Vaping, Alcohol Use & Other Risky Youth Behaviors | Dr. Bonnie Halpern-Felsher

1. 0:00 – 1:40

   Dr. Bonnie Halpern-Felsher

   1. AHAndrew Huberman0:00

      Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Dr. Bonnie Halpern-Felsher. Dr. Bonnie Halpern-Felsher is a professor of pediatrics and adolescent medicine at Stanford University School of Medicine. A developmental psychologist by training, Dr. Halpern-Felsher is a world expert in the risk behaviors that adolescents, teens, and young adults participate in. Today, we discuss nicotine use, both by way of smoking as well as vaping and e-cigarette use. We also discuss cannabis and some of the correlative as well as possibly causal data linking cannabis use to psychosis in young adults. And we discuss some of the other common risky behaviors that adolescents, teens, and young adults participate in, including risky driving behavior, alcohol consumption, and risky sexual behavior. We discuss the various factors that impact whether or not a young person will participate in risky behaviors, including the family and home, as well as peer group and social media. And as we discuss social media, we get into a deep discussion about how marketing is combining with peer pressure in order to drive youth toward particular risky behaviors. By the end of today's conversation, you will have learned from Dr. Halpern-Felsher the latest research on risk-taking behavior in adolescents, teens, and young adults and what we can each and all do to ensure that they either avoid these behaviors or, if they are already engaging in these behaviors, that we can mitigate some of the potential harms and potentially get them to eliminate these behaviors toward having a life of enhanced mental and physical

2. 1:40 – 5:38

   Sponsors: Eight Sleep, Mateina & LMNT

   1. AHAndrew Huberman1:40

      health. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast. Our first sponsor is Eight Sleep. Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity. Now, I've spoken many times before on this podcast about the critical need to get sleep, both enough sleep and enough quality sleep. When we do that, everything, our mental health, our physical health, performance in any sports or school, et cetera, all get better. And when we're not sleeping well or enough, all those things suffer. One of the key things to getting a great night's sleep is that your body temperature actually has to drop by about one to three degrees in order to fall and stay deeply asleep, and in order to wake up feeling refreshed, your body temperature actually has to increase by about one to three degrees. One of the best ways to ensure that happens is to control the temperature of your sleeping environment, and with Eight Sleep, it makes it very easy to do that. You program in the temperature that you want at the beginning, middle, and end of the night. You can even divide the temperature for two different people w- if you have two different people sleeping in the bed, and it tracks your sleep. It tells you how much slow wave sleep and rapid eye movement sleep you're getting. It really helps you dial in the correct parameters to get the best possible night's sleep for you. I've been sleeping on an Eight Sleep mattress cover for well over three years now, and it has completely transformed my sleep for the better. If you'd like to try Eight Sleep, you can go to EightSleep.com/Huberman and save $150 off their Pod 3 cover. Eight Sleep currently ships in the USA, Canada, UK, select countries in the EU, and Australia. Again, that's EightSleep.com/Huberman. Today's episode is also brought to us by Mateina. Mateina makes loose-leaf and ready-to-drink yerba mate. I often discuss yerba mate's benefits, such as regulating blood sugar, its high antioxidant content, the ways that it can improve digestion, and possible neuroprotective effects. I also drink yerba mate because I love the taste. While there are a lot of different choices of yerba mate drinks out there, I love Mateina because, again, they have the no-sugar variety, as well as the fact that both their loose-leaf and their canned varieties are of the absolute best quality, so much so that I decided to become a partial owner in the company. Although I must say, even if they hadn't allowed me to do that, I would be drinking Mateina. It is the cleanest-tasting and best yerba mate you can find. I love the taste of brewed loose-leaf Mateina yerba mate, and I particularly love the taste of Mateina's new canned cold brew zero-sugar yerba mate, which I personally helped them develop. If you'd like to try Mateina, go to DrinkMateina.com/Huberman. Right now, Mateina is offering a free one-pound bag of loose-leaf yerba mate tea and free shipping with the purchase of two cases of their cold brew yerba mate. Again, that's DrinkMateina.com/Huberman to get the free bag of yerba mate loose-leaf tea and free shipping. Today's episode is also brought to us by LMNT. LMNT is an electrolyte drink that has everything you need and nothing you don't. That means zero sugar and the appropriate ratios of the electrolytes sodium, magnesium, and potassium. And that correct ratio of electrolytes is extremely important because every cell in your body, but especially your nerve cells, your neurons, relies on electrolytes in order to function properly. So when you're well-hydrated and your hydration also includes the appropriate ratios of electrolytes, your mental functioning and your physical functioning is improved. I drink one packet of LMNT dissolved in about 16 to 32 ounces of water when I wake up in the morning, as well as while I exercise, and if I've sweat a lot during that exercise, I often will drink a third LMNT packet dissolved in about 32 ounces of water after I exercise. If you'd like to try LMNT, you can go to Drink LMNT, spelled L-M-N-T, .com/Huberman to try a free sample pack. Again, that's DrinkLMNT.com/Huberman. And now for my discussion with Dr. Bonnie Halpern-Felsher.

3. 5:38 – 9:19

   Adolescence

   1. AHAndrew Huberman5:38

      Dr. Halpern-Felsher, welcome.

   2. BHBonnie Halpern-Felsher5:41

      Thank you so much for having me.

   3. AHAndrew Huberman5:43

      We're going to talk about a very important and sometimes troubling period of life. Not always troubling, but I think for everyone, adolescence and the teen years, youth, essentially, is a tricky landscape.

   4. BHBonnie Halpern-Felsher6:00

      Yes, it is. It can be.

   5. AHAndrew Huberman6:02

      Yeah. As our brain and bodies mature, we have more autonomy in where we take them, but that means also more exposure to the ideas, suggestions, actions, peer pressure of others, and, um, that's sometimes where the, the problems arise, and who knows, probably also where the solutions come from too from time to time. But I think as conscientious people, um, who mind the wellbeing of others of our species, we'd all like to know sort of like what are the key features that mark this stage of development? Maybe we'll just start off by talking about this through the lens of, um, your expertise as a developmental psychologist. You know, what is adolescence and the teen years? Like, what's going on? Um, what sorts of things are being worked out psychologically, um, that we might not be aware of? And then we can talk about some of the common pitfalls and the risk-taking behavior, everything from smoking, vaping, drug use, um, sexual behavior, uh, addictive behaviors as it relates to social media, bullying, risky driving. There's so much there. But, uh, maybe we could just look at this stage of youth through the lens of a developmental psychologist and share with us anything y- you feel is worth, worth knowing.

