I have been battling an addiction for over the last 20 years. Once I experience a high, I can only make plans for the next fix. It has consumed a large amount of my time, having had a negative effect on my professional career and my family relationships (who have also suffered a heavy burden). The physical harm I have suffered has been immense and I have been frequently warned about the long-term effects on my body. I now see my daughter picking up my addiction and it worries me for her future. I cannot begin to calculate how much money I have wasted on completely stupid things, exploited by marketers who have identified my vulnerabilities. It is such a widely shared addiction that satirical groups have formed online to show how sad and ridiculous we are. At the same time, I do not plan to quit my addiction. It brings me pleasure.

For the last 20 years, I have been suffering from the addiction to running.

Now before you tell me that running is not an addiction, I think you need to examine your prejudice in defining what an addiction is. And this is the problem. While there are clear and tragic cases where addictions take lives and break up relationships, there is not a clear consensus on what an addiction is, and when it requires remedial measures. There is a wide continuum of addictions from opioids and heroin at one end and running and compulsive shopping at the other.

This article will examine certain elements of addiction and try to place non-combustible nicotine addiction in this continuum. Is vaping closer to an opioid addiction or a running addiction? A good part of what follows are ideas drawn from an inspiring presentation on addiction by Robert West at this year’s E-Cigarette Summit in London.

What is an Addiction?

By and large, addiction is a social construct. We only talk about addiction in relation to something that causes significant harm, but harm itself is socially determined by a multitude of factors. What is the line where a habit becomes an addiction? Drugs, alcohol and tobacco fall under this category and are subject to harm reduction strategies. While they fill up pages on TikTok, Cocaholics and chocoholics don’t suffer any significant harm so it would be hard to consider such “addictions” in any clinical sense.

Moreso, addiction involves harmful patterns of behaviour (with negative consequences) that drive our decision to identify and treat addictions. These behaviours are stigmatized by the general population as anti-social, dangerous or destructive. If gambling is addictive, but not playing lotteries or gaming, it becomes clear that addiction determination is socially relative. A lottery addict likely loses money more slowly than a gambler but what about day-traders in the investment world? A gamer who stays up all night for just one more round (fix) has a harmful pattern of behaviour but might find other explanations for failing a school year or losing a job.

Addiction is considered a disease, framed as a medical condition or clinical disorder, requiring treatment. History has had some rather shocking treatments for addicts (literally) but today it seems that sufferers can only be cured, if ever, via complete abstinence. Often mental health issues are tied to these disorders (anxiety, personality disorders, traumas or those with behavioural and developmental issues). In our label-driven culture, it becomes easy to defend stigmatization by identifying the addiction with a disorder.

There are two types of addiction or addictive behaviour: those tied to psychological needs and those that are physiological. Are our cravings emotional or physically grounded? Likewise, what about our withdrawal experiences? Recent activist attacks on the food industry have tried to identify ultra-processed foods (however defined) as starting as a psychological addiction (as consumers are attracted to tastes, smells, textures, packaging, marketing…) that then create physiological dependencies. Like coffee, we are so chronically addicted to processed food, they argue, that we rarely understand how addicted we are until we suffer withdrawal effects.

Compulsive behaviour is often tied to addictions. During COVID-19, many people confessed to me they had become obsessed with hand sanitisers. To this day, they still carry bottles with them and regularly spray surfaces as well as their hands (and sometimes me).

Addiction is associated with weakness, perhaps the worst stigmatization, so people rarely talk openly about their addictions. When I confess that I am addicted to running, people fail to accept this as a serious disorder – they see running ultra-marathons as an inspiring personal strength. They do not see it as a harmful activity or disorder and seriously question the dependencies I suffer from.

Other repetitive, compulsive activities also do not qualify under this socially constructed definition of addiction, including consensual sex, over-working, shopping, coffee, sugar, social media, binge streaming on Netflix, music and dancing and using smokeless nicotine products.

Nicotine Addiction – Closer to a Running or a Hard Drug Addiction?

How addictive are non-combustible nicotine products (like vaping or nicotine pouches) and should it be considered like my running addiction or like more health harming addictions such as opioids or hard drugs. The WHO and the Bloomberg-funded NGOs that made up over half of the observers at the recent Framework Convention on Tobacco Control COP11 believe that these non-combustible harm-reduction smoking cessation tools are as addictive, if not more than tobacco products.

The most important marker for highlighting a need for a health policy intervention is the level of harm an addiction is causing. (Belgian healthcare providers are not interested in the state of my toenails so any harm I incur from running is my own damn fault.) A UK government study has shown that vaping nicotine is 95% less harmful than tobacco smoking. Nicotine does not fall under the harm level used to define addiction. The WHO and the Bloomberg flotilla of NGOs are dead wrong when they try to associate tobacco harm reduction products in the same addiction class as smoking cigarettes.

Note: Smokers, in any case, get little support from most healthcare systems to deal with their tobacco addiction. Instead, we profit from smokers with higher taxes and insurance costs. We are only having this conversation because a few well-funded health zealots are using the nicotine addiction argument to spread misinformation about the safety of tobacco harm reduction products as an alternative to smoking, confusing smokers trying to quit and costing millions of lives.

Vaping is not tied to mental health addictions. To the contrary, nicotine use actually helps people deal with mental health challenges without the high level of health-harming consequences. Likewise, when I started running, many of the personal issues and stress I had been struggling with became easier to manage.

Part of the strength of both running and nicotine addictions is that people who vape (or run) have often overcome challenges to achieve their present status. Ex-smokers look at vaping as a liberation from tobacco, reclaiming their health and adding years onto their lives. This is the same for many running addicts. For myself, I conquered obesity in my early years of running and know that with hereditary cardiovascular disease, I would be dead today if I had not made that decision to reclaim my health and fitness. I don’t plan to stop … even as my arthritis advances.

It seems quite clear that tobacco harm reduction strategies like vaping and nicotine pouches are addictive in the same way that my running is addictive, and not in the way that serious clinical addictions are considered. The next time some health zealot tries to confuse smokers with claims that this very successful tobacco harm reduction strategy is highly addictive, just tell the little Bloomberg bugger to go out for a very long run.