Dr. Bonnie Halpern-Felsher: Vaping, Alcohol Use & Other Risky Youth Behaviors

welcome to the huberman Lab podcast

where we discuss science and

science-based tools for everyday

[Music]

life I'm Andrew huberman and I'm a

professor of neurobiology and

Opthalmology at Stanford School of

Medicine my guest today is Dr Bonnie

helper felsher Dr Bonnie helper felsher

is a professor of Pediatrics and

Adolescent Medicine at Stanford

University School of Medicine a

developmental psychologist by training

Dr Halper felshire is a world expert in

the risk behaviors that adolescents

teens and young adults participate in

today we discuss nicotine use both by

way of smoking as well as vaping and

ecigarette use we also discuss cannabis

and some of the correlative as well as

possibly causal data linking cannabis

use to psychosis in young adults and we

discussed some of the other common risky

behaviors that adolescence teens and

young adults participate in including

risky driving behavior alcohol

consumption and risky sexual behavior we

discussed the various factors that

impact whether or not a young person

will participate in Risky behaviors

including the family and home as well as

peer group and social media and as we

discuss social media we get into a deep

discussion about how marketing is

combining with peer pressure in order to

drive youth toward particular risky

behaviors by the end of today's

conversation you will have learned from

Dr Halper felshire the latest research

on risk-taking behavior in adolescence

teens and young adults and what we can

each and all do to ensure that they

either avoid these behaviors or if they

are already engaging in these behaviors

that we can mitigate some of the

potential harms and potentially get them

to eliminate these behaviors toward

having a life of enhanced mental and

physical health before we begin I'd like

to emphasize that this podcast is

separate from my teaching and research

roles at Stanford it is however part of

my desire and effort to bring zero cost

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and science related tools to the general

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huberman and now for my discussion with

