Thread by @aftariak

A 🧵on dual use. What is "dual use?" When it comes to quitting combustible tobacco - cigarettes - a person continues to smoke but ALSO vapes. We see dual use with people who take methadone or buprenorphine & continue to use illicit opioids (use on top)

But dual use is also seen in other attempts at behavior change. Ever try to eat more healthy? You eat brown rice but still go to Burger King on the regular. You get double cheese burgers with bacon, DON'T hold the🍟! But you like brown rice, too

What's going on? Change takes time especially for smokers who have engaged in the behavior for decades. 🚬are old, familiar friends. It's hard for some smokers to make the switch to vaping on the first, second or third try. For a period of time there will be dual use. So what?

In harm reduction we say "Any Positive Change." That a person is trying to switch to a safer nicotine product but hasn't been 💯 percent successful yet is still a very positive change. It takes time. Again, the burger & brown rice

And there is often the issue of ambivalence. The notion that I want to stop smoking and switch but I don't. Ambivalence is normal, we all experience it when attempting behavior change.

Add to the mix the Stages of Change. The reality is some people are not ready, willing or able to stop smoking & switch, they are in the stage of precontemplation. That's okay according to the 2 dope kings, James Prochaska & Carlo DiClemente

This is REAL & we all go thru these stages, some faster than others. We all know someone who made the switch in days, months or years.

There are also structural drivers that impact the ability to make change easier or more difficult: race, class, mental health & socioeconomic status, housing instability, social/familial support, health insurance, employment, disability, etc.

In the vaping/nicotine wars, tobacco controllers and vape haters are increasingly seizing on "dual use" to argue that vapes are not effective, that people keep smoking & they cannot switch. Interestingly they don't say this about people who use the patch but continue to 🚬

In fact, smoking cigarettes & continuing to use the patch are recommended. This promoting of "dual use" as a problem when it comes to vaping is hypocritical. Public health agencies should support smokers switching to a clearly safer nicotine product no matter how long it takes

BECAUSE: E-cigarettes were more effective for smoking cessation than nicotine-replacement therapy, when both products were accompanied by behavioral support nejm.org/doi/full/10.10…

Tobacco harm reductionist have patience & empathy for dual users: the burger 🍔 & brown🍚We support smokers trying to make the switch to ANY safer nicotine product. ANY POSITIVE CHANGE!