Quelling anxiety and relaxing are common reasons people give for smoking or vaping. But is that really possible? Will nicotine help relieve anxiety or other mental health conditions?

Robin Koval, CEO and President of Truth Initiative, discusses the nuances between vaping and smoking and their impact on mental health and anxiety. We also delve into some common beliefs about nicotine and answer the question “Is it true that vaping is safer than smoking?” Join us as the Truth Initiative tells us, you guessed it, the truth!

Robin Koval

Robin Koval is CEO and President of Truth Initiative®, the national public health organization dedicated to achieving a culture where all young people reject smoking, vaping, and nicotine.

Since joining Truth Initiative in 2013, Koval has transformed the national award-winning truth® youth tobacco prevention campaign and grown the organization’s world-class research, youth activism, and digital cessation programs. Under her leadership, truth has prevented millions of young people from becoming smokers and helped drive the youth smoking rate to a historic low of less than 2%. As youth e-cigarette use skyrocketed, Koval expanded the organization’s reach to be a leader in the fight against the youth e-cigarette crisis and all forms of youth nicotine addiction. Research now shows that truth campaign awareness is significantly associated with lower likelihood of vaping among young people ages 15–24. She has led the expansion of the truth brand to include innovative quitting tools and resources designed to protect and empower young people to live nicotine-free lives, including the first-of-its kind text message quit vaping program for teens and young adults,This is Quitting,which has enrolled over 570,000 since launch and a national youth e-cigarette prevention curriculum Vaping: Know the truth, now reaching almost 6,000 schools across the country.

Koval has also led Truth Initiative’s efforts to translate its expertise to address our nation’s opioid crisis. The Emmy® Award-winning The Truth About Opioids campaign has been proven to increase knowledge of the risks of opioid misuse among youth and young adults and decrease attitudes around stigma. Truth Initiative is continuing to contribute expertise to this crisis by launching a peer-to-peer opioid misuse prevention digital curriculum modeled after the success of Vaping: Know the truth.

During her tenure, truth has been voted one of the most influential campaigns of the 21st century and named the most effective brand of the year by the American Marketing Association. Fast Company has recognized Truth Initiative as one of the World’s Most Innovative Companies and a top ten nonprofit organization in 2022.

Prior to joining Truth Initiative, Koval, a highly acclaimed leader in the advertising and marketing world, was co-founder and CEO of the Kaplan Thaler Group, which she grew from a fledgling start-up in 1997 to a billion-dollar agency working with leading brands such as Procter & Gamble, Pfizer, Wendy’s, and Aflac. She was named CEO when her agency merged with Publicis to become Publicis Kaplan Thaler and led the 700-person agency to become the fifth largest in New York City. In addition, Koval is a New York Times best-selling author. She and co-author Linda Kaplan Thaler have written several books, including Grit to Great: How Perseverance, Passion and Pluck Take You from Ordinary to Extraordinary, The Power of Nice, and The Power of Small.

Gabe Howard

Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.

To book Gabe for your next event or learn more about him, please visit gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard. ​​

Gabe Howard: Hey everyone, welcome to the podcast. I’m your host, Gabe Howard, and calling in today we have Robin Koval. Robin is the CEO and president of Truth Initiative, the national public health organization dedicated to achieving a culture where all young people reject smoking, vaping and nicotine. Robin, welcome to the podcast.

Robin Koval: Oh, well, thank you so much for inviting me. Happy to be here.

Gabe Howard: Thank you so much for being here. You know, it’s well-documented how nicotine harms our physical health. But what’s less talked about is the connection between nicotine and mental health. And in fact, many people believe that smoking and vaping nicotine helps their anxiety, therefore helping to improve their mental health. Is that true?

Robin Koval: That is not true. That is a myth that’s been sort of well ingrained in culture by the tobacco industry over time. But actually, the opposite is true. What happens is nicotine, when people first start using it, can feel good. It’s a very powerful drug. It helps release that dopamine in your brain, but very, very quickly, because nicotine is highly addictive, those effects wear off. And what really sets in is just a constant treadmill of craving for nicotine. And what the research shows is that not only is nicotine not a stress reliever, it’s actually a bit of an amplifier. So there’s research that shows that nicotine can amplify feelings of stress, anxiety, depression. So the very thing that many people are reaching for because they think it will help them in terms of how they are feeling emotionally is actually making it worse.

Gabe Howard: I really think that we all have a coworker or a friend or a family member who is absolutely insufferable until they get a smoke break. So it certainly seems like it’s true from a layperson’s perspective that smoking reduces stress or anxiety and therefore is beneficial to mental health. Is this what drives the idea that nicotine is beneficial?