Dr Bonnie helper felshire Dr Helper

felshire welcome thank you so much for

having me we're going to talk about a

very important and sometimes troubling

period of life not always troubling but

I think for everyone adolescence and the

teen years youth essentially is a tricky

landscape yes it is it can be yeah as

our brain and bodies mature we have more

autonomy in where we take them but that

means also more exposure to the ideas

suggestions actions pure pressure of

others and um that's sometimes where the

the problems arise and who knows

probably also where the solutions come

from too from time to time but I think

as conscientious people um who mind the

well-being of others of our species we'd

all like to know sort of like what are

the key features that Mark this stage of

development maybe we'll just start off

by talking about this through the lens

of um your expertise as a developmental

psychologist you know what is

adolescence in the teen years like

what's going on um what sorts of things

are being worked out

psychologically um that we might not be

aware of and then we can talk about some

of the common pitfalls and the

risk-taking Behavior everything from

smoking vaping drug use um sexual

behavior

uh addictive behaviors as it relates to

social media bullying risky driving

there's so much there but uh maybe we

could just look at this stage of Youth

through the lens of a developmental

psychologist and share with us anything

you feel is worth worth knowing sure so

first of all ages adolescence uh can be

anywhere from start starting roughly

around age 10 some people would say

ending around age 18 maybe 21 if you

want to go into young adulthood then

maybe mid2

and really adolescence is a wonderful

time of as you said exploration it's a

time when first of all marked by pubal

changes on set amenes for girls um and

and really the pubal and physical

development SE secondary sexual

characteristics are coming out we also

have a lot of emotional development

going on during this time height changes

are occurring during this time but we're

getting a lot of social changes as well

as you said peer pressures so one misn

is parents think that they don't matter

during adolescence they still really

matter but peers also come in and matter

quite a bit and then teens are really

trying to figure out who they are you

get a lot of questions who am I where am

I going in life what do I want to do

when I grow up what's important to me

how do other people feel about me and

then how do I feel about other people so

a lot of the social and psycho Social

Development is happening as well and you

get

asynchronous development too if a young

person for example starts puberty at a

younger age say 10 where they're

physically looking older more mature but

emotionally in psychosocially they still

might be young versus the late matures

physical matures who may be not having

and looking like in a older teener an

adult till 16 17 18 but they're more

mature emotionally than others then you

might have some confusion to that young

person I look older but I don't feel

older and stuff like that but it's

really this wonderful time of

exploration for an adolescent and a time

of really wanting autonomy and wanting

to make a lot of decisions that we

should like them make but there are some

risks that we have to be careful about

at the same

time I often heard this word autonomy as

it relates to this uh stage of you know

puberty and the teen years you mentioned

that kids of the that age still really

need their parents um you know in the

last gosh 20 30 years in this country

there's been a market increase in the

frequency of divorce um is there any

direct evidence that single parent homes

or homes where I don't know people are

remarried or just basically divorced

homes are somehow um creating more

challenges in terms of risk-taking

behavior in adolescence and teens or um

or not because I know plenty of people

who had you know grew up in single

parent homes um sometimes parents

remarried and sometimes didn't and I by

my mind I can't seem to come up with any

direct correlation you know plenty of uh

those kids did fine and plenty of kids

in two parent homes that I know had had

challenges and and vice versa yeah I

haven't contributed actually that was

some my earlier dissertation work and I

haven't really contributed to that

literature for a while but what you're

saying is is pretty accurate to what

I've seen which is really the literature

would say it's not the divorce per se

it's the conflict that is happening so

if parents actually get divorced usually

if the conflict resumes teenagers and

children generally do well and

particularly within about two years if

the conflict uh resolves if the conflict

resolves right so you can have two

parents who are married and living in

the same home and may or may not be a

good relationship but living in the same

home if there's no conflict or that then

generally teens will do well or as

you're saying there's not necessarily a

direct correlation the problem comes in

whether parents are living at home

together or separated or divorced is if

there's conflict and then that conflict

tends to result in social issues

emotional issues a lot of social anxiety

a lot of feeling like I need to do

better so that way my parents like me

more and we see that with children too

that's not just adolescence a lot of

depression and with depression can come

self-medication and uh self-medicating

around other drugs and so on but that

generally is resolved if the conflict

resolves but as you're saying we're

seeing adolescent angst regardless of

parenting uh what we really need though

it's not a matter of just the divorce or

not divorce or the relationship between

the parents it's parenting that's

important so parents being good monitors

being involved in their kids' lives not

this oh you're 16 you have a car you can

go wherever you want and we're not going

to keep an eye on you we still need

parents to monitor to pay attention to

find out their kids' friends where are

they going after school that

discretionary time when parents are

working and teenagers come home between

3 and 5 or 3 and six tends to be the

most risky couple of hours they're it's

called discretionary hours where there's

no parent around and we don't always

know where those teenagers are hanging

out so that's more important knowing

where their children are and what

they're doing and that there's some

adult presence some monitoring then

whether or not they're still in a

relationship my sense is that

smartphones have allowed more

communication and monitoring between

parents and kids but also more

interactions between kids and other kids

and kids and adults more broadly so is

there any evidence that uh the Advent of

smartphones is directly creating

problems for kids that um has to do with

just so much more PE PE to peer

interaction or peer to-peer exposure

like when I was growing up we didn't

have smartphones uh if you did something

stupid like that meaning that kids would

laugh at it might get told to a small

group of people maybe a larger group of

people but um in general it just kind of

didn't go anywhere you're like a I

screwed up and then You' get teased a

bit and then it would kind of dissipate

but now of course that can propagate

very very far very fast is there any

evidence that that mere fact is creating

issues for for kids so I would say it's

not a blanket statement I think it

depends on the behavior that we're

talking about bullying no doubt the

example that you gave no doubt that if

you mess up if you do something stupid

it's getting filmed and it's going to go

viral it will go on social media and

then it will perpetuate and escalate

amongst the peers um that we definitely

know is happening and certainly in terms

of drug use and marketing there there's

def some peer-to-peer interaction look

how cool I am look at the Smoke Ring I

did look at other things that I've been

doing there there is no doubt but in

general there are also some good things

about it parent communication they can

monitor where their children are they

can put a tracker on the phone uh I know

with my own kids sometimes it was the

best way to say you seem a little sad

when face-to-face communication wasn't

happening I could use the the phone to

have that conversation so yes there is

some evidence that overall phones and

smartphones have increased risk behavior

but it's more the access to the behavior

and then the viral of really getting

that information out like you said if

somebody screws up um somebody dresses

wrong if somebody kisses somebody that

that could go pretty viral I wouldn't

say that smartphones and social media as

a whole is the problem I think it's

situation specific and behavior specific

that we're seeing and particularly

around marketing for example that

teenagers have more access now to

YouTube to marketing that they're

promoting not only are Industries

promoting for example ecigarettes or

cannabis promoting to young people but

teens are promoting to each other and

that we didn't see before smartphones

right we didn't see I took a picture or

Instagram look at me smoking or look at

me dressing sexy or look at me looking

cool or anything like that that did

happen before it was more just word of

mouth so that is definitely where we're

a lot more concerned about social media

um but more my concern about social

media is the outside world targeting

young people and that's where where I've

been the the biggest concern about it

teenagers targeting each other with

bullying no doubt big issue but in other

ways there's more support there's more

social

interaction the other time I get

concerned though around teenagers is is

more the social piece of sitting around

together at a table and they're not

talking they're on the phones so what we

really don't know enough is how is the

not getting out and playing and instead

playing on a game not going to the park

and and instead communicating through

phones how is that changing their social

and physical development is where I'm

also very

concerned yeah I uh have family

relatives with um who are in their teens

and it's interesting to see them

interact um where they're on their

phones a lot of the time but I've also

noticed that there's a cohort of kids

that are really trying to put their

phones away and just spend time together

and that was actually directly stated to

me that oh yeah we hang out and we make

it a point not to be on our phones when

we hang out and then but then of course

they'll text or be on the iPad with one

another in the evening when they're

apart so they're sort of never apart

right um but I do think there seems to

be at least a sub movement of um kids

and teens that are trying to do more

face Toof face interaction with devices

at least put aside I answer a really

good point I've talked to some teens who

say that they all they get together and

they will deliberately put the phones

face down in the middle no phones and

have dinner have a conversation so I I

think you're right I definitely think

that that that has been a movement and I

really appreciate that and I think

that's fantastic I've also seen

circumstances where two teens are trying

to help each other with homework and

they're texting each other which is fine

but I've often said why don't you just

pick up the phone and call the person

and in five minutes you can figure out

the math assignment instead of 20 30

minutes of back and forth it's just not

as efficient unless you're literally