   6. BHBonnie Halpern-Felsher7:15

      Sure. So, first of all, ages. Adolescence, uh, can be anywhere from star- starting roughly around age 10, some people would say ending around age 18, maybe 21. If you want to go into young adulthood, then maybe mid-20s. And really adolescence is a wonderful time of, as you said, exploration. It's a time when... First of all, marked by pubertal changes, onset of menses for girls, um, uh, and, and really the pubertal and physical development, se- secondary sexual characteristics are coming out. We also have a lot of emotional development going on during this time. Height changes are occurring during this time. But we're getting a lot of social changes as well, as you said, peer pressure. So one misnomer is parents think that they don't matter during adolescence. They still really matter, but peers also come in and matter quite a bit. And then teens are really trying to figure out who they are. You get a lot of questions, "Who am I? Where am I going in life? What do I want to do when I grow up? What's important to me? How do other people feel about me? And then how do I feel about other people?" So a lot of the social and psychosocial development is happening as well. And you get asynchronous, uh, development too if a young person, for example, starts puberty at a younger age, say 10, where they're physically looking older, more mature, but emotionally and psychosocially, they still might be young versus the late matures, physical matures who may be not having and looking like an, uh, a older teen or an adult till 16, 17, 18, but they're more mature emotionally than others. Then you might have some confusion to that young person, "I look older, but I don't feel older," and stuff like that. But it's really this wonderful time of exploration for an adolescent, and a time of really wanting autonomy and wanting to make a lot of decisions that we should let them make, but there are some risks that we have to be careful about at the same time.

4. 9:19 – 12:35

   Household Conflict, Parents; Smart Phones

   1. BHBonnie Halpern-Felsher9:19

   2. AHAndrew Huberman9:20

      I've often heard this word autonomy as it relates to this, uh, stage of, you know, puberty and the teen years. You mentioned that kids of that age still really need their parents. Um, you know, in the last, gosh, 20, 30 years in this country, there's been a marked increase in the frequency of divorce. Um, is there any direct evidence that single parent homes or homes where, I don't know, people are remarried or just basically divorced homes are somehow, um, creating more challenges in terms of risk-taking behavior in adolescents and teens or, um, or not? Because I know plenty of people who had, you know, grew up in single parent homes, um, sometimes parents remarried and sometimes didn't, and I, by my mind, I can't seem to come up with any direct correlation, you know? Plenty of, uh, those kids did fine and plenty of kids in, uh, two parent homes that I know had, had challenges and, and vice versa.

   3. BHBonnie Halpern-Felsher10:15

      Yeah. I haven't contributed... Actually, that was some of my earlier dissertation work and I haven't really contributed to that literature for a while, but what you're saying is, is pretty accurate to what I've seen, which is really the literature would say it's not the divorce per se, it's the conflict that is happening. So if parents actually get divorced, usually if the conflict resumes, teenagers and children generally do well and particularly within about two years.

   4. AHAndrew Huberman10:42

      If the conflict, uh, resolves, so-

   5. BHBonnie Halpern-Felsher10:44

      If the conflict resolves.

   6. AHAndrew Huberman10:45

      Yeah.

   7. BHBonnie Halpern-Felsher10:45

      Right. So you can have two parents who are married and living in the same home and may or may not be a good relationship but living in the same home. If there's no conflict or that, uh, then generally teens will do well. Or, as you're saying, there's not necessarily a direct correlation. The problem comes in whether parents are living at home together or separated or divorced is if there's conflict, and then that conflict tends to result in social issues, emotional issues, a lot of an- social anxiety, a lot of feeling like I need to do better so that way my parents like me more. And we see that with children too. That's not just adolescence. A lot of depression, and with depression can come self-medication, uh, self-medicating around other drugs and so on. But that generally is resolved if the conflict resolves. But as you're saying, we're seeing adolescent angst regardless of parenting. Uh, what we really need though, it's not a matter of just the divorce or not divorce or the relationship between the parents. It's parenting that's important. So parents being good monitors, being involved in their kids' lives, not this, "Oh, you're 16, you have a car, you can go wherever you want and we're not going to keep an eye on you." We still need parents to monitor, to pay attention, to find out their kids' friends, where are they going after school. Uh, that discretionary time when parents are working and teenagers come home between 3:00 and 5:00 or 3:00 and 6:00 tends to be the most risky couple of hours. They're, it's, it's called discretionary hours where there's no parent around and we don't always know where those teenagers are hanging out. So that's more important, knowing where their children are and what they're doing and that there's some adult presence, some monitoring, than whether or not they're still in a relationship.

5. 12:35 – 18:25

   Smart Phones & Social Media

   1. AHAndrew Huberman12:35

      My sense is that smartphones have allowed more...... communication and monitoring between parents and kids, but also more interactions between kids and other kids, and kids and adults more broadly. So, is there any evidence that, uh, the advent of smartphones is directly creating problems for kids that, um, has to do with just so much more peer-to-peer interaction or peer-to-peer exposure? Like, when I was growing up, we didn't have smartphones. Uh, if you did something stupid, like that ... meaning that kids would laugh at, it- it might get told to a small group of people, maybe a larger group of people, but, um, in general, it just kinda didn't go anywhere. You're like, "Oh, I screwed up." And then you'd get teased a bit, and then it would kind of dissipate. But now, of course, that can propagate very, very far very fast. Is there any evidence that that mere fact is creating issues for- for kids?