Robin Koval: Well, you know, as with any addiction, when you and this is very true of nicotine. So if you are addicted to nicotine, you smoke a cigarette or you vape and very, very quickly, it goes in seconds from your lungs to your brain. And so you get that feeling, which is really just the relief of your cravings. And so if you were feeling irritable or cranky or annoying, your colleague in the desk next to you, when you go have that dose of nicotine, your cravings are alleviated. But really, you haven’t done anything to improve your mental health status or your stress status. You’re just simply feeding this cycle of addiction, which will very quickly reverse. It hits your brain almost immediately and then quickly declines. So you’re like a rat sort of trapped on a treadmill.

Gabe Howard: I really believe that everybody listening understands that if someone is addicted to a substance, whether it’s nicotine, whether it’s alcohol, whether it’s illegal drugs, that one feeds the other. This idea that you need it because you’re taking it and that if you just wiped out the middle man, stopped smoking, stopped doing drugs, stopped drinking, etc., you would solve your own problem. What’s curious to me, though, is for some reason, nicotine gets a pass. It’s okay. I don’t know of anybody that says, Oh, you’re insufferable. You need to take a hit of cocaine. Oh, you’re insufferable. I need you to get really, really drunk and then come back to work. But for some reason, nicotine has become so incredibly socially acceptable that even nonsmokers are recommending it as a mental health treatment for their friends, family and coworkers. How did this happen?

Robin Koval: Um, well, the tobacco industry has had a big influence in our culture, certainly for decades and decades. We can all go back and be sort of amazed now at ads from the 40s and 50s and 60s where, you know, doctors even recommended brands of cigarettes. And of course, Hollywood and Hollywood still does glamorize the consumption of nicotine. So culturally, it’s very present. But I would say that we have come a long way since then, and I hope not too many people are actually recommending to their friends that you look stressed. You need a cigarette because there are many better ways to deal with it that are not as dangerous to your health.

Gabe Howard: Are young people aligned with the idea that nicotine causes mental health issues or at least exacerbates them?

Robin Koval: Well, I think this is something that they are learning and it makes sense when they hear it and they’re very concerned about their mental health. But we are out there trying to reverse some conventional wisdom because there’s a very well-funded industry, the tobacco industry. Their interests are served by perpetuating a myth that tobacco, that nicotine is a stress reliever. So we are definitely giving young people news they may not know, but once they hear it, it makes sense to them.

Gabe Howard: Statistically, vaping tobacco is safer than smoking. However, if the choice is to do nothing or vape, you should absolutely do nothing. But what if the choice is between smoking cigarettes or vaping? Shouldn’t then you choose vaping? How has the truth campaign addressed this? Does truth support a harm reduction model or is it straight-up abstinence?

Robin Koval: That’s a great question and it’s a complicated one. We at Truth Initiative, there is just no question that, number one, we believe that every smoker should do everything they can to quit using combustible tobacco, which is incredibly deadly. And in fact, that’s why we offer a free program to individuals called Become an Ex. You can find it at becomeanex.org. That being said, for smokers, if you were to 100% replace your combustible cigarettes with vaping to help you quit and to help you eventually and as soon as possible, quit the use of all nicotine that will probably improve your individual health. What we haven’t seen, however, is that e-cigarettes, as they are currently marketed in the United States, which is very lightly regulated, available everyplace, not specifically marketed for tobacco cessation, and there are a lot of reasons for that. Are really not.

Robin Koval: Producing the evidence that says this is a major, um, uh, advancement in helping smokers quit. It can. The other thing that I think I would say is the idea of harm reduction is a well-accepted public health strategy. Um, certainly we’ve seen it in substance use. We’ve seen it in the use of condoms when the HIV crisis was happening. But for example, you don’t see methadone sold on every street corner in America, in 7-Eleven, where kids can walk in and buy it on their way to school. Um, unfortunately, that is what has happened with the use of products like e-cigarettes in the United States. So we have a very challenging environment in terms of how these products are marketed, how they’re available to people, who’s actually using them. But I will say categorically that Truth Initiative supports harm reduction when done responsibly and in the interests of public health versus in the interests of growing the revenue and profits for the tobacco industry.

Gabe Howard: I remember when vaping first came out and it was marketed as being so safe. Is that just more of that propaganda that while it may be safer than cigarettes, there’s there’s lots of things that are safer than something else and both are still dangerous? Is this just more of a of a misleading the public, this idea that, oh, well, we all know that smoking cigarettes is bad, but don’t worry if you smoke this way, it’s safer. And while it may be safer, we’ve ignored the part where it is still dangerous?

Sponsor Break

Gabe Howard: And we’re back discussing mental health and nicotine with the CEO and president of Truth Initiative, Robin Koval.