copying and showing the picture but is

that having a change on their social or

physical development or emotional

development probably not it's just a

different world the way that they

communicate and that's why I say I'm

less worried in some ways as long as

they're still getting out and they're

playing and they're being creative I'm

less worried about that kind of social

interaction on on phones and social

media it's a different way we don't have

a lot of evidence to say when we're the

other but if they're still doing the

things that they should be doing as

young people my concern is that outside

world the the um concern of predatory

behaviors the concern of Industry the

concern of mass media and marketing to

teens that's the part that gets me

particularly worried yeah well we know

for sure that this is the first time in

human evolution that

um humans have essentially written with

their thumbs there's got to be a massive

expansion of the brain's representation

of the thumbs relative to you know 20 30

years ago but maybe now would be a good

time to talk about risky behaviors uh or

even just behaviors that are known to

have some detriment to health smoking

and vaping and e cigarettes um primarily

and we should be probably distinguishing

between nicotine

and

cannabis um maybe let's just start with

nicotine what what are the statistics on

um smoking vaping and ecigarettes just

rough statistics I I um saw a talk that

you did online decided some pretty

outrageous increases in um or shocking

increases in smoking and vaping in the

last couple of years just staggering so

maybe if you give us the top Contour of

those sure absolutely so the good news

is smoking rates conventional cigarette

smoking rates has gone down pretty

dramatically in the last couple of

decades with teenagers with all people

in the US which is wonderful by

teenagers to um well below 10% if not

really well below 5% of teenagers that's

the good news in terms of ecigarette use

which I prefer the term ecigarette use

than vaping because they're they're not

Vapes they're aerosols uh but ecigarette

use has gone up pretty dramatically so

ecigarettes came on the market in the US

in 200 seven and they were slow to to

for uptick amongst teenagers they look

like cigarettes when they first came on

the market they weren't very popular

with teenagers they didn't have they had

some flavors not a lot didn't have a lot

of nicotine it was probably around 2011

to 2014 we started seeing an uptick but

then it was really in 2017 to 19 that we

saw a dramatic increase and that was the

the statistics there we saw upwards of

27 to 29% of teens using ecigarettes

during th those couple years daily use

past 30 days so any use in the past 30

days okay uh was and in daily use it'll

be some smaller percentage of that it

was something like a 78% increase in

high school student use and a 48%

increase in middle school use over those

couple of years so a very dramatic

increase in use since 2019 it's gone

down but I'm going to give a caveat it's

gone down in 2020 to the numbers are

showing uh they went to around 20% and

now around 10% part of that was in 2020

we had covid and initiation of

ecigarette use really occurs socially

and going back to socialization it's a

lot of teens getting together and it's

not pure pressure of you have to try

come on try this it's more like my

friends are using I'm at a party I feel

like using yeah I'll try it well during

the pandemic and the shutdown teens were

not at school they weren't with their

friends so initiation went down teens

who were addicted and we can certainly

talk about levels of nicotine and eats

but teens who were addicted continues to

use some tried to quit which was great

but we still saw a fair amount of use so

part of the decrease in those 2020 to

2021 have to do with just access and

socialization had changed and so rates

went down since then even we publish a

paper showing relationships between Co

and vaping we saw evali ecigarette and

vaping Associated lung illness so that

that we think was part of why we also

saw further drops around 2021 but people

were concerned about their lung health

and teens as well and that's

great the latest data show that their

rates are under 10% the National Data I

actually don't think it's true and the

reason I don't think it's true is I'm in

the schools doing

curriculum presentations all the time

where I teach and educate teachers to

use our tobacco and cannabis prevention

curriculums and we've never been busier

than we are right now with schools just

crying for help we have an another group

of teenagers using ecigarettes nicotine

or cannabis or whatever it's way more

than 10% I would say schools are telling

me it's 40 to 60% of their students are

using ecigarettes so for with for

we don't know or canis it's very hard to

know it's very hard to know what's in

there uh but 40 to 60% that's what the

schools are saying at some point in the

last 30 days at some point in the last

30 days they're catching just exorbitant

numbers of students using right now and

so from a science perspective is it 10%

20% 30 we don't know I can just tell you

that the national CDC data would say 10%

and maybe it's a problem with the

surveys or the questions or teens aren't

being honest but from a school's

perspective it's much higher and then we

have some National Data suggesting it's

more in the 20 to 30 to 40% range as

well whatever it is it's too many it's

too many teens who are inhaling nicotine

and and cannabis as well wow a lot to

unpack there first of all um nicotine I

did an episode of the podcast about

nicotine um and a little bit of that got

um confused in the way it landed

um so I'll just quickly State

nicotine known cognitive enhancer also

known to dramatically increased blood

pressure and vasil constriction not

healthy for the body just to be clear

it's not healthy for the body so when

people hear that it's a cognitive

enhancer increases focus and alertness

that's true um in the short term highly

addictive highly highly addictive um and

habit forming since sometimes those are

separated maybe we um delve into that

distinction but by my

observation very few people can use

nicotine occasionally people who try it

seem to um like it um at least in the

short run and keep using it um so

presumably kids are

using I should say youth are using

nicotine either by vape

ecigarette and they quote unquote like

the way it makes them feel who knows

maybe it'll allows them to focus on

their studies better I don't know uh but

it is known to improve certain forms of

cognition but only transiently and it's

highly addictive and it's bad for their

health for anyone's health so that puts

us in kind of a tricky situation when

evaluating in the statistics that you

just uh laid out because uh one wonders

you know are they taking it and then

continuing to take it because of peer

pressure because of lack of peer

pressure to not do it because it helps

them with their schoolwork um because

they're naturally a little bit depressed

and it provides a kind of um

anti-depressant signal I mean what what

do we know about why they're actually

starting and why they're continuing and

why they are reluctant to quit maybe we

just parse those so why does a teenager

try

nicotine so there are a few reasons why

they start um based on the the

literature scientific literature and

just talking to teens one has to do with

the marketing no doubt if you look at

the marketing it is targeting young

people uh it's targeting them with first

of all the devices themselves they are

cool looking uh they're easy to hide

they look like USB devices they look

like highlighters in fact there's a new

brand out called highlight that is a

highlighter that's a working highlighter

but it's actually a nicotine ecigarette

so a highlighter pen to to study

highlighter pen to study and then but

it's actually you take the cover off and

it's actually a nicotine ecigarette

device clearly marketed toward students

clearly marketed towards students wow

you have what's it called Boba uh you

know um teas drinks oh yeah the tea with

the yeah a little mimicking that drink

that's actually a that the straw is

actually The Vaping inhaling there

little pieces you have um Star Wars

shapes you know it goes on and on just

the cartoon shapes that are clearly

being targeted to not just teenagers

children that we're sing CH children

like young children children like young

children so wait so I'm I'm I'm

um shocked so kids younger than 10 are

are having these products push their way

they are and actually I didn't tell you

in the statistics the statistics I was

citing I should go back and clarify a

couple there to that are even more

shocking so those are the numbers for

middle and high school we don't have

data from elementary but again the other

part of in addition to the science I

contribute to the interventions I do I

am getting Elementary School teachers

calling us for help they are catching

second and third graders using nicotin

cigarettes I'm not kidding and not just

one or two quite a bit we said we would

never develop an elementary school

version of a vaping prevention

curriculum that's what we call our uh

you and me together vaperee we would

never we have a middle school and a high

school we were never going to do

elementary we've had so many schools

across the country call us and say we

need something for elementary so we

actually created a curriculum so we're

having there there was a story of an

8-year-old uh back East who was caught

and using and and the teachers and

police didn't know what to do and of

course I said it's not a police matter

why aren't we helping this young person

so we are we're we're seeing younger now

sometimes they're starting because

they're siblings older siblings uh it's

being marketed to it they don't realize

that it's a nicotine ecigarette or

cannabis ecigarette they just don't

realize what it is but the number of

these products that are being targeted

to young people is absolutely ridiculous

ous what they look like uh the pictures

are endless and the problem is they're

coming out with new products every few

months that are targeting

kids so

marketing the other is flavors and

flavors and marketing go hand in hand

you know if it if it looks bad looks

like or and smells like and tastes like

nicotine or tobacco teens know that

that's gross that's why we don't have

cigarette use anymore teens we've

socialized our country to say if you

smell tobacco it's it's nothing that we

want to smell we walk away from it you

walk across the street whatever we've

done a really good job in Tobacco

Control getting the word out around that

these products e cigarettes smell and

taste like sugar like sweets like

dessert like candy so you've got and and

the names are things like unicorn poop

and sugar booger and honey dooo that's

not for adults those names are squarely

for kids it's kids who are using

chocolate it's kids who are using these

flavors that are on the market and then

the marketing around it are these I mean

they're beautiful they're these you know

Pizzazz of pineapple dancing around or

of you know um strawberries dancing or

whatever it is that are very animated

they're a juice box style that uh that

have come out juice boox style vaping

devices that are marketed looking like

juice boxes again that's that's not

targeting you and me that's targeting a

kid interesting and uh scary uh to hear

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huberman what percentage of adults in