   2. BHBonnie Halpern-Felsher13:30

      So, I would say it's not a blanket statement. I think it d- depends on the behavior that we're talking about. Bullying, no doubt, uh, the example that you gave, no doubt that if you mess up, if you do something stupid, it's getting filmed and it's gonna go viral. It will go, uh, on social media, and then it will perpetuate and escalate amongst the peers. Um, that we definitely know is happening. And certainly, in terms of drug use and marketing, there- there's definitely some peer-to-peer interaction. "Look how cool I am. Look at the smoke ring I did. Look at other things that I've been doing." There- there's no doubt. But in general, there are also some good things about it. Parent communication. They can monitor where their children are. They can put a tracker on the phone. Uh, I know with my own kids, sometimes it was the best way to say, "You seem a little sad," when face-to-face communication wasn't happening. I could use the- the phone to have that conversation. So yes, uh, there is some evidence that overall, phones and smartphones have increased risk behavior, but it's more the access to the behavior and then the viral-ness of really getting that information out. Like you said, if somebody screws up, um, if somebody dresses wrong, if somebody kisses somebody, that that could go pretty viral. I wouldn't say that smartphones and social media as a whole is the problem. I think it's situation-specific and behavior-specific that we're seeing, and particularly around marketing, for example, that teenagers have more access now to YouTube, to marketing that they're promoting. Not only are industries promoting, for example, e-cigarettes or cannabis promoting to young people, but teens are promoting to each other, and that we didn't see before smartphones, right? We didn't see, "I took a picture," or Instagram, "Look at me smoking," or, "Look at me dressing sexy," uh, "Look at me looking cool," or anything like that. That didn't happen before. It was more just word of mouth. So, that is definitely where we're a lot more concerned about social media. Um, but more my concern about social media is the outside world targeting young people. That's where I- where I've been the- the biggest concern about it. Teenagers targeting each other with bullying, no doubt, big issue, but in other ways, there's more support. There's more social interaction. The other time I get concerned, though, around teenagers is, uh, uh, is more the social piece of sitting around together at a table and they're not talking. They're on the phones. So, what we really don't know enough is how is the not getting out and playing and instead playing on a game, not going to the park and- and instead communicating through phones, how is that changing their social ph- and physical development is where I'm also very concerned.

   3. AHAndrew Huberman16:24

      Yeah. I, um, have family relatives with, um, who are in their teens, and it's interesting to see them interact, um, where they're on their phones, uh, a lot of the time. But I've also noticed that there's a cohort of kids that are really trying to put their phones away and just spend time together. And that was actually directly stated to me that, "Oh yeah, we hang out and we make it a point not to be on our phones when we hang out." And then th- but then, of course, they'll text or be on the iPad with one another in the evening when they're apart. So, they're sort of never apart.

   4. BHBonnie Halpern-Felsher16:55

      Right.

   5. AHAndrew Huberman16:55

      Um, but I do think there seems to be at least a sub-movement of, um, kids and teens that are trying to do more face-to-face interaction with devices at least put aside.

   6. BHBonnie Halpern-Felsher17:06

      I think that's a really good point. I've talked to some teens who say that they all- they get together and they will, uh, deliberately put the phones face down in the middle, uh, no phones, and have dinner or have a conversation. So, I- I think you're right. I definitely think that that- that has been a movement, and I really appreciate that, and I think that's fantastic. I've also seen circumstances where two teens are trying to help each other with homework and they're texting each other, which is fine, but I've often said, "Why don't you just pick up the phone and call the person, and in five minutes you can figure out the math assignment instead of 20, 30 minutes of back and forth?" It's just not as efficient unless you're literally copying and showing the picture. But is that having a change on their social or physical development or emotional development? Probably not. It's just a different world, w- the way that they communicate. And that's why I say I'm less worried in some ways, as long as they're still getting out and they're playing and they're being creative, I'm less worried about that kind of social interaction on- on phones and social media. It's a different way. We don't have a lot of evidence to say one way or the other, but if they're still doing the things that they should be doing as young people, my concern is that outside world, the- the, um, concern of predatory behaviors, the concern of industry, the concern of m- m- mass media and marketing to teens. That's the part that gets me particularly worried.

6. 18:25 – 23:46

   Vaping, E-Cigarettes, Nicotine & Cannabis

   1. BHBonnie Halpern-Felsher18:25

   2. AHAndrew Huberman18:25

      Yeah. Well, we know for sure that this is the first time in human evolution that, um, humans have, uh, essentially written with their thumbs. There's gotta be a massive expansion of the brain's representation of the thumbs relative to, you know, 20, 30 years ago. But...Maybe now would be a good time to talk about risky behaviors, uh, or even just behaviors that are known to have some detriment to health, smoking and vaping and e-cig-cigarettes, um, primarily. And we should be probably distinguishing between nicotine and cannabis. Um, maybe let's just start with nicotine. What- what are the statistics on, um, smoking, vaping, and e-cigarettes? Just rough statistics. I- I, um, saw a talk that you did online that cited some pretty outrageous increases in, um... or shocking increases in smoking and vaping in the last couple of years. Just staggering.

   3. BHBonnie Halpern-Felsher19:22

      Yeah.

   4. AHAndrew Huberman19:22

      So, maybe if you give us the top contour of those.

   5. BHBonnie Halpern-Felsher19:25

      Sure, absolutely. So, the good news is smoking rates, uh, conventional cigarette smoking rates has gone down pretty dramatically in the last couple of decades with teenagers, with all people in the US, which is wonderful, but teenagers to, um, well below 10%, if not really well below 5% of teenagers. That's the good news. In terms of e-cigarette use, which I prefer the term e-cigarette use than vaping 'cause they're- they're not vapes, they're aerosols. Uh, but e-cigarette use has gone up pretty dramatically. So, e-cigarettes came on the market in the US in 2007, and they were slow to- to- for uptick amongst teenagers. They looked like cigarettes when they first came on the market. They weren't very popular with teenagers. They didn't have... they had some flavors, not a lot. Didn't have a lot of nicotine. It was probably around 2011 to 2014 we started seeing an uptick, but then it was really in 2017 to '19 that we saw a dramatic increase, and that was th- the statistics that we saw, upwards of 27 to 29% of teens using e-cigarettes during tho- those couple years.

   6. AHAndrew Huberman20:31

      Daily use?

   7. BHBonnie Halpern-Felsher20:32

      Past 30 days, so any use in the past 30 days-

   8. AHAndrew Huberman20:35

      Okay.