Robin Koval: Well, there’s more and more research that’s being published every day that e-cigarettes have their own set of harms, respiratory, cardiovascular and, you know, are definitely not safe. So maybe the best way to put it is being safer than a cigarette, which is probably one of the most deadly products, consumer products ever to be to be marketed and would never, ever be allowed on the market today. If you could imagine a product with a safety profile like this being out there is perhaps not the standard we are using. And so if you don’t use a tobacco product, any tobacco product, you definitely shouldn’t start. E-cigarettes are not safe. If you are a smoker and you believe that using an e-cigarette for a short period of time to help you completely quit combustible tobacco might be something you want to try. We would support any smoker in any effort they want to undertake to quit the use of combustible tobacco and ideally the use of all tobacco eventually.

Gabe Howard: I really see smoking and vaping as a maladaptive coping skill. And I’m just very, very curious why? Why do they find nicotine? Is there no other options? Is it easy? Does it work in the short term? Because there’s no shortage of maladaptive coping skills. And yet not all of these maladaptive coping skills lead to multi-billion-dollar industries that have lasted for decades.

Robin Koval: First of all, think about how available tobacco is. There are more outlets selling tobacco in the United States than there are McDonald’s by many multiples. So, this is a drug that is sold on every street corner in America. It’s also very interesting in the sense that this is a drug that most people who start to consume nicotine, whether it was smoking originally, now primarily vaping, happens for teens. Right? People don’t wake up on their 35th birthday and say, you know what, I really think today I want to become a nicotine user. And if you think about the way these products are used and consumed and the industry has been very clever about this, they come in like sort of techie looking devices. Of course, we’ve all heard about JUUL. There are now many, many, many different ones out there. Puff Bar and ELFBARs. And I could go on and on and name them for you that if you could go online today and find YouTube video after YouTube video of young people promoting these products to each other.

Robin Koval: In some ways, the industry doesn’t even have to do the advertising. Kids are doing it for each other. That’s the power of social media these days.

Robin Koval: However, we find that young people today, they are aware of health effects. I think just as a culture, we’re all more health concerned than we were in the past. They don’t like short term health effects. So, things like, you’re more susceptible to wrinkles. There are dental effects that can be bad for your teeth. So your child may not be concerned about something that’s going to happen to them 40 years or 30 years in the future. But they are concerned about things that are happening to them right now. And we know that young people are very concerned these days about mental health issues. We are going through a mental health crisis in our country. You know that better than anyone. And young people feel that intensely. Statistics are alarming in terms of the numbers of young people who say they are suffering from mental health issues on a daily basis. And so we have found by helping to inform young people and give them the facts and let them know that vaping nicotine isn’t a stress reliever, it’s actually a stress multiplier. Is is you know, to use a phrase, news they can use. And so parents can help convey that information as well.

Gabe Howard: I love that you brought up that mental health is everywhere, especially with young people. Does the truth campaign have an effort to tie mental health and nicotine together? And if so, what are those efforts?

Robin Koval: Well, we, like everybody, have tremendous empathy for the issues young people are going through today and the exploding crisis of mental health with young people. So we launched a campaign almost two years ago now called It’s Messing with Our Head. And the idea was really to debunk the myth that nicotine in particularly for young people, vaping nicotine is a stress reliever when in fact it’s a stress multiplier, can make feelings of anxiety and depression worse. We, of course, with young people, you try to be a little clever about it. We we thought about what what do people colloquially call cigarettes? They call them cancer sticks. Well, you know what we should call a vape? We should call it a depression stick because that’s literally what it is. And then, in fact, we ran a campaign that came after that called Breath of Stress Air. Campaign has been very successful. We just published data from our first outcome study of of this particular campaign. And what we found is that young people who are exposed to the truth campaign, which is what our effort is called, are significantly less likely to to start vaping and are significantly more likely to quit vaping. And that’s very, very, very significant because it’s the first youth anti-vaping campaign we’ve been able to prove that awareness is significantly associated with both prevention and cessation outcomes.

Gabe Howard: Robin, thank you so much for taking the time to be with us today. Where can folks find the truth campaign online?

Robin Koval: Well, go to thetruth.com and that would be the best place for any young person who’s listening to learn more about truth. And if you want to learn more about Truth Initiative, which is the parent of the truth campaign, you can go to truthinitiative.org Google this is quitting you’ll find it in a in a heartbeat.

Gabe Howard: I love that. Thank you so much for being here.

Robin Koval: It’s been my pleasure. Thank you for giving me the opportunity to share all this information.

Gabe Howard: Robin, you are very welcome, and I want to give a big thank you to all of our listeners. My name is Gabe Howard and I’m an award winning public speaker and I could be available for your next event. I’m also the author of “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon or any bookstore, but you can get a signed copy with free show swag or learn more about me by heading over to gabehoward.com. Wherever you downloaded this episode, please subscribe or follow the show. It is absolutely free and you don’t want to miss a thing. And listen, can you do me a favor? Recommend the show, Do it on social media. Do it in an email, Do it in a support group. Do it at work. Hell, send somebody a text message because sharing the show is how we grow. I will see everybody next Thursday on Inside Mental Health.

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