the US Vapor use ecigarettes just by way

of comparison so I've seen numbers

anywhere from 5% to around 20% depending

on the statistic I actually haven't

looked at the latest data on on adults

um but but the majority of adults who

are using are it's a little bit

different to think about it adults are

using generally they're not initiating

tobacco through ecigarettes they're

generally and I'm talking 30 and up they

generally have been smoking cigarettes

and then maybe they're trying to use

ecigarettes to quit which is a whole

another uh set of literature that it's

not say as effective as we're hoping

that it is there isn't good literature

on a popul ation level that ecigarettes

help adults quit uh

cigarettes the difference with teenagers

is they're initiating with ecigarettes

and they're not saying huh here's a

cigarette here's an ecigarette which one

do I choose it's not that they're

substituting or replacing they're not

using cigarettes some are now because

they're switching back and forth but

they're initiating with these cigarettes

they're initiating because of the

marketing they're initiating because of

the flavors and the products and the

ability to hide it parents don't know

what these products look like so the

landscape is very different so you were

telling us Why teens and Adolescent

start vaping and marketing is clearly

oriented toward them there are a number

of reinforcing factors that at least to

my mind as you're describing all this

make it sound like the stuff is supposed

to be quote unquote playful that it's

it's not um it's not a drug that sort of

thing reminds me a little bit of sugary

cereals when I was a kid you'd buy this

the cereal cuz you wanted the taste but

you also wanted the colorful box you had

the you know the cartoons that it

related to on TV and there's usually a

toy inside that you wanted some surprise

that you could then collect across boxes

so there was a lot of levels of incentiv

foration why do they keep smoking or

vaping are they addicted to nicotine

yeah absolutely so so the other reason

why they start is they like like the

taste and they like the rush so I've

talked to so that's the other piece as

so a few more reasons why they start and

then and then certainly answer your

question around the nicotine um teens

have told me outright that they like the

taste they like the rush they like the

buzz and we could talk about how much

nicotine is in there it's astonishing

and I can explain that but they like the

buzz they they another reason by the way

is stress and coping right now teens are

so stressed out they' they've been

stressed out for years but they're

particularly stressed with the pandemic

and even though we're a couple years out

of the lockdown teens are still they're

having socialization issues social

emotional learning issues they're still

confused uh they missed a couple of

years particularly high school students

may have missed part of middle school

where you're learning to socialize with

other people so they're very stressed

and we know that there's a pretty strong

relationship between stress not being

able to cope and using any drug but incl

Nico

tee so there's a lot of different

reasons why young people and certainly

the peers and again it's not peer

pressure it's more like a lot of friends

are using it I've talked to teens who

say I wasn't intending on but I tried it

and wow I really like the taste I like

the flavor and then there's the amount

of nicotine that's in there in

2015 when the newer products came on the

market it was a salt-based

nicotine so cigarettes and then earlier

ecigarettes have a freebased nicotine

freebased nicotine uses ammonia and

sugar to bind to the nicotine and the

other chemicals there's hundreds of

chemicals in there to go through the

body lungs into the brain and give you

that

Rush the free based nicotine is very

costic if you think the litmus test it's

very much on the basic side of the

litmus test there and if you're a

nicotine naive youth which again Most

teens starting with nicotine ecigarettes

have not used nicotine before

when you start you don't want that

costic throat hit feeling that's how

it's described teens will say they don't

like it they cough it tasted bad well to

an adult who's been using cigarettes

they don't mind that they're used to it

but a teen is not well I will mention

juel here because it's relevant juel

came on the market in 2015 with a

salt-based nicotine which essentially uh

for those who aren't familiar with CTIC

and um litmus tests and things like that

the salt-based nicotine as I understand

is quote unquote smoother it's um it

causes less U sort of coughing um static

contraction of the the muscles in the

mouth and throat you know and so it's

basically more palpable and more of a of

a kind of gradual on-ramp which is

exactly what a company wants um if you

want somebody to start using something

you don't want to hit them Square in the

face that's exactly right that's exactly

right so salt-based nicotine generally

uses benzoic acid to move that Li Mist

test needle from the CTIC towards acidic

because it's it's an acid but really

towards neutral so exactly so when you

use it it's smooth it's easy to use you

don't have that throat hit you don't

cough you don't feel sick from it so

teens will say and I I've talked to

teens and young adults who tried earlier

ecigarettes and didn't like it and then

tried the salt Bas style and said oo I

like it couple with the flavors it's

also more absorbent so there's some

suggestion and some early evidence that

it's also more

addictive so when those products first

came on the market before earlier

ecigarettes had say 0 to 36 milligram of

nicotine suddenly we jumped up to 59 Mig

per mil which is about generally about a

40 41 milligram uh because it's about a

7 mil uh sorry little chemistry and math

that we a lot here but you're looking at

basically it's anywhere from the

nicotine that you see in either one to

two packs of cigarettes per per device

per pod per ecigarette device and how

long does a pod typically last a let's

say like a 15 or 16 year old kid who's

um you know taking a hit off The Vape

Pen um I don't know what five times a

day so I've asked teens in some of the

early earlier Publications we did now

not with the newer devices but the older

devices and they would say that they

were using a pot a week which is about

two or three cigarettes a day to one to

four pods a day one to four pods a day

one to four now these are highly

addicted teenagers that is one to eight

packs of cigarettes depending on the

debates on how much nicotine is in there

but you're looking at several packs of

cigarettes worth of nicotine okay so

just to backtrack a little bit because

we got a little bit um technical um

which is great but I want to make sure

everyone's on board the amount of

nicotine in one of these pods that goes

into the vape pen or EIG

is significantly greater than the amount

of nicotine in one pack of cigarettes in

many cases in many cases and there are

many youth so adolescence and

teens you said before between ages of 10

and 21 roughly 10 to 18 10 to 21 that

are going through as many as four pods

per day which has to be at least the

equivalent of four packs of cigarettes

but could be as much as eight packs of

cigarettes per day correct in terms of

nicotine concentration correct now I I

guess to be fair they are not smoking in

the traditional sense so that presumably

there's some tars and other contaminants

that are not going into their system but

we know that there are a lot of

chemicals in these pods besides just

nicotine and I think that's where a big

source of the um debate and interest is

now is you know how dangerous are those

those other chemicals is really an

interesting question so um a lot of

things that you said are really

important to highlight U absolutely now

not all teenagers are using four pods a

day these are extreme very highly

addicted teens uh and and unfortunately

teens we've seen with lung collapses and

and other pretty significant health

issues typically teens are using maybe a

pod a day the newer ecigarettes by the

way

have probably four times that they're

bigger volume so you're looking at 60 70

Mig of nicotine some of them are

equivalent to about 3 to 500 cigarettes

worth of nicotine now are they using

them in a day probably not we haven't

done the studies on that but it's really

the first nicotine product we've had

that you can use 247 when I've talked to

teens you know I wake up in the middle

of the night I may check my phone and

check my email teens are waking up in

the middle of the night to take a hit

and they're they're hiding them under

their pillows in their nightstands

whatever and they're telling me that

they're just using them all the time and

they could just suck on them all the

time are they using when you say all the

time that's interesting forgive me for

interrupting but no no no are they using

it specifically to wake up to study to

um or just to maintain Baseline I mean

that's the that's the problem with any

addictive substance or habit forming

substance is that what starts off as a

rush becomes less of a rush and then um

when one doesn't use they feel below

basic Baseline I've done a lot of

discussions about dopamine and Baseline

versus you know um non-baseline peaks in

dopamine and some of that is smooth out

for General discussion uh dopamine does

many things besides set up reward

systems and um incentives in the brain

but it's at least one of the things it

does so are kids starting off taking

nicotine and then and feeling like whoa

that makes them feel really elevated in

terms of mood focus and alertness and

then finding that without it they're

just depressed is that is that the

general them I'm not trying to lead the

the the witness here I just want to know

what what's what's going on internally

absolutely no no no all all great um

questions there so what we're what we're

finding when we talk to teens is that

pretty rapidly they're going from I like

it to I need it so you know your your

multi-art question which is great what

makes them start and what makes them

continue they start because of the

flavors and and the marketing and they

like the The Taste and all that they

continue because of that high level of

nicotine and we are seeing that teens

are addicted and we're seeing we

actually published a couple of studies

showing that teens who have been using

ecigarettes in the past 30 days that the

majority are showing signs of addiction

pretty rapidly too within a few weeks

it's such high levels of nicotine and

there are some people who don't believe

that teens are becoming addicted to

nicotine and that you the levels of

nicotine are not the same as what we're

seeing in cigarettes that's actually not

the case and we've seen more and more

studies and to the question of using it

as soon as they wake up there's a study

by colleague of mine that showed in the

last few years the the data are showing

that teens a greater percentage of teens

who use ecigarettes are doing so in the

first five minutes a waking that is a

sign of addiction so you wake up maybe

go to the bathroom maybe not and you

take that hit and so and all the

National Data are showing even though

initi ition may go down the percentage

of teens who we're using daily has gone

up and I attribute that a lot to the

type of nicotine the salt-based nicotine

and to the huge amount of nicotine