   9. BHBonnie Halpern-Felsher20:36

      ... uh, was and daily use will be some smaller percentage of that. It was something like a 78% increase in high school student use and a 48% increase in middle school use over those couple years, so a very dramatic increase in use. Since 2019, it's gone down, but I'm gonna give a caveat. It's gone down in 2020 to... the national numbers are showing, uh, they went to around 20% and now around 10%. Part of that was in 2020, we had COVID, and initiation of e-cigarette use really occurs socially. Uh, going back to socialization, it's a lot of teens getting together, and it's not peer pressure of, "You have to try. Come on, try this." It's more like, "My friends are using. I'm at a party. I feel like using. Yeah, I'll try it." Well, during the pandemic and the shutdown, teens were not at school, they weren't with their friends, so initiation went down. Teens who were addicted, and we can certainly talk about levels of nicotine in e-cigarettes, but teens who were addicted continues to use. Some tried to quit, which was great, but we still saw a fair amount of use. So, part of the decrease in those 2020 to 2021 have to do with just access and socialization had changed, and so rates went down. Since then, even we published a paper showing relationships between COVID and vaping. We saw EVALI, e-cigarette and vaping-associated lung illness. So, that- that, we think was part of why we also saw further drops around 2021, but people were concerned about their lung health, in teens as well, and that's great. The latest data show that the rates are under 10%, the national data. I actually don't think it's true. And the reason I don't think it's true is I'm in the schools doing curriculum presentations all the time where I teach, uh, and educate teachers to use our tobacco and cannabis prevention curriculums, and s- we've never been busier than we are right now with schools just crying for help, "We have an- out- another group of teenagers using e-cigarettes, nicotine, or cannabis," or whatever. It's way more than 10%. I would say schools are telling me it's 40 to 60% of their students are using e-cigarettes, so-

   10. AHAndrew Huberman22:57

       For n- with- for nicotine?

   11. BHBonnie Halpern-Felsher22:59

       We don't know.

   12. AHAndrew Huberman23:00

       Or cannabis?

   13. BHBonnie Halpern-Felsher23:00

       Uh, it's- it's very-

   14. AHAndrew Huberman23:01

       Yeah.

   15. BHBonnie Halpern-Felsher23:01

       ... hard to know.

   16. AHAndrew Huberman23:02

       Okay.

   17. BHBonnie Halpern-Felsher23:02

       It's very hard to know what's in there. Uh, but the point is-

   18. AHAndrew Huberman23:05

       40 to 60%?

   19. BHBonnie Halpern-Felsher23:06

       That's what the schools are saying. I mean-

   20. AHAndrew Huberman23:08

       At some point in the last 30 days?

   21. BHBonnie Halpern-Felsher23:09

       At some point in the last 30 days.

   22. AHAndrew Huberman23:11

       Okay.

   23. BHBonnie Halpern-Felsher23:11

       They're catching just exorbitant numbers of students using right now. And so, from a science perspective, is it 10%, 20%, 30? We don't know. I can just tell you that the national CDC data would say 10%, and maybe it's a problem with the surveys or the questions or teens aren't being honest. But from a school's perspective, it's much higher, and then we have some national data suggesting it's more in the 20 to 30 to 40% range as well. Whatever it is, it's too many. It's too many teens who are inhaling nicotine and- and cannabis as well.

7. 23:46 – 30:41

   Adolescent Nicotine Use: Marketing, Flavors

   1. BHBonnie Halpern-Felsher23:46

   2. AHAndrew Huberman23:46

      Well, a lot to unpack there. First of all, um, nicotine, I did an episode of the podcast about nicotine, um, and a little bit of that got, um, confused in the way it landed, um, so I'll just quickly state. Uh, nicotine, known cognitive enhancer, also known to dramatically increase blood pressure and vasoconstriction. Not healthy for the body, (laughs) just to be clear. It's not-

   3. BHBonnie Halpern-Felsher24:13

      Yes.

   4. AHAndrew Huberman24:13

      ... healthy for the body. So, when people hear that it's a cognitive enhancer, increases focus and alertness, that's true, um, in the short term. Highly addictive, highly, highly addictive, um, and habit-forming. Since sometimes those are separated, maybe we'd, um, delve into that distinction. But by my observation, very few people can use nicotine occasionally. People who-

   5. BHBonnie Halpern-Felsher24:36

      Correct.

   6. AHAndrew Huberman24:37

      ... try it seem to, um, g- like it, um, at least in the short run, and keep using it. Um, so-Presumably, kids are using, or I should say, youth are using nicotine either by vape or e-cigarette, and they, quote-unquote, "like the way it makes them feel." Who knows? Maybe it allows them to focus on their studies better. I don't know. Uh, but it is known to improve certain forms of cognition, but only transiently and it's highly addictive and it's bad for their health, for anyone's health. So, that puts us in a kind of a tricky situation when evaluating in the statistics that you just, uh, laid out because, uh, one wonders, you know, are they taking it and then conti- continuing to take it because of peer pressure, because of lack of peer pressure to not do it, because it helps them with their schoolwork, um, because they're naturally a little bit depressed and it provides a kind of, um, antidepressant signal? I mean, w- what, what do we know about why they're actually starting and why they're continuing and why they are reluctant to quit? Maybe we just parse those. What-

   7. BHBonnie Halpern-Felsher25:44

      Sure.

   8. AHAndrew Huberman25:44

      ... so, uh, uh, why does a teenager try nicotine?

   9. BHBonnie Halpern-Felsher25:49

      So, i- i- ... there are a few reasons why they start, um, based on the, the literature, scientific literature and just talking to teens. One has to do with the marketing, no doubt. If you look at the marketing, it is targeting young people. Uh, it's targeting them with f- first of all, the devices themselves. They are cool-looking. Uh, they're easy to hide. They look like USB devices. They look like highlighters. In fact, there's a new brand out called Hi-Lite that is a highlighter, that's a working highlighter, but it's actually an, a nicotine e-cigarette.

   10. AHAndrew Huberman26:24

       Right. So a highlighter pen to d- to study.

   11. BHBonnie Halpern-Felsher26:26

       Highlighter pen to study.

   12. AHAndrew Huberman26:28

       And then-

   13. BHBonnie Halpern-Felsher26:28

       But it's actually, you take i- uh, the cover off and it's actually a nicotine e-cigarette device.

   14. AHAndrew Huberman26:33

       Clearly marketed toward students.

   15. BHBonnie Halpern-Felsher26:35

       Clearly marketed towards students.

   16. AHAndrew Huberman26:37

       Wow.

   17. BHBonnie Halpern-Felsher26:37

       You have, what's it called? Uh, boba, uh, you know, um, teas, drinks. It-

   18. AHAndrew Huberman26:42

       Oh, yeah. The, the tea with the, uh, yeah. Yeah.

   19. BHBonnie Halpern-Felsher26:44

       Yeah, with the little... Mimicking th- that drink that's actually a s- that the straw is actually the vaping, inhaling there, little pieces. You have, um, Star Wars shapes. Y- y- you know, it goes on and on, just the cartoon shapes that are clearly being targeted to not just teenagers, children, that we're seeing.

