is exercising its enforcement discretion, whether the sale or use of e-cigarettes is "illegal" should not be determined by the state of Iowa…The case is filed under docket number 25-2087 at the United States Eighth Circuit Court of Appeals.”
Texas Ban on Chinese Vape Products Can Take Effect, Judge Says. “A new Texas law banning the sale of e-cigarettes containing ingredients manufactured in China will take effect next week as planned, a federal judge ruled Wednesday. During an emergency hearing scheduled just two days in advance, Judge Keith Ellison of the Southern District of Texas said “I haven’t had any time” to form a judgment on whether the law infringes on the federal government’s authority to regulate commerce.” (paywalled)
2Firsts Exclusive with Former WHO Director Tikki Pang: FCTC Overlooks Tobacco Harm Reduction, and Asia’s Tobacco Control Challenges Demand Urgent Solutions. “Ahead of AFN25, 2Firsts interviewed former WHO director Tikki Pang, who reflected on two decades of the FCTC. While acknowledging its early successes, Pang pointed to its greatest shortcoming—excluding tobacco harm reduction—and noted its limited impact in Asia. He called for advancing THR and emphasized that proper regulation should balance reducing risks for adults and preventing youth access, while ensuring affordability and curbing illicit trade.”
Human Rights, Philanthropy, and Tobacco Harm Reduction. “Ultimately, the success of harm reduction will depend on the willingness of governments, philanthropic organizations, and international bodies like the WHO to adapt their frameworks to evolving evidence and the changing needs of individuals.”
FCTC Article 5.3: A mandate for transparency or silence? “In conclusion, Article 5.3 is a call for vigilance-not silence. It empowers government to engage responsibly, not to disengage entirely. As Bangladesh continues its efforts to strengthen its tobacco control framework, let us advocate for policies that are not only health-driven but also economically sound and democratically legitimate.”
250 Firebombings: Australia’s Tobacco and Vape War Has Reached Breaking Point. “Across Australia, countless businesses next door to these targeted outlets have never recovered. Some are still shuttered, some struggling under debt, others uninsured and abandoned. The destruction radiates far beyond the tobacconists themselves, it tears holes in entire communities.”
Snapchat still failing to stop illegal vape sales to Dutch teens. “On 8 August Snapchat finally responded, promising better slang and emoji detection, account blocks, parental controls and filters for teenagers. But doctors who oversaw a panel of 15 teenagers testing the platform before and after that date, said the measures failed.”
Collaborative development of an experience measure: Insights on lived experience involvement from the SUSOSE Project. (Video) “The Service Users’ Survey of Outcomes, Satisfaction and Experience (SUSOSE) is a unique point-in-time survey conducted across alcohol, tobacco, and other drug (ATOD) treatment and harm reduction services in the ACT. The survey—including an embedded experience measure—was co-designed by a multi-stakeholder team, with significant leadership and input from people with lived and living experience of alcohol and other drug use.”
“Lived experience: The PHS conference seeks to promote research featuring meaningful inclusion of people with lived experience. All submissions will be asked about the involvement of people with lived experience.”
Response to questions: South Africa Portfolio Committee on Health. “At the end of my presentation, committee members asked a wide range of questions. Due to the time constraints, the chair requested a written response to these.”
Volunteers repurpose vapes to power Ukrainian drones. “Volunteers at Leeds Ukrainian Community Association (LUCA) recycle components, such as batteries and wires, from the discarded vapes to send to Ukraine to be turned into energy sources for soldiers in remote locations. The recycled components are used to power drones, phones and night vision devices in the trenches. Viacheslav Semeniuk, a LUCA trustee, said the repurposed vapes are used "as a light source and in cooking" adding, "this is sometimes the only source of power.”
Boulder County Vape Aware. “Boulder County, City and County of Broomfield, and Town of Erie residents can dispose of vape waste for FREE at participating Vape Aware locations.”
Vape sellers to pay disposal costs under plans to end UK’s ‘throwaway culture’ “Ministers say online vendors of electrical goods such as microwaves will also have to contribute to recycling fees.”
Final thoughts…
…Every opportunity to remind others to see people, not numbers.
Notes:
I create these newsletters as a personal project. They are not affiliated with any current or past employers or groups with which I volunteer. I receive no financial compensation for my efforts to create these newsletters. Thank you to those who have offered to fund this project and compensate me for my time. This is my gift to people who are interested in nicotine. Community service is important to me. Volunteering is something I have done since I was a child.
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