that's been on the market so yes teens

are definitely feeling it they're

definitely going through withdrawal

symptoms that that feeling uh shaking

the the sweats all the feelings that

they need lack of

concentration the problem is when you

talk to teens they they think that

ecigarettes are helping with school and

and by the way I've not heard a teen

tell me that they started because of

school reasons or

concentration maybe they're continuing

for that reason but teens have said that

taking the hit makes them feel good what

they don't understand is it's that it

makes them feel not bad right the

withdrawal is making them feel bad and

they don't realize that that hit and

that that doping room Rush that they now

need it that they're going through a

withdrawal either way

I'm wondering where they're getting the

money to pay for all this uh nicotine

when I was a kid I worked um I like mode

Lawns I had a newspaper out for a little

while but mostly um started working when

I I think I was about 14 or so coffee

shop skateboard shop um bus tables did

that kind of thing so I made money and I

was able to use that money on the things

that were important music skateboarding

and bus passes and stuff that that's

what it was back then

food um

Etc where are 12-year-olds getting the

money to buy four or even one Vape

cartridge pod as you called it um per

day I mean someone's got to pay for this

stuff um I mean unless they're stealing

it and I can't imagine that they're all

stealing it where are they getting it

how are they getting it yeah it's a

great question so there's not one way uh

in terms of money I think there's

questions around money and questions

around access right and they're not

necessarily the the same thing money

babysitting the problem is when some of

the newer products came on the market

some of them the the say 2020 2021

products were about a dollar or two per

pod compare that with a pack of

cigarettes which is $10 to $15 depending

on the state you live in so they are

cheap they're easy to get now newer ones

and older ones are a few dollars more

but they're not that expensive they

started off very expensive when they

first came on the market Market but they

haven't been the other is the sharing

and we used to hear about pod parties

where somebody buys the device which is

more expensive buys the device and then

you bring your own not beer bring your

own pod which is a few dollars then you

pop it in and then you share it

around um we've also heard stories of a

few teenagers buying them and then

selling for a few cents or a few dollars

a puff so meet me in the bathroom for 50

cents or a dollar you can have a couple

of Puffs so I think teens are getting

very very creative we've also seen

unfortunately parents buying e

cigarettes for their teens well at least

they're not smoking

cigarettes that's not the right

comparison um so I think they're very

creative they're getting into many many

different ways I've heard students say

I'm not using my lunch money to buy

lunch I'm going to use it to buy Vapes

um there's no one way uh there's not

and unfortunately access is easier than

it should by the way one thing I think

is incredibly important for people to

understand is across the US in 2019

December 2019 the legal age to be

allowed to purchase or to sell nicotine

products across the US is is become 21

so many people think it's so 18 so you

go into a vape shop or a tobacco shop

and if the shop owner doesn't realize

it's 21 they'll sell it to somebody

who's 18

and even if they know it's 21 they're

still selling it because there's not

enforcement right now going on so we

really do need our the public we need

all the parents listening we need

Educators police officers to really

enforce the and regulate this age

restriction because teens are getting

them from vape shops really easily

they're getting it online really easily

um they're buying them for each other

somebody's going and buying 10 and and

then reselling them if the looks older

there's not a lot of carding going on or

fake cards ID cards is pretty easy still

to get so unfortunately we have a

product that is appealing to teens in a

very unregulated market right now the

FDA is not regulating it local shops are

not regulating it that it's just it it

is the wild west out there so setting

aside the issue of whether or not vaping

is quote unquote better for us than

smoking cigarettes

because that argument is um a

complicated one uh to say the least what

do we know about the health hazards of

vaping per se um does it increase

um lung disease does it increase cancer

rates I mean um my understanding is that

nicotine the chemical is not what causes

cancer in cigarettes it's the tars and

other things that um are consumed or

brought into the lungs and therefore

blood stream when one smokes um that's

not to say nicotine is safe I have to be

careful here sometimes Clips get cut and

people run wild and I I'm not saying

nicotine is safe but

um what are the problems with vaping

nicotine um even let's just say one or

two hits per day um especially in kids

you know do we do are there known

challenges for brain development are

there known challenges for cognitive

development are there known challenges

for um lung function is it I mean

nicotine is a vasoconstrictor and it

raises blood pressure so that's

basically stress on the system chronic

stress uh but yeah what do we know about

what um vaping and ecigarettes are doing

to malign

Health yeah so first of all start with

the brain and and nicotine uh absolutely

these high levels of nicotine and really

any nicotine is harmful to the

developing brain and our brains continue

to develop until we're around 25 24 or

26 depending but to around 25

so in that process of of your brain

developing of your brain changing if you

introduce nicotine you're changing your

brain you're changing the brain

chemistry and you're so much more likely

to become addicted as an adolescent and

young a young adult the tobacco industry

knows this I mean they that's why they

target teens we've no this with

cigarettes if we target a teen then

we're going to have have them for life

so significantly more likely to become

addicted because it actually rewires

your brain and there's plenty of

evidence for that the the other pieces

that we're worried about is now you're

right nicotine in terms of cancer

although I will tell you having talking

to some oncologist they would say the

vast amount of nicotine still worries

them in terms of cancer we just haven't

had enough research on ecigarettes to

really know now you're right ecigarettes

do not have tar but ecigarettes have

alahh tides and alahh have been L linked

to cancer so there's still some concern

there there's some early anecdotal

evidence and probably some of my

colleagues out there would say no no

there's pretty good evidence around

cancer I we just don't have enough body

a

resarch but again it took 50 years to

figure out cancer and cigarettes we've

not had the amount of ecigarette use or

or that we saw with cigarettes for that

long for that many people to really know

it's still pretty new I just might want

to just interject the alahh tides um

like parap from alahh from Malahide

these are the same chemicals that we use

in Laboratories to um fix as it's called

tissues to make those tissues firm so

that then they can be cut and analyzed

under the microscope um alahh highes

cross-link proteins um basically change

the configuration of proteins and turn

what would otherwise be appliable tissue

into kind of a hard rubbery think of

like a dense eraser like um consistency

and in other words not the configuration

most conducive for those cells to live

and Thrive actually quite the opposite

um which is why um that's for sake of

doing anatomy on well any body part you

use param alahh glut alahh um and for

Malahide to cross-link proteins it

basically kills tissue by cross-linking

proteins taking a nice you know pliable

configuration that's uh amendable to

life and twisting the the U or shearing

the proteins more or less um relative

cross-linking them and making them nice

and rigid so if that's happening in the

living child that can't be good that

can't be good they can't be good lugs

bloodstream everything and all the

alhida cancer right right and so that's

why there's a lot of concern there and

when I talk to teens uh and in our

curriculum we we often say uh because

when you just say and you gave a

beautiful explanation of the alahh tides

but for a teenager what I generally say

is is if you ever dissected a had

biology and you dissect a frog yes how

did it smell it was gross well that's

what you're putting into your body when

you're vaping uh because that that's

exactly the point and and that kind of

helps them understand it a little bit

more but there's a lot of concern around

the alahh highes uh there's lead there's

cadmium there's propylene glycol and

glycerin so there's a lot of other

chemicals so no we may not have the

thousands of chemicals that we have in

cigarettes but we certainly have

hundreds of chemicals in an ecigarette

that's very concerning so there are a

lot of studies now really showing pretty

significant effects of ecigarette use on

heart and lungs a lot

um not only all the chemicals we've

mentioned but also the flavorants

there's cinnamon alide another alahh

there's vanilla there's um uh what is it

the The Buttery flavor um that's in

there is also a lot of concern so that

you're inhaling these flavors and I have

often explain you can take flavors you

can take butter and heat it to several

hundred degrees and eat it if you don't

burn your tongue but you then take it

and really inhale the resulting aerosol

and then we're seeing the the lesions on

the lungs we're seeing young people who

have been using ecigarettes having lung

collapses pneumonia asthma amongst

people who have not had seizures uh one

of the teens I know who was using four

pods a day was having seizures uh so

makes sense because nicotine is a

stimulant yes it can cause runaway

excitability in the brain If too much is

taken um if 40 to 60% of kids are using

ecigarettes um and it's destructive to

the lungs uh and it sounds like the

brain as well where are all the young

athletes are they the the remaining um

uh are they the remaining fraction yeah

and and I should say 40 to 60 is what

schools are telling me and that might

just be using once in a while we don't

really know but even kids just like I

had to do PE class when I was in high

school yeah yeah we had to run a few

laps I can't imagine doing that if your

um if your lungs don't function properly

no it is actually much harder and teens

will say that and adults I know I

actually know an adult who said that

when he went from smoking cigarettes to

eat cigarettes it actually was harder

for him to exercise and to ride his Bic

and and and exercise and do other things

on the ecigarette compared to the

cigarettes that the the impact on the

lungs is so strong so you're right it is

probably hurting um Athletics right now

where actually there are some

curriculums on athletes and and vaping

and we're building one as well because

there's a lot of concern when you tell a

teen you know I'm worried about lung

cancer in 20 years years H I don't care

about 20 years from now but you would

tell a teen it's harder to run they're

more likely to listen to you I'd like to

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waking up.com huberman we haven't talked