   20. AHAndrew Huberman27:06

       Chil- uh, children, like young children?

   21. BHBonnie Halpern-Felsher27:08

       Children, like l- young children. So, when I-

   22. AHAndrew Huberman27:10

       Wait, so I'm, I'm, I'm, um, shocked. So, k- kids younger than 10 are, are having these products pushed their way?

   23. BHBonnie Halpern-Felsher27:20

       They are. And actually, I didn't tell you in the statistics, the statistics I was, uh, citing, I should go back and clarify a couple there, too, that are even more shocking. So those are the numbers for middle and high school. We don't have data from elementary, but again, the other part of, in addition to the science I contribute to, the interventions I do, I am getting elementary school teachers calling us for help. They are catching second and third graders using nicotine e-cigarettes. I'm not kidding. And not just one or two. Quite a bit. We s- said we would never develop an elementary school version of a vaping prevention curriculum. That's what we call ours, uh, You & Me Together VapeFree. We would never. We have a middle school and a high school. We were never gonna do elementary. We've had so many schools across the country call us and say, "We need something for elementary." So we actually created a curriculum. So we're having... There, there was a story of an eight-year-old, uh, back East who was caught and, uh, using and, and the teachers and police didn't know what to do, and of course I said, "It's not a police matter. Why aren't we helping this young person?" So, we are... we're, we're seeing younger now. Sometimes they're starting because their siblings, older siblings, uh, it's being marketed to. I- they don't realize that it's a nicotine e-cigarette or a cannabis e-cigarette. They just don't realize what it is. But the number of these products that are being targeted to young people is absolutely ridiculous, what they look like. Uh, the pictures are endless, and the problem is they're coming out with new products every few months that are targeting kids. So, marketing. And the other is flavors, and flavors and marketing go hand in hand. You know, if, i- i- ... if it looks bad, looks like, or, and smells like and tastes like nicotine or tobacco, teens know that that's gross. That's why we don't have cigarette use anymore. Teens... We've socialized our country to say if you smell tobacco, it's, it's nothing that we want to smell. We walk away from it, you walk across the street, whatever. We've done a really good job in tobacco control, getting the word out around that these products, e-cigarettes, smell and taste like sugar, like sweets, like dessert, like candy. So you've got... And, and the names are things like Unicorn Poop and Sugar Booger and Honey Doo-Doo. That's not for adults. Those names are squarely for kids. It's kids who are using chocolate. It's kids who are using these flavors that are on the market. And then the marketing around it are these... I mean, they're beautiful. They are these, you know, pizazz of pineapple dancing around or a, you know, um, uh, strawberries dancing or whatever it is that are very animated. There are juice box style that, uh, that have come out, juice box style vaping devices that are marketed looking like juice boxes. Again, that's, that's not targeting you and me. That's targeting a kid.

   24. AHAndrew Huberman30:37

       Interesting and, uh, scary, uh, to hear all

8. 30:41 – 32:13

   Sponsor: AG1

   1. AHAndrew Huberman30:41

      this.I'd like to take a brief break and acknowledge our sponsor, AG1. By now, most of you have heard me tell my story about how I've been taking AG1 once or twice a day, every day since 2012. And indeed, that's true. I started taking AG1, and I still take AG1 once or twice a day because it gives me vitamins and minerals that I might not be getting enough of from whole foods that I eat, as well as adaptogens and micronutrients. Those adaptogens and micronutrients are really critical because even though I strive to eat most of my foods from unprocessed or minimally processed whole foods, it's often hard to do so, especially when I'm traveling and especially when I'm busy. So, by drinking a packet of AG1 in the morning, and oftentimes also again in the afternoon or evening, I'm ensuring that I'm getting everything I need. I'm covering all of my foundational nutritional needs. And I, like so many other people that take AG1 regularly, just report feeling better. And that shouldn't be surprising because it supports gut health, and of course, gut health supports immune system health and brain health, and it's supporting a ton of different cellular and organ processes that all interact with one another. So, while certain supplements are really directed towards one specific outcome, like sleeping better or being more alert, AG1 really is foundational nutritional support. It's really designed to support all of the systems of your brain and body that relate to mental health and physical health. If you'd like to try AG1, you can go to drinkag1.com/huberman to claim a special offer. They'll give you five free travel packs with your order, plus a year's supply of vitamin D3K2. Again, that's drinkag1.com/huberman.

9. 32:13 – 41:35

   Nicotine Initiation, Freebase vs. Salt-Based Nicotine, Concentration

   1. AHAndrew Huberman32:13

      What percentage of adults in the US vape or use e-cigarettes, just by way of comparison?

   2. BHBonnie Halpern-Felsher32:18

      So, I've seen numbers anywhere from 5% to around 20%, depending on the statistic. I actually haven't looked at the latest data on, on adults. Um, but the m- uh, w- majority of adults who are using, uh, it's a little bit different to think about it. Adults who are using generally, they're not initiating tobacco through e-cigarettes. They're generally, and I'm talking 30 and up, they generally have been smoking cigarettes, and then maybe they're trying to use e-cigarettes to quit, which is a whole nother, uh, set of literature that it's not necessarily as effective as we're hoping that it is. There isn't good literature on a population level that s- e-cigarettes help adults quit, uh, cigarettes. The difference with teenagers is they're initiating with e-cigarettes, and they're not saying, "Huh, here's a cigarette. Here's an e-cigarette. Which one do I choose?" It's not that they're substituting or replacing. They're not using cigarettes. Some are now because they're switching back and forth, but they're initiating with e-cigarettes. They're initiating because of the marketing. They're initiating because of the flavors and the products and the ability to hide it. Parents don't know what these products look like. So, the landscape is very different.

   3. AHAndrew Huberman33:36

      So, you were telling us why teens and adolescents start vaping.

   4. BHBonnie Halpern-Felsher33:42

      Right.

   5. AHAndrew Huberman33:42

      The marketing is clearly oriented toward them. There are a number of reinforcing factors that, at least to my mind as you're describing all this, make it sound like this stuff is supposed to be, quote-unquote, "playful." That it's, it's not, um, it's not a drug, that sort of thing. It reminds me a little bit of sugary cereals.

   6. BHBonnie Halpern-Felsher34:00

      Yeah. Yeah.

