E-Cigarette Users Report Addictive Symptoms Consistent with Tobacco Use Disorder

According to a new study, the marketing of e-cigarettes tends to imply the devices serve as a less harmful alternative to tobacco, though discussion within the research community has emphasized that the evidence regarding health and addiction among users is limited and inconsistent. Since their introduction to the market, the popularity of e-cigarettes has increased, with an estimated amount of 68 million users in 2020 reported worldwide.

Because e-cigarettes contain nicotine, which is known to have addictive qualities, it’s been hypothesized that e-cigarettes have addictive potential and symptoms would likely be observed among users. However, this mechanism is not completely understood in relation to these devices.

Daria Szafran, MSc, Division of Public Health, Social and Preventive Medicine, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, and investigators aimed to understand the role of addiction related to e-cigarettes. This study is the first to utilize a netnographic approach in exploring unfiltered self-reports of individuals’ experience with e-cigarette addiction.

Investigators found that a portion of the users expressed subjective experiences that aligned with the criteria of tobacco use disorder, according to the DSM-5. Concurrently, reports indicated that many users maintained a sense of control over their use, particularly compared with their previous use of tobacco cigarettes.

The Netnographic Approach

The investigation used 3 German online forums found in a systematic Google search and identified e-cigarette language. With deductive content analysis, a netnographic approach was employed to investigate posts within the forums that were relevant.

The screening process included 5337 threads from the 3 forums, which amounted to a total of 451 threads with relevant content for analysis. Criteria from the DSM-5 regarding tobacco use disorder that was adapted for e-cigarettes were used to code the study data and display the possible experiences of addiction.

User reports showed experiences that aligned with the DSM-5 criteria, like craving e-cigarettes, excessive time spent vaping, and health issues related to use. Investigators acknowledged the online forum provided a key benefit by limiting social desirability bias, which is unavoidable within focus groups and face-to-face research.

The Results

While many reports exhibited consistency with tobacco use disorder, results revealed that some common behaviors or symptoms associated with typical tobacco use disorder were not as prevalent in this analysis of e-cigarette use. Reports of “successful attempts to reduce nicotine dosage” were far fewer than the absence of this particular measure.

The majority of themes investigated were represented by the absence of reports mentioning related criteria, as opposed to their presence. For the most part, the self-perception of addiction among users was observed only in comparison to prior tobacco smoking.

In the first netnographic study of self-reported experiences with e-cigarette addiction, investigators explained that based on results, the subjective experiences reported by some but not all users fit the DSM-5 criteria for tobacco use disorder. The indication that e-cigarette users reported feelings of control regarding their behavior was highlighted in the findings, and was noted in contrast to their experience with tobacco cigarettes.

“The finding that some e-cigarette users subjectively experience addiction highlights the need for effective cessation programs to support users who experience their e-cigarette use as burdensome,” investigators stated. “This research can guide the refinement of instruments to assess e-cigarette addiction and guide cessation programs.”

The study "Addictive Potential of e-Cigarettes as Reported in e-Cigarette Online Forums: Netnographic Analysis of Subjective Experiences" was published in the Journal of Medical Internet Research.