too much about peer pressure or just

social pressure um I remember when I was

a kid it was in the just say not drugs

era and um remember seeing the

television commercials with the eggs

like two like really beautiful raw eggs

and say this is your brain and then was

this your brain on drugs and it was

frying and you know Nancy Reagan was the

big like was everywhere those in that in

that time you know just say no just

saying no in any case um there must be a

lot of data indicating that what

messages kids respond to I was told and

I don't know if this is true but I was

told by a researcher um that the

anti-smoking campaign that was effective

in kids was not one that convinced them

that smoking was bad for their health

but was one that um convinced them that

it was um their purchasing and use of

cigarettes that was making uh other

people rich and then um kind of

demonizing those people that was

effective kind of like show uh the

commercials of of these guys um you know

kind of cackling behind closed doors you

know making fun of the the people that

were um in their words um you know not

bright enough to know that that they

were being taken advantage of and then

that set a kind of a psychological

warfare between teens and these people

that they perceived as I'm taking

advantage of them for money right and

that that was effective in getting them

to smoke less as opposed to telling them

Hey listen smoking is really bad for

your health right absolutely so first of

all the just say no not effective say

just having saying just say no around

any Behavior to a teenager whether it's

tobacco cannabis cigarettes um and sex

does not work it does not work and for

many reasons first of all te are curious

and when you say just say no why well

because it's bad for you well wait a

second exactly what you're saying just

telling me that it's bad for me if you

tell me I'm going to get lung cancer or

I'm going to have lung disease or

anything and I tried the ecigarette and

I didn't have lung problems and instead

I actually liked it then we look bad we

look like we're lying to

teenagers and instead what we were

talking about earlier the the feeling

the rush the flavor The Taste the

perceived in real benefits outweigh the

concerns over the risks as a teenager so

when we say to a teen just say no don't

and they say well why well your brain or

your heart or your lungs or it's bad for

you they don't believe us and and we

absolutely Lo lose credibility so we

talk to teens and this is based on

decision-making research that I've been

doing for 25 years we have to help teens

weigh the benefits and the risk now I

don't mean that we say hey it's good for

you or you're going to like it certainly

not but if we only come from a risk

model and a just say no model that never

works for teens we need to help them

understand the

balance and and teens know that there

are good things about using some drugs

real or perceived and we can't lie to

them on that so that gets to then how do

we have those messages and you're right

if we only harp on and and our research

would show this too the long-term health

risks the your brain on on drugs those

kinds of things that's so far in the

future or the tra you know you're going

to have a tra if you smoke but they're

showing the 80-year-old and no

16-year-old even looks at somebody at

that age or cares about somebody that's

so that other person that that's the

problem so we need to talk about the

social aspects that teens really care

about you you may get wrinkles although

we don't know that so much with these

cigarettes but um but the Athletics the

things that are important to

teens now the campaigns that you're

talking about are really effective as

well particularly the mass Campaign

which a level that we see social media

Campaign which is do you realize that

the industry ecigarettes tobacco

nicotine cigarette whatever you want to

call it is targeting you as a teenager

on purpose they want you as a smoker I

used to go to middle school students and

say before eat cigarettes when

cigarettes were of concern and I I love

saying to to young people 400,000 adults

are dying each year from a cigarette

from cigarette use you're a replacement

smoker and it was great cuz teen said we

get really angry and say wait I this

12-year-old boy was so cute wait I don't

want to be a replacement smoker Dr money

was a big deal to him and I I don't want

to give money to the industry and it's

great channel that energy and get young

people mad that's what really worked

showing that the Seven Dwarfs we call it

the seven CEOs of the to Big tobacco

companies at the time said nicotine's

not addictive nicotine is not addictive

there our cigarettes are not addictive

and that clearly they were lying to

teens you show that to a teen and

explain how nicotine is addictive and

they knew it but they're trying to get

you works really well and and same thing

with marketing we we have a whole lesson

on marketing do you think that that that

candy was for me as an middle-aged adult

it's for you and that gets the mad

because they don't want to be duped they

don't want to be targeted that is a much

better message now we still have to tell

them about the health risks we

absolutely do they still need the

knowledge they still need to understand

what they're doing is unhealthy but we

can't do it in a lecturing way and we

can't do it in a way that makes them

feel stupid we can't tell them their

brains are developing till 25 and

therefore they're dumb our lessons on

talking about brain are more like it's

really cool that you're developing it's

why you can do dance that's why you can

sing better you can learn language

there's so much that you could do that's

really cool that I can't do right now

but because of that that's why you're so

much more likely to become addicted and

the industry knew that that's why

they're targeting you those are the

messages that work a lot better for

teens sounds like the the key is to

never undervalue the spirit of defiance

in youth yeah and perhaps to um wager it

um against these clearly destructive

behaviors to be honest I'm shocked that

um there's so much Vape use and

ecigarette use I mean these numbers are

staggering yeah maybe we could weave in

a discussion about cannabis sure uh I

did an episode about can cannabis um the

landscape around cannabis has changed so

much since I was a kid it was highly

illegal at least where I grew up um now

I think it's um been decriminalized

certain places still illegal elsewhere I

don't want anyone getting in trouble um

as a consequence of not understanding

what you know the laws in their area uh

and outright legal pretty easy to get in

a lot of the country and um it's not

clear that at least with individual use

that it's being um you know punished as

fre nearly as frequently as it used to

be so the you know 10-word summary of of

the Cannabis thing is that the ratio of

THC to CBD is important it is true that

a lot of cannabis has much much higher

levels of THC now than in the past

although I'm told that high THC level

cannabis always existed um but it seemed

seem to be the concentration of THC that

is of let's just say concern as it

relates to the potential development of

psychosis um if there's a

predisposition um as in terms of the uh

how addictive the Cannabis is and so on

and so forth which is not to say that

CBD is totally innocuous but it seems to

be like the THC concentration is the

kind of the thing that to mainly focus

on so what do we know about cannabis and

here we're going to assume cannabis with

a a reasonable to high level of THC in

it so not pure CBD um what do we know

about vaping and EIG use of cannabis

specifically is it true that youth that

are taking um nicotine by way of Vape or

ecigarette then transition into using

cannabis is it sort of a Gateway into

cannabis use and how prevalent is

cannabis use in kids age 10 to 21 first

of all your right I mean THC levels

we're seeing today's joint is about 10

joints when I was a te uh so the the

dramatic increases in the potency right

now that we're seeing around THC and

then you get something like dabbing

which is about 80% THC versus 20 to 30%

of of the more mainstream products that

we have on the market when I say

mainstream I mean like uh uh joints or

or ecigarettes so the potency has gone

up dramatically and it is of concern so

depending on the study you're going to

see anywhere from 10 to 20% of teens

saying that they're using some form of

cannabis either smoked or in the form of

a joint or a blunt and for those who

don't know a blunt a lot of people don't

realize is a combination of both tobacco

and cannabis so it's it's a cigar leaf

or some people buy a cigar and pull out

the tobacco and put in the Cannabis or

they'll just get the cigar leaf and and

roll the the cannabis flower then you're

getting both the kind of the double

whammy and the Chaser the high of both

of nicotine and THC so we're seeing a

fair number of it's interesting even

though teens are not smoking cigarettes

they're still using joints which is

interesting uh but very quickly

increasing is ecigarettes with cannabis

in there you could buy a cannabis style

ecigarettes and that's been around for a

long time with volcano vaporized and

specific cannabis vaporizers that's not

new but it's become much much more

popular but now we're also seeing teens

buy a nicotine

ecigarette inhale half of it and then

add the the cannabis wax or oil to it

and then basically get the combination I

had one young young teenager probably

123 14year old young man who said yeah I

I got a cherry nicotine vape and I

inhaled half of it probably use the word

inhale but I used half of it and then I

added in some cannabis oil and now I had

a cherry flavored cannabis nicotine

device so we're seeing that more and

more and even though you're not

technically supposed to and the

manufacturers of nicotin cigarettes will

say don't open them and add stuff a

simple YouTube video will teach you how

to do it um and unfortunately the videos

are not using gloves and bedz zoic acid

is coming your skin and things like that

but which is bad for which is does it go

transdermally does it go through the

skin it supposedly it does yeah yeah if

the benzoic acid is going transdermally

presumably when one inhales off one of

these pods they're also bringing benzoic

acid into the lungs correct and um

hopefully people realize this from our

episodes on breathing but if not I'll

just make it clear now that when you

breathe in a substance you know a

airborne substance into your lungs

because of the um interface between the

vasculature the blood supply and the

lungs I mean basically things pass from

the lungs into the blood supply very

very readily quickly and then if those

things are able they'll cross the bloodb

brain barrier correct correct and it

only takes about 7 to 10 seconds to go

through the whole system and into the

brain too so it's a very fast process so

yes so teenagers are definitely uh

vaping or using cannabis ecigarettes

and the the problem is you know for one

teasel think it's healthier than just

like nicotina cigarettes they think it's

healthier than combustible I mean yes

you're not burning it but you're still

inhaling and you still are inhaling

there seems to be the purp and glycol

the glycerin the flavorant all the alahh

tides even if it's just just a an

cannabis ecigarette so there's a lot of

concern there and then addiction is

still huge it's a huge issue when you're

talking about cannabis the same reasons

that we talked about with nicotine the

brain development and so

on psychosis just a lot a lot to think

about here psychosis um there's actually

some scientists now who are really

strongly saying it's not associated as

causal that if you are predetermined to

have a mental health issue psychosis

schizophrenia then it starting to use or

using cannabis can actually trigger and

cause you to become psychotic um I don't

totally understand the mechanism yet I

don't think we totally do yet but that

there seems to be more than just it

might happen and it seems to be right in

that older adolescent young adult time

frame that it is happening so around the

same time that the brain's developing um

and we're hardwiring the rest of our

brain that that change is happening from

from a neur neuronal connection

perspective um my understanding sorry to

interrupt but my understanding is that

indeed um

the use of high THC cannabis in youth in

particular male youth right predisposes

and you're saying might even be causal

toward the development of psychotic

symptoms correct in late teens early 20s

correct and that some of those cases um

are ones in which the psychosis is

irreversible correct um is it sometimes

the case that somebody exhibits

psychotic symptoms as the consequence of

using

THC and The Psychotic symptoms resolve

or is it you know some sort of circuit

switch that is then permanent you know

it's a good question I honestly don't

really know the answer to that of what

what percentage um the the few cases I

know of and in talking to the

psychiatrist uh would say that it that

it's causal and it may be permanent now

it could be it could be managed it

doesn't mean that somebody's going to be

having psychotic episodes all the time I

mean certainly can be managed and

certainly we say please don't continue

to use uh would be very important but

whether it's completely reversible is

something that I'm not sure of uh

somebody more versed in this but we you

know what you do in in your research and

what I know is you know changes to the

to the neural circuitry is not

changeable you know when we hurt our uh

brain cells that is not something that

we could recover from so that is very

much concerning yeah as an as adults

there are very few new neurons added to

the brain um um there is significant

plasticity and recovery of function in

some cases both by virtue of traumatic

brain injury um certainly people can get

over uh certain behavioral patterns and

that no doubt involves plasticity but it

it takes work and um and when it comes

to addiction uh there's evidence that

some of the reward circuitry can adjust

but um again it it takes um adherence to

specific things in order to make that

happen um I'm very concerned about this

uh potentially causal relationship but

certainly correlation between high THC

containing cannabis and psychosis mostly

because we already have a serious

problem with psychosis on the planet a

lot of people don't realize that you

know approximately 1% of the world's

population has schizophrenia and by the

way I have to be careful with the

language nowadays you know has

schizophrenia or is schizophrenic or all

that that language gets murky but meet

the diagnostic criteria for

schizophrenia I think is a safe way to

put it um so if one is then adding to

that number of people exhibiting or and

suffering from psychotic symptoms that

prevent them from having uh functional

work lives Etc that that's that's an

issue um how difficult is it for these

Adolescent and teens to quit vaping and

ecigarettes and cannabis I mean um can

they quit just by deciding are there

programs are they all going into um you

know recovery programs are there