   7. AHAndrew Huberman34:00

      When I was a kid, you'd buy the s- the cereal 'cause you wanted the taste, but you also wanted the colorful box. You had the, you know, the cartoons that it related to on TV, and there's usually a toy inside that you wanted, some surprise that you could then collect across boxes. So, there was a lot of levels of incentivization. Why do they keep smoking or vaping? Are they addicted to nicotine?

   8. BHBonnie Halpern-Felsher34:23

      Yeah, absolutely. So, so the other reason why they start is they like the taste and they like the rush.

   9. AHAndrew Huberman34:30

      Oh, right, yeah.

   10. BHBonnie Halpern-Felsher34:30

       So, I've talked to... So, that's the other pieces. So, a few more reasons why they start, and then, and then certainly answer your question around the nicotine. Um, teens have told me outright that they like the taste, they like the rush, they like the buzz, and we could talk about how much nicotine is in there. It's astonishing, and I can explain that. But they like the buzz. They, they... Another reason, by the way, is stress and coping. Right now, teens are so stressed out. They've, they've been stressed out for years, but they're particularly stressed with the pandemic. And even though we're a couple years out of the lockdown, teens are still, they're having socialization issues, social-emotional learning issues. They're still confused. Uh, they missed a couple of years, particularly high school students may have missed part of middle school where you're learning to socialize with other people, so they're very stressed. And we know that there's a pretty strong relationship between stress, not being able to cope, and using any drug but including nicotine. So, there's a lot of different reasons why young people... And certainly the peers. And again, it's not peer pressure. It's more like a lot of friends are using it. I've talked to teens who say, "I wasn't intending on, but I tried it, and wow, I really like the taste. I like the flavor." And then there's the amount of nicotine that's in there. In 2015, when the newer products came on the market, it was a salt-based nicotine. So, cigarettes and then earlier e-cigarettes have a free-based nicotine. Free-based nicotine uses ammonia and sugar to bind to the nicotine and the other chemicals, there's hundreds of chemicals in there, to go through the body, lungs into the brain and give you that rush. The free-based nicotine is very caustic. If you think the litmus test, it's very much on the basic side of the litmus test there. And if you're a nicotine-naive youth, which again, most teens starting with nicotine e-cigarettes have not used nicotine before, when you start, you don't want that caustic throat hit feeling. That's how it was described. Teens will say they don't like it. They cough. It tasted bad. Well, to an adult who's been using cigarettes, they don't mind that. They're used to it. But a teen is not.Well, I will mention Juul here 'cause it's relevant. Juul came on the market in 2015 with a salt-based nicotine.

   11. AHAndrew Huberman36:51

       Which essentially, uh, for those who aren't familiar with caustic and, um, litmus tests and things like that, the salt-based nicotine, as I understand, is quote-unquote "smoother."

   12. BHBonnie Halpern-Felsher37:01

       Correct.

   13. AHAndrew Huberman37:02

       It's, it's, um, it causes less, uh, sort of coughing, um, static contraction of the- the- the muscles in the mouth and throat, you know, and so, it- it's basically more palpable and more of a- of a kind of gradual on-ramp.

   14. BHBonnie Halpern-Felsher37:18

       Yeah.

   15. AHAndrew Huberman37:18

       Which is exactly what a company wants, um, if you want somebody to start using something. You don't want to hit them square in the face.

   16. BHBonnie Halpern-Felsher37:26

       That's exactly right. That's exactly right. So, salt-based nicotine generally uses benzoic acid to move that litmus test needle from the caustic towards acidic, because it's- it's an acid, but really towards neutral, so exactly. So, when you use it, it's smooth. It's easy to use. You don't have that throat hit. You don't cough. You don't feel sick from it. So, teens will say, and I- I've talked to teens-

   17. AHAndrew Huberman37:50

       Ahem.

   18. BHBonnie Halpern-Felsher37:50

       ... and young adults who tried earlier e-cigarettes and didn't like it, and then tried the salt-based style and said, "Ooh, I like it," coupled with the flavors. It's also more absorbent, so there's some suggestion and some early evidence that it's also more addictive. So, when those products first came on the market, before, earlier e-cigarettes had, say, 0 to 36 milligrams of nicotine. Suddenly, we jumped up to 59 milligrams per mL, which is about, generally about a 40, 41 milligram, uh, 'cause it's- it's about a 0.7 mL, uh, sorry, little chemistry and math that we do a lot here. But you're looking at, basically, it's anywhere from the nicotine that you see in either one to two packs of cigarettes.

   19. AHAndrew Huberman38:35

       Per?

   20. BHBonnie Halpern-Felsher38:36

       Per device, per pod, per e-cigarette device.

   21. AHAndrew Huberman38:41

       And how long does a pod typically last? A, let's say, like, a 15 or 16-year-old kid who's, um, you know, taking a hit off the vape pen, um, I don't know, what, five times a day?

   22. BHBonnie Halpern-Felsher38:55

       So, I've asked teens in some of the earlier publications we did, now, not with the newer devices but the older devices, and they would say that they were using a pod a week, which is about two or three cigarettes a day, to one to four pods a day.

   23. AHAndrew Huberman39:10

       One to four pods a day?

   24. BHBonnie Halpern-Felsher39:11

       One to four. Now, these are highly addicted teenagers. That is one to eight packs of cigarettes, depending on the debates on how much nicotine is in there, but you're looking at several packs of cigarettes' worth of nicotine.

   25. AHAndrew Huberman39:22

       Okay. So just- just to backtrack a little bit-

   26. BHBonnie Halpern-Felsher39:25

       Yeah.

   27. AHAndrew Huberman39:25

       ... 'cause we got a little bit, um, technical, um, which is great, but I wanna make sure everyone's on board. The amount of nicotine in one of these pods that goes into the vape pen or e-cig is significantly greater than the amount of nicotine in one pack of cigarettes in many cases.

   28. BHBonnie Halpern-Felsher39:42

       In many cases.

   29. AHAndrew Huberman39:43

       And there are many youth, so adolescents and teens, you said before between the ages of 10 and 21, roughly 10 to 18, 10 to 21, that are going through as many as four pods per day, which has to be at least the equivalent of four packs of cigarettes, but could be as much as eight packs of cigarettes per day.

