lauantai 20. elokuuta 2016

Part 14: Testing my addiction again and some thoughts on dependence scales

Earlier today, I released a questionnaire in Finnish that is based on the nicotine dependence syndrome scale (NDSS). It's something that seems much more appropriate to the wider audience I want to capture, even though it is designed to measure the dependence in smokers specifically. I did edit it somewhat to suit the need of measuring nicotine dependence between different products, because that sort of thing is rarely if ever done.

The reason for that are mainly these:
- It is widely assumed that nicotine products are equivalent in their "addictive" potential, which is of course absurd considering the huge differences in chemistry.
- Simply introducing a chemical to the system is not even remotely enough to induce addiction in any meaningful sense, so logically also the amount of that chemical in the system cannot be used to determine how addicted a person is or even if they are at all.
- The only widely used instrument is the fagerström test for nicotine dependence (FTND), which is notoriously bad when it comes to anything that is not smoking. It's simply utterly uninformative when it comes to a product that is not highly standardized and as such, extremely consistent in the effect it has when it comes to heaviness of use.

For instance, when I was a smoker my FTND score was "8 - high dependence". Now I don't actually smoke in any consistent capacity and it still indicates a score of one, because it assumes cigarettes are consumed regularly. Trying to modify it to fit vaping seems like a fool's errand, because there simply is no reasonable method to determine what amount is equivalent to a specific number of cigarettes.
NDSS however, goes into much more detail and leans much more on aspects like social issues, impulse control and so on, while leaving out the explicit reliance on heavy use. It also corresponds well with the diagnostic and statistic manual for mental illnesses, which has one of the most common descriptions of addiction.

My interest in doing this on a wider scale came from reading through a lot of different methods of measurement and applying some of them on myself, including comparing my scores from when I was a smoker and now as a vaper. While very subjective of course, what I realized that at least I have a very radical difference experience and that actual studies of dependence in vapers and other alternative nicotine users are unbelievably rare, despite all the claims of "switching one addiction for another".

So, I'll show you what I mean by radical difference :)
NDSS uses different scales for it's multi-dimensional analysis, which in the source material I used were condensed like this:
Drive and priority, meaning the time and necessity to engage in nicotine use
Stereotypy and continuity, meaning the consistency of nicotine use from day to day
Tolerance, which is self evident
And a total score, which can be used as a sort of dependence score

Here's what came up in my calculations, which are rather rough approximations, but should give an idea:
Drive/priority - vaping score a bit under half of smoking
Stereotypy/continuity - vaping 1/3 lower
Tolerance - vaping 1/3 lower
Total score - vaping slightly less than half of smoking
These results are also fairly consistent with smokers defined as nondependent, except in the stereotypy and continuity scores, because my consistency of vaping is much higher.

Obviously the fact is that this is in no way scientifically rigorous (to be blunt. it is rather unscientific really, sorry about that), just my subjective analysis of myself. But it did give me a bit more information to add to the hypothesis, that vapers are significantly less dependent than smokers.
This also highlights something more about the fagerström test, suppose it was modified to a vaping dependence scale, I would very likely score substantially higher simply due to the fact that I do vape a lot.. Despite both the NDSS and DSM indicating my addiction is low to nonexistent.

Now, the problem does somewhat remain with NDSS too, it's not fully compatible with vaping either.. But it does seem to be the best option we do have right now. There remains a distinct need to design a scale that properly works with alternative nicotine products.
But I am hopeful NDSS offers a useful starting point.

To be continued.. :D