recovery programs in schools I mean how

successful are they in

stopping it's really difficult and and

maybe I'll talk about nicotine first and

the same would be true for cannabis but

a little bit less extent I me both are

addictive and interestingly not a lot of

people realize that cannabis is

addictive and about one in six teens or

people who are using particularly under

the age of 25 do become addicted so they

don't realize that it's addictive they

don't realize it's addictive the

argument I often heard was it's not as

bad as alcohol which is a um kind of a

lame argument I understand why people

default to that but I mean getting hit

by a car might not be as bad as getting

hit by a train um but yeah I don't I

wouldn't even look at that analogy as

accurate there just different um levels

of destructive different types of

destructive

um yeah these not as bad as

blank doesn't really seem to to work no

no and and you know I often say people

say well why' you start studying tobacco

I mean there is no safe level of tobacco

use period yes we have very few

30-year-olds who suddenly pick up a

cigarette and become addicted you know

at that point you you your development

of your brain now can if you use regular

Le are you still going to hurt your

lungs and and heart and stuff like that

absolutely the brain changes may not be

there in the same way but most people

don't pick up a cigarette or a cigarette

for the very first time in their 30s or

40s and and on so absolutely it's

addictive and and it is probably the

most difficult to quit uh drug that's

out there whereas alcohol we don't see I

mean yes we have alcoholism I'm not

downplaying that it's a huge issue in

this country it's a huge issue on this

planet but you're not going to have

people in two weeks three weeks suddenly

say I'm addicted to alcohol you are

going to with nicotine and you are with

cannabis to some extent as well so yes

uh nicotine is incredibly addictive and

we have so many teens who are addictive

addicted to nicotine through ecigarettes

and really struggling to get off of it I

gave a talk recently to a group of

parents and they said this is all great

information Bonnie but how do I help my

kid and I just felt awful because

there's not a lot that we have so taking

a few different things first of all we

don't have there are some programs there

are inpatient programs absolutely

showing some some POS impatient program

there are actually some impatient

programs and but those are going to be

expensive or require that people have

insurance that will cover that

absolutely and they take weeks and then

you're taking a young person out of

their natural environment out of their

school out of their friends stigmatizing

which hopefully we're not stigmatizing

drug use anyway but you know you take a

young person at 12 14 16 you put him in

another place that's very difficult on

them and if part of why they're using in

the first place is stress you're just

enhancing

that outpatient programs we have some

things but the problem is we don't have

the best recommendations because we

don't have great research so for example

nicotine replacement therapy the patch

first of all it's not authorized for use

by the FDA something it approved by the

FDA for anybody under 18 and and yet we

have a lot of teenagers who are addicted

we just don't have the right studies and

they haven't gone to the FDA for that

approval now a lot of doctors are using

nicotine patches and prescribing them

for somebody under 18 it's considered

off label but you still can do it and

most people would recommend it the the

problem is and and I don't mean problem

with using them I have no problem with

and I've often suggested to I don't

treat I I want to make sure that I'm not

misquoted there either I don't directly

treat see patients myself but based on

the evidence and the American Academy

Pediatrics recommendations we should be

using a patch with those under 18 te but

then the question is how much if a

nicotine patch is about 21 milligrams of

nicotine and a teenager is using 40

milligrams in a day do you give two

patches and I've had some doctors say

wow that's a lot of nicotine I say Well

they're using a lot of

nicotine what I've heard some uh my

adolescent medicine colleagues have

suggested as one patch and then

supplement with gums and suckers and La

Anders not as a starting I don't mean

like what we're seeing with with some uh

pouches out there like Zen as a starter

I don't mean that I mean as a uh a form

of treatment as a way to wean them off

so reducing the dosage over time correct

correct and and now but then they also

don't have the the hand to mouth piece

that we see that is difficult so gum in

this case I mean non- nicotine gum just

chewing regular gum um I've heard

teenagers say that they're that they're

withdraw last three to four minutes so

they have a one teenager said I have a

playlist on my phone that's each song is

three to four minutes and when I start

to feel the withdrawal I pop the music

in my ears and I go do something and I

listen to the song and by then that

uncomfortable feeling is over I've heard

teens say that they'll run that there's

many different things that they'll do um

chewing on a toothpick not a nicotine

toothpick but just a toothpick um other

ways to really get their mind off of

that feeling is really important but we

also have to know with adults and

cigarettes it can take 7 to 11 tries so

we can't expect until they're fully off

of a cigarette can't expect a teenager

to quit overnight especially with the

social pressure and again sorry to

interrupt but I think the the 7 to1

tries um did an episode on on nicotine

and I talked about smoking a bit and

most people fail most people fail they

relapse it's very very difficult to quit

smoking people that do it and stick to

it are real heroes of the process uh

it's not not easy um

but that's with a heavy incentive you

know immediate health issues sometimes

it's Financial um Etc with kids it feels

like all all the pressures are pushing

in the opposite direction because it's

socially rewarded they get that you know

elevation of mood and focus and there's

just oh so much um driving them to you

know continue using absolutely right one

of the things that we do in our program

to help teens quit is we talk about

social withdrawal and it was actually

one of our we have a wonderful group of

40 youth who work with us we call our

youth action board our yab our reach lab

yab uh our yabs say that we need to talk

about social withdrawal not just

physical because of exactly what you're

talking about they may not be able to go

to that party at on a Saturday night

where they know their friends are vaping

because it'll and we know the brain cues

up that they'll see or smell or or

witness somebody using an ecigarette and

those cues will happen and they'll want

to use it so they actually have to

isolate themselves from their friend

group who was using so it's very

difficult so really setting up your

social M you really setting up your

friends who are not using really trying

to talk uh and and have your family

around you and I really tell parents

it's not the time to get pissed off with

your kids for using it's the time to

really help them let's be in this

together and often I say the reason why

they're using isn't their fault let's go

back to the beginning of our

conversation about marketing and and

that they're being targeted and teens

didn't even know what was hitting them

what was going on so let's not be mad at

them let's be sympathetic and help so

they need the combination of nicotine

replacement they needed to change their

milu they need to have healthy snacks

and water and and exercise and all kinds

of things around them and they may also

need cond behavioral therapy or some

other therapy to really get them it's

not going to be a one stop we need to

work with them and that's the same with

cannabis by the way this is just any

drugs and just feel so bad it is such a

problem right now when we built our

curriculums same thing I said I was

doing middle and high school and never

thought I'd do elementary and we have an

ele curriculum I thought I was only

going to do prevention we now have

intervention and moving towards

sensation that's how many young people

are just struggling right now when I was

in high school there seemed to be a

phenomenon of you know certain behaviors

allowed kids to have some social clout

um by virtue of I guess they used to

call it holding like if someone had weed

or if somebody um yeah if they had weed

then sort of gave them a position in the

social structure often times the um kids

that you know I mean I was friendly and

knew most people in my high school class

um you know and a few of them were kind

of like less socially engaged than

others but then at some point Midway

through High School one of them was like

start showing up with weed at parties or

something and suddenly like they had

like a social clout um it was kind of

interesting to see how you know having

paraphernalia having nicotine or

cannabis or whatever it is is sort of um

I think has long been a kind of like an

instant um sort of uh route to inserting

oneself into a social structure which is

obviously unhealthy I'm not I'm not

promoting this yeah and then it is

social right that there's a there's sort

of an instant substrate for

communication when I was growing up I

worked at skateboard shop and on my

break I would go behind the shop there's

a little alley there we'd skateboard

there's this little bump and but

occasionally like um employees would

share a share a cigarette or you you'd

ask someone for a cigarette this this

was kind of a way of bridging social

gaps um so again I I feel like it's so

hard to be a teenager there's so much

going on internally and externally and

everything you're talking about you know

in terms of the the negative health

effects the paraphernalia the marketing

The Taste the addictive qualities of it

Etc um just start to pile on on all

these these challenges to to staying

away from it but a big one seems to be

the kind of instant um social cred that

one gets when they participate in

something that other people are

participating in because for instance

like a sport like if there's a pickup

basketball game you have to play

reasonably well to get into get into the

game otherwise you're it's not going to

be easy or you have to be very bold yeah

right um so unless you're engaged in a

sport you're in theater or you're doing

other things it it's sort of an instant

route

okay I think I've made my point um is

there anything about that um that by way

of understanding you know can help you

know create like replacement behaviors I

mean it's going to be hard to take a kid

who's you know entire life is hanging

out with their friends and vaping

cannabis or nicotine after school and

hanging around and playing on their

phone and saying Hey listen you're going

to quit vaping nicotine you're going to

feel worse your friends are all going to

be doing it and um you'll still be their

friend but you're not really part of it

it's almost like you have to create a

culture of quitting before this can

really go the other direction you do and

and what you're saying is is so correct

and so relevant and why I feel so bad

for teens right now and and and the

social media right you put put that in

there as well and it's all over the

place right now with them they're

bombarded by all of the different

factors that you talked about and it was

interesting we were talking about

earlier around the social aspects too I

was thinking there was a point where it

was so cool particularly around Joel it

was so cool to jeel that I had teens

come up to me and say Dr Bonnie do you

have a fake ecigarette and I said a fake

ecigarette well yeah all my friends are

using and I don't want to but I want to

fake it and I just felt so bad and I

said no I'm not going to get you a fake

e cigarette but I will help you with

refusal skills and teach you how to say

no but in this case not just say no but

teach you how to feel good about about

saying no to certain things that you

don't want to be

doing and during that time there was it

was very difficult for teens to come up

and say I either want to quit or I don't

want to be a user I just don't want to

start because that was not cool I think

we changed in the last couple years

thankfully I think there are more teens

who are not using who are open to it or

who open to quitting a lot of teens want

to quit right now so thankfully we're in

a new era where this yes the pressures

to use are absolutely there but there's

starting to be a tide change where we

getting more teens who are getting on

the so-called bandwagon to either quit

or not use I think the social supports

are being there a lot more than we've

ever seen before we have more youth

groups who are getting on board of

either trying to help quit or trying to

make sure that it's okay not to use um

it's still hard and what you're talking

about so it's our job as adults and

healthc care providers and Community

Partners and Educators to really talk to

young people to set up those social

groups and say it's okay not to use it's

okay to come on over to this group and

yeah maybe you're not going to be with

that same social group on Saturday night

let's start a new social group for you

I'm not saying it's easy this is not

easy for young people and it's not easy

parents are struggling too they're

struggling to know what how to talk to

their teenagers but this is what we have

to work towards and setting up those

social networks of it's cool not to

use one of the other things by the way

that we talk talk about is the

environment when we talk to teens about

not using and why why it's bad for them

heart lungs Etc and all the things and

being duped and being marketed to and

and the money the environment piece has

also been interesting you know teens

right now may not care about their

hearts their lungs 20 years from now

they care about the environment and

there are environmental aspects to these

the Plastics the the pods don't

disappear the benzoic acid does not

evaporate and and we've got secondhand

Vapor secondhand smoke secondhand and

third hand so what I mean by that is if

I were to use any ecigarette near you

you would actually get a lot of the

volatile organic chemicals a lot of the

nicotine is in the air actually some

stays suggest covid might even be on

those droplets there's a lot of issues

there and then third hand is it just

doesn't dissipate that Vapor aerosol

it's not a vapor that Aeros so then

settles into carpets and and clothes and

so on and this is toxic to pets to

Children things like that so we talk to

teens about that that's another way to

get young people to be willing to either

quit or to Rally around not using is the

environment know I if I wash dishes for

too long and my my younger was out of

the house but when when she comes over I

get yelled across the room mom turn the

water off the environment we have to

save water that's what they care about

so much that if we could at least get

that into young people's hands say you

know what you may not care about

yourself but what about your friends and