   30. BHBonnie Halpern-Felsher40:03

       Correct.
10. 41:35 – 48:48

    Addiction & Withdrawal; E-Cigarette Access

    1. BHBonnie Halpern-Felsher41:35

    2. AHAndrew Huberman41:35

       Are they using... When you say all the time, I, that's interesting. Forgive me for interrupting, but-

    3. BHBonnie Halpern-Felsher41:39

       No, no, no.

    4. AHAndrew Huberman41:39

       ... are they using it specifically to wake up, to study, to, um, or just to maintain baseline? I mean, that's the, that's the problem with any addictive substance or habit-forming substance is that what starts off as a rush becomes less of a rush, and then, um, when one doesn't use, they feel below baseline. I've- I've done a lot of discussions about dopamine and baseline versus, you know, um, non-baseline peaks in dopamine, and some of that is smoothed out for general discussion. Uh, dopamine does many things besides set up reward systems and, um, uh, incentives in the brain, but it's at least one of the things it does. So, are kids starting off taking nicotine and then... and feeling like, whoa, that makes them feel really elevated in terms of mood, focus, and alertness, and then-... finding that without it, they're just depressed. Is that- is that the general theme?

    5. BHBonnie Halpern-Felsher42:28

       Yeah.

    6. AHAndrew Huberman42:29

       I'm not trying to lead the- the- the, uh, witness here.

    7. BHBonnie Halpern-Felsher42:31

       No.

    8. AHAndrew Huberman42:31

       I just wanna know what- what's- what's going on internally.

    9. BHBonnie Halpern-Felsher42:34

       Absolutely. No, no, no. All- all great, um, questions there. Th- so what we're f- what we're finding when we talk to teens is that pretty rapidly, they're going from, "I like it," to, "I need it." So, you know, your- your multi-part question, which is great, what makes them start and what makes them continue, uh, they start because of the flavors and- and the marketing and they like the- the taste and all that. They continue because of that high level of nicotine. And we are seeing that teens are addicted. And we're seeing... We actually published a couple of studies showing that teens who have been using e-cigarettes in the past 30 days, that the majority are showing signs of addiction. Pretty rapidly too, within a few weeks. It's such high levels of nicotine. And there are some people who don't believe that teens are becoming n- a- addicted to nicotine and that y- the levels of nicotine are not the same as what we're seeing in cigarettes. That's actually not the case and we've seen more and more studies into the question of using it as soon as they wake up, there's a study by a colleague of mine that showed in the last few years, the- the data are showing that teens, a- a greater percentage of teens who use e-cigarettes are doing so in the first five minutes of waking. That is a sign of addiction. So you wake up, maybe go to the bathroom, maybe not, and you take that hit. And so a- and all the national data are showing even though initiation may go down, the percentage of teens who are using daily has gone up. And I attribute that a lot to the type of nicotine, the salt-based nicotine, and to the huge amount of nicotine that's been on the market. So yes, teens are definitely feeling it. They're definitely going through withdrawal symptoms, that- that feeling, uh, shaking, the f- the sweats, all the feelings that they need, lack of concentration. The problem is when you talk to teens, they- they think that e-cigarettes are helping with school. And- and by the way, I've not heard a teen tell me that they started because of school reasons or concentration. Maybe they're continuing for that reason, but teens have said that taking the hit makes them feel good. What they don't understand is it's that it makes them feel not bad, right? The withdrawal is making them feel bad and they don't realize that that hit and that- that dopamine rush, that they now need it, that they're going through withdrawal either way.

    10. AHAndrew Huberman44:58

        I'm wondering where they're getting the money to pay f- for all this...

    11. BHBonnie Halpern-Felsher45:01

        (laughs)

    12. AHAndrew Huberman45:01

        ... uh, nicotine. Uh, when I was a kid, I worked. Um, I, like, mowed lawns, I had a newspaper route for a little while, but mostly, um, started working when I, I think I was about 14 or so. Coffee shop, skateboard shop, um, bus tables, did that kind of thing. So I made money and I was able to use that money on the things that were important, music, skateboarding, and bus passes and stuff. That- that's what it was back then. Food, um, et cetera. Where are 12-year-olds getting the money to buy four or even one vape cartridge, pod as you called it, um, per day? I mean, someone's gotta pay for this stuff, um, I mean, unless they're stealing it and I can't imagine that they're all stealing it. But where are they getting it? How are they getting it?

    13. BHBonnie Halpern-Felsher45:48

        Yeah, it's a great question. So there's not one way. Uh, in terms of money, I think there's questions around money and a- a question around access, right? And they're not necessarily the same thing. Money, babysitting. The problem is when some of the newer products came on the market, some of them, the- the, say, 2020, 2021 products were about a dollar or two per pod. Compare that with a pack of cigarettes which is $10 to $15 depending on the state you live in. So they are cheap. They're easy to get. Now, newer ones and older ones are a few dollars more, but they're not that expensive. They started off very expensive when they first came on the market, but they haven't been. The other is the sharing. And we used to hear about pod parties where somebody buys the device which is more expensive, buys the device, and then you bring your own... Not beer, bring your own pod, which is a few dollars, then you pop it in and then you share it around. Um, we've also heard stories of a few teenagers buying them and then selling for a few cents or a few dollars, a puff. "So meet me in the bathroom. For 50 cents or a dollar, you can have a couple of puffs." So I think teens are getting very c- very creative. We've also seen unfortunately parents buying e-cigarettes for their teens. "Well, at least they're not smoking cigarettes." Uh, that's not the right comparison. Um, so I- I think they're very creative, they're getting into many, many different ways. I've heard students say, "I'm not using my lunch money to buy lunch, I'm going to use it to buy vapes." Um, there's no one way, uh, there- there's not. And unfortunately, access is easier than it should. By the way, one thing I think is incredibly important for people to understand is across the US, in 2019, December of 2019, the legal age to be allowed to purchase or to sell nicotine products across the US is- is become 21. So many people think it's still 18. So you go into a vape shop or a tobacco shop and if the shop owner doesn't realize it's 21, they'll sell it to somebody who's 18. And even if they know it's 21, they're still selling it because there's not enforcement right now going on. So we really do need our- our... The public, we need all the parents listening, we need educators, police officers to really enforce the, and regulate this age restriction because teens are getting them from vape shops really easily. They're getting it online really easily. Um, th- they're buying them for each other. Somebody's going and buying 10 and- and then reselling them if the person looks older. There's not a lot of carding going on or fake cards, ID cards. It's pretty easy still to get.So, unfortunately, we have a product that is appealing to teens and a very unregulated market right now. The FDA is not regulating it. Local shops are not regulating it. That it's just... It, it is the Wild West out there.

