Q&A with Dr. Jonathan Avery

Read below for my Q&A with Dr. Jonathan Avery, an addiction psychiatrist at Weill Cornell Medicine/New York-Presbyterian Hospital.

Katie Couric: What’s your take on the new FDA policy restricting how and where e-cigarettes are sold?
Dr. Avery: I agree that these efforts are critical to make them less appealing and less available to adolescents and young adults. We know that efforts that made it more clear that cigarettes are harmful and not just fun helped decrease smoking, and so we hope that these policy and public health efforts will similarly help decrease use of these newer devices.

Katie: To that point, I was really surprised to learn that the vast majority of kids who vape often don’t realize that e-cigarettes contain nicotine. What did you learn about the effects of raising awareness in your own study?
Dr. Avery: In our pilot project we did at Weill Cornell Medicine/New York-Presbyterian Hospital, which was designed to provide information and treatment to adolescents who were vaping and Juuling, and their families, it was amazing to see how a little bit of information went such a long way in changing use patterns. I felt like a physician from decades ago, who was informing patients that cigarettes may actually be harmful, and was surprised by their disbelief and shock.

Katie: The addiction stats are pretty startling—more than 20 percent of high school students vape regularly. How did we get here after so much success warning against smoking and nicotine addiction?
Dr. Avery: The percentage of high school students who smoke cigarettes has been steadily declining for years. Cigarettes are no longer popular, and everyone knows the risks. Electronic Nicotine Delivery Systems came along with clever marketing strategies and appeared safe, fun, and anti-cigarette. And here we are with so many adolescents using nicotine again.

Katie: Why has it taken so long for these necessary services and treatment guidelines to be put in place? What still needs to be done?
Dr. Avery: We don’t have robust addiction treatment services for adolescents in general. The focus of the treatment services that exist has been on other substances, given the decline in nicotine use among adolescents over the last decade.

As with all addictions, the first step has been to provide education to pediatricians, child psychiatrists, and all other professionals (teachers, etc.) on the front lines—those that see these adolescents most often. And then, of course, we need to provide information to the adolescents and their parents/families. Often, this is sufficient to curb use of these devices, as many don’t know the devices contain nicotine and other harmful products.

For those that need treatment and help stopping use, it is hard to find good treatment programs, but a number of people are working on different online and in-person individual and group treatments. These still need to be developed further, though, and properly studied.

Katie: Are kids who vape more likely to eventually smoke cigarettes? How much more difficult is it for them to successfully quit once the threshold to cigarettes has been crossed?
Dr. Avery: We don’t have great data to definitively predict what will happen to all these adolescents who are vaping, but there is some evidence that it will lead to the use of cigarettes and other substances, which may make quitting substances more challenging.

Katie: If you’re a parent of a child with a vaping addiction who needs treatment, what steps do you recommend to start the process toward quitting? How can parents and kids get help?
Dr. Avery: I would start by discussing the use with one’s pediatrician. I wish there were more addiction programs, addiction doctors and other professionals, and overall more awareness and discussion of addiction in the medical community. But as things stand, addiction treatment is often done by pediatricians and primary care doctors. And these clinicians will hopefully be aware of who and where to send adolescents to when the adolescents need more intensive care. My wish, though, is that, with time, we would have more adolescent addiction programs that are cost-effective and accessible for all.

Katie: You’ve started a counseling-based treatment program for adolescents with vaping dependencies. What have you learned about the contours of this crisis during this process?
Dr. Avery: Even though I knew so many adolescents were using Electronic Nicotine Delivery Systems, I was surprised by the number of adolescents and families who wanted and took advantage of treatment. I received so many calls, and saw around 30 adolescents and families in just a few weeks. They were hungry for information about these devices more than anything else.

Katie: How severe are the addictions that you’ve encountered with the kids you’ve treated? Are most of your patients able to successfully quit?
Dr. Avery: Most who are motivated to change have been able to change their use patterns after discussing the risks/harms with us and their parents. A significant minority, though, have found quitting to be very difficult, and have required on-going individual and group care, which can include medications to help them quit.

Katie: You’ve said that there is no “good data” on which strategies work for adolescents hooked on nicotine. What’s being done to gather that data, and how do you think it can be used to create effective treatments?
Dr. Avery: I think there are several thoughtful clinicians and researchers who are trying out different strategies, and it’s my hope that we will be able to study these interventions and collect meaningful data soon. This all takes time.

Katie: Are you hopeful that this epidemic can be halted once and for all?
Dr. Avery: I am always hopeful! Change always takes time though, and these electronic nicotine delivery systems have certainly made their way into the hands of a lot of young people.