what about the environment I think we

can also shift some of the generation

right now interesting yeah I think

replacement behaviors concerned for the

environment seem like good incentives

and I'm hearing all this I feel really

lucky that I was always obsessed with

something growing up whether or not it

was like birds and fish tanks or

skateboard or prior to that soccer or

you know um I mean certainly there were

drugs and alcohol around but there was

there were always activities that kept

us busy um and I guess I wonder whether

or not the Advent of social media has

created less interest in activities I

you know after school activities I guess

they used to call them but um I mean

even if it's video games um if it's

playing a sport if it's theater if it's

um art if it's music uh presumably kids

are still doing all that stuff but is it

the case that the kids that are vaping

let's say nicotine maybe cannabis as

well are less likely to be engaged in

other activities I mean is this thing

becoming just kind of a closed loop of

reward I mean that that's to me the real

danger of any substance that um

increases the dopamine system activation

without a lot of effort right because

the as you and I know that the the whole

of dopamine circuitry as it relates to

reward is all about effort reward

reinforcement effort reward

reinforcement um but the effort piece is

key and drugs basically bypass the

effort piece and then you get the reward

reinforcement and then eventually the

rewarding and reinforcing levels of of

return on that drug nicotine cannabis

Etc diminishes and then you're just

caught in a behavioral Loop right right

right absolutely um so you know are kids

doing less stuff are they are they

studying less as a consequence of this

are they are they playing fewer sports

are they less engaged in youth theater

and music and youth groups and things

like that when we were talking about

cigarettes when I first started my

career up until probably 2014 I would

say yes you're absolutely correct and it

was generally the teens who would say

I'm bored and I didn't know what to do

with myself and that's why I picked up

cigarettes or um or I'm not an athlete

or or this was my social

outlet I haven't seen that as a result

as much with ecigarettes now as a result

of ecigarettes yes but not as a cause of

using because it's so ubiquitous

ecigarettes we're seeing everywhere it

doesn't matter if you're how old you are

male female used to be more males using

because some of the earlier devices were

more Tech and guys were using it and

some of the females didn't want to put

them in their person because they would

leak we now are seeing more of an equal

if not a little bit more female using um

it's it's not your so-called bad or good

kids it's not anything it's not the

young people who are struggling with

school it's everywhere right now

independent of location race ethnicity

things like that so I don't see so much

what you're talking about in terms of a

predictor in terms of a of a result

absolutely I mean then we're seeing

teens who become more isolated who are

not engaged as much who are more bored

because they're sitting home and they're

vaping um but I also see a lot of young

people sitting around together vaping uh

so I I do think that that landscape has

changed um is it going to change back I

don't know is hopefully we change the

culture again uh but it it's an

interesting thought I mean as soon as

you said that I was thinking yeah I mean

they're certainly not out as much as

they used to be in terms of and we're

talking about this at the beginning

we're not seeing them out in Parks as

much we're not seeing them playing

pickup sports games as much as we used

to but I don't think that's because of

ecigarette use I think that's because of

social media and just the whole change

and honestly parents being afraid of

letting their kids out for some

predatory behavior and in other ways um

and you mean if kids are let out of the

house they're more at risk to predatory

behavior but of course they're also at

risk when but just by use of the phone

because the phone connects everywhere

absolutely the phone connects everywhere

and that's something we try to teach

teens as well but I think that that's

been something that parents are worried

about you know I have to you almost the

pendulum almost swung too much of now I

have to keep my kid in because I don't

want to let them out of the house and I

don't want to let them alone driving and

alone at the park and things like that

but I think that we've reduced you were

talking earlier about autonomy we've

reduced teens just autonomy and they

they have to get into a little bit of

trouble they have to jwalk they have to

do I mean I'm not encouraging but you

know but but we there's some natural

amount of getting together and hanging

out and being crazy at the park and

playing and playing games and things

like that and I think that has stopped

or or slowed down a lot uh I I see it

with with some people in my own

Community I don't see as much just

hanging out in the front yard and

shooting the breeze and instead they're

they're inside and they're on their

phones and and stuff like that so could

that be part of why we're seeing more

ecigarette use possibly I just don't

haven't I haven't seen the studies on it

yeah perhaps that's a good segue into

risky behaviors when I was a kid I mean

the dumb stuff that we did um meaning

dumb because it was dangerous to

ourselves I mean I am not suggesting

people do this kids please don't do this

just don't but just the dumb stuff of

you know jumping off roofs or between

roofs

um I'm not going to give any other uh

any anecdotes just uh it's amazing that

we all survived um and and some didn't

but that was largely the consequence of

drugs alcohol mental health issues of

kids I knew um but car accidents um

actually I grew up in the uh in the

mother's Against Drunk Driving era and

there was a there real

discouragement around drunk driving I

was fortunate that at least in high

school most of my friends didn't drink

or didn't drink much um but you still

heard about fatalities kids happen um

even one is is too many obviously um

what's going on now in terms of

risk-taking behavior um driving fast

driving drunk um doing what used to be

just described as dumb stuff um that

unfortunately sometimes is is fatal or

you know results in paralysis people

jumping off bridges into water without

testing the water depth you know we've

all heard the stories and sadly um they

true stories of people becoming

paralyzed that kind of thing dumb stuff

dangerous stuff teens do more of it um

is it still true that males are doing

more of that physical danger stuff than

than um than females or is that not true

that's what we used to hear but then of

course there's been this big push

importantly really to um balance out the

amount of research on on both

sexes yeah it's a good point I mean some

of it has to do with just the methods of

our research to know you know what's

interesting I haven't seen more recent

data in terms of differences by sex of

of risk engagement and risk behavior I

mean a lot of what I've seen is balanced

out I think it's maybe different kinds

of risk behaviors that that people do

but we're still seeing it I we're still

seeing teens drinking we're still seeing

teens going to parties and getting drunk

we're still seeing teens out on the

beach and getting drunk I think the big

difference now is whether from Mothers

Against now I think it's destructive

driving is that what it's called I think

it's now mothers destructive driving I

think that's so that includes drunk

driving and racing and racing and and

driving under the influence of cannabis

or anything else which can be harmful

but at least in in a lot of the teens

and young adults I've talked to at least

we've gotten that word out to teens so

they're still drinking and they're still

doing stupid stuff when they drink but

they're not getting behind the wheel as

much um much less and this idea of a

designated driver or sober driver um

Uber or Uber Uber's really I guess or

lift or any R shair let's just say any

ride share has certainly been uh a game

Cher in in in the landscape of teenagers

and young adults right now uh and in

fact I've heard not just a designated

driver but a designated partner or a

sober a sober sitter so this idea that

you go to a part party and there may be

drinking going on but you make sure that

there's one person who's sober not just

for driving but to make sure you're not

going home with somebody you don't want

to go home with to make sure that you're

not leaving drunk and falling downstairs

to make sure that you're not falling out

of that window so that message we've

gotten across really well which I'm

thrilled about are we still seeing drunk

driving in accidents I certainly have

among some people I know certainly we

are but I think that the message overall

is gten out there some people I've

talked to said we just just don't get

behind the wheel period what's also

interesting is more and more teens are

not driving they're delaying driving

more and more whether that's because of

uber lift I mean it's it's as a parent

it's less expensive to pay for a ride

share than to pay for insurance for

somebody under 25 or to pay for a car so

certainly that might be it um but but

that is there doing other stupid stuff I

mean in addition to drugs jumping

skateboarding certainly we're still

seeing that well skateboarding is a good

sport you got to don't exceed your skill

level but jumping between buildings not

smart um unless you're super skilled and

know what you're doing I mean you know

there are the parkour kids and the

skateboard kids and in the BMX cuz we we

don't want to take away what the

incredible things that they can can do

but but there's risk there right I was

referring to people who lack the skill

to to complete the to complete the

maneuver and um and getting badly hurt

or or in some cases not getting badly

hurt but you you just kind of shake your

head and wonder why you why you ever

engaged in that kind of stuff just so

risky yeah yeah we're definitely still

seeing risk behavior amongst teenagers

and part of it has to do with

impulsivity we know that teens's up

until around part of the development

right of cognitive and social

psychosocial and Social Development it's

up until around 16 17 they're still very

impulsive uh we know with the brain

development right the back of the brain

develops f faster and first and that's

our amydala our emotional Center our

motor coordination versus the front of

the brain which is our executive

functioning our uh uh planning for the

future our really slowing down and being

able to think of the risks and benefits

and make those decisions a little slower

and a little bit better more like we

would as adults so we certainly see

impulsive decision you know hey let's go

teepee that house or let's go ride on

that car or let's go do things that

probably hopefully wouldn't get them

killed or injured but may get them

busted in other ways we're still seeing

that I think there have been more

programs to help teens sort of rehearse

in in situations so they're not more

life skills training so they're not

making some of those impulsive decisions

but teens will teens are going to be

teens which by the way is why we don't

put things in front of them like you

know sugar booger and unicorn kind of

marketing that's going to get te

attractive because that is buying into

that knee-jerk impulsive it looks cool

everyone's doing a kind of thing that

they can resist I don't mean that they

can't but just buys right into teens are

going to be teens and that's what

they're going to

do um what about sexual behavior you

mentioned that kids are driving less um

or getting their driver's license less

frequently um which by the way with

respect

to teens wanting to drive less that just

like baffles my mind I mean one of the

reasons I like skateboarding as a sport

is you could do it anywhere it was also

transportation and I like the social

milu I loved the social milu of it um

and but getting my driver's license was

like one of the most important events of

my life me too I could drive to yede in

the summer I could do all sorts of

things with that I'm so surprised that

kids wouldn't want to do that um such

autonomy there so much fun um oh I I

agree but I've also heard that um rates

of of sexual behavior are going down is

that true yeah stabilizing and going

down um and certainly rates of risky

sexual behavior has also gone down so we

are getting the message across around

condom use around um STI testing around

birth control things like that which is

also really good but rates overall have

gone down is teen pregnancy down I think

it's down actually I haven't looked at

the latest numbers I think it's down uh

certainly I don't think has gone up but

I'm I actually would need to look back

at those numbers it's been a little

while since I've looked at them and is

what we're talking about um today mostly

within the United States and the United

States alone or is it carry over to

other countries as well so it it totally

depends on the behavior that we're

talking about let's say vaping um or E

use of cannabis uh or nicotine so

interestingly ecigarette nicotine

ecigarette use has not been as high in a

lot of other countries it depends on the

country but for example the UK or Europe

we haven't seen the rates as high in the

last few years part of it was that a lot

of other states have a nicotine standard

so that means a minimum amount or

maximum amount excuse me of nicotine

that you're allowed to have so for

example the UK I think it's around

1.7% in the US we have no nicotine

standard which is another major issue

with regulation we don't have we have as

I was saying 5% 10% nicotine s there is

no regulation about how much nicotine

that you could have so in certain

countries if it's right around the

addictive level or a little bit below it

we're going to see fewer teens becoming

addictive it's still bad at any amount

but we're going to see fewer people

becoming addicted the other is the

marketing was not as big in other

countries and really was the marketing

was ecigarettes if you're trying to stop

smoking cigarettes not marketed to teens

that has changed in the last year or two

so in countries I've talked to for

example the UK I've been interviewed by

them many times in the last few years

and they would say we don't have the

same problem and now they're saying boy

we are seeing a pretty significant

increase in the number of teens who are

using part of it is a different

landscape of the kind of ecigarette

that's out there the kind of marketing

that's out there whatever it is we are

now seeing is it as high as we have in

the US I don't think so but it's

certainly increasing same thing in in

other countries where they actually

didn't allow certain ecigarettes to be

on the market have now come in and and

been on the market and infiltrated and

even in this country certain ecigarettes

are illegal and they're coming in um

illegally through illicit trading is

happening in and and crossing the

borders so um so ecigarette we're still

seeing cannabis depends on this on the