11. 48:48 – 56:32

    Vaping Health Hazards, Aldehydes, Flavors

    1. AHAndrew Huberman48:48

       So, setting aside the issue of whether or not vaping is, quote-unquote, better for us than smoking cigarettes, because that argument is, um, a complicated one, uh, to say the least, what do we know about the health hazards of vaping per se? Um, does it increase, um, lung disease? Does it increase cancer rates? I mean, um, my understanding is that nicotine, the chemical, is not what causes cancer in cigarettes. It's the tars and other things that, um, are consumed or brought into the lungs, and therefore bloodstream when one smokes. Um, that's not to say nicotine is safe. I, I have to be careful here.

    2. BHBonnie Halpern-Felsher49:32

       Yes. (laughs)

    3. AHAndrew Huberman49:33

       Sometimes, uh, clips get cut and people run wild, and I, I'm not saying nicotine is safe, but, um, what are the problems with vaping nicotine? Um, even, let's just say, one or two hits per day, um, especially in kids? You know, do we... Are there known challenges for brain development? Are there known challenges for cognitive development? Are there known challenges for, um, lung function? Is it... I mean, nicotine is a vasoconstrictor, and it raises blood pressure, so that's basically stress on the system, chronic stress. Uh, but, you know, what, what do we know about what, um, vaping and e-cigarettes are doing to malign health?

    4. BHBonnie Halpern-Felsher50:15

       Yeah. So first of all, I'll start with the brain and, and nicotine. Uh, absolutely, these high levels of nicotine or really any nicotine is harmful to the developing brain, and our brains continue to develop until we're around 25, 24 or 26 depending, but to around 25. So, in that process of, of your brain developing or of your brain changing, if you introduce nicotine, you're changing your brain, you're changing the brain chemistry, and you're so much more likely to become addicted as an adolescent and young, a young adult. The tobacco industry knows this. I mean, they... That's why they target teens. We've known this with cigarettes. If we target a teen, then we're gonna have them for life. So, significantly more likely to become addicted because it actually rewires your brain, and there's plenty of evidence for that. The, the other pieces that we're worried about is... Now, you're right. Nicotine, in terms of cancer, although I will tell you, having talked to some oncologists, they would say the vast amount of nicotine still worries them in terms of cancer. We just haven't had enough research on e-cigarettes to really know. Now, you're right. E-cigarettes do not have tar, but e-cigarettes have aldehydes, and aldehydes have been li- linked to cancer. So, there's still some concern there. There's some early anecdotal evidence, and probably some of my colleagues out there would say, "No, no, there's pretty good evidence around cancer." I... We just don't have enough body of research. But again, it took 50 years to figure out cancer in cigarettes. We've not had the amount of e-cigarette use or, or... That we saw with cigarettes for that long, for that m- many people to really know. It's still pretty new.

    5. AHAndrew Huberman51:59

       I just might wanna just-

    6. BHBonnie Halpern-Felsher52:00

       Yeah.

    7. AHAndrew Huberman52:00

       ... interject that aldehydes, um, like paraformaldehyde, formaldehyde, these are the same chemicals that we use in laboratories to, um, fix, as it's called, tissues to make those tissues firm so that then they can be cut and analyzed under the microscope. Um, aldehydes cross-link proteins, um, basically change the configuration of proteins and turn what would otherwise be a pliable tissue into kind of hard, rubbery... Think of like a dense eraser-like, um, consistency, and, uh, in other words, not the configuration most conducive for those cells to live and thrive. Actually, quite the opposite, um, which is why, um, that's for sake of doing anatomy on, well, any body part, you use paraformaldehyde, glutaraldehyde, um, and formaldehyde to cross-link proteins. It basically kills tissue by cross-linking proteins, taking a nice, you know, pliable configuration that's, uh, amenable to life and twisting the, the, um, or shearing the proteins more or less, um, relative, cross-linking them and making them nice and rigid. So, if that's happening in the living child, that can't be good.

    8. BHBonnie Halpern-Felsher53:12

       Yeah. That can't be good.

    9. AHAndrew Huberman53:12

       That can't be good.

    10. BHBonnie Halpern-Felsher53:13

        Lungs, bloodstream, everything-

    11. AHAndrew Huberman53:15

        Right. And all the aldehydes-

    12. BHBonnie Halpern-Felsher53:16

        And it's-

    13. AHAndrew Huberman53:16

        ... are, are carcinogens. Cal- cal-

    14. BHBonnie Halpern-Felsher53:18

        Correct.

    15. AHAndrew Huberman53:18

        We know they cause cancer.

    16. BHBonnie Halpern-Felsher53:19

        Right, right. And so, that's why there's a lot of concern there. And when I talk to teens, uh, and in our curriculum, we, we often say, uh, because when you just say and you gave a beautiful explanation of the aldehydes, but for a teenager, what I generally (laughs) say is, is, "Have you ever dissected a, uh... You had biology and you dissect a frog? Yes. How did it smell? It was gross. Well, that's what you're putting into your body when you're vaping," uh, because that, that's exactly the point, and, and that kind of helps them understand it a little bit more. But there's a lot of concern around the aldehydes. Uh, there's lead. There's cadmium. There's propylene glycol and glycerin. So, there's a lot of other chemicals. So no, we may not have the thousands of chemicals that we have in cigarettes, but we certainly have hundreds of chemicals in an e-cigarette that's very concerning. So, there are a lot of studies now really showing pretty significant effects of e-cigarette use on heart and lungs a lot. Um, not only all the chemicals we've mentioned but also the flavorants. There's, uh, cinnamon aldehyde, another aldehyde. There's vanillin. There's, um, uh, what is it? The, the, the buttery flavor, um, that, that's in there is also a lot of concern so that you're inhaling these flavors, and I have often explained, you can take flavors. You can take butter and heat it to several hundred degrees and eat it-... if you don't burn your tongue. But you then take it and really inhale the resulting aerosol, and then we're seeing the- the lesions on the lungs. We're seeing young people who have been using e-cigarettes having lung collapses, pneumonia, asthma, amongst people who have not had seizures. Uh, one of the teens I know who was using four pods a day was having seizures. Uh, so-

    17. AHAndrew Huberman55:04

        Makes sense because nicotine is a stimulant.

    18. BHBonnie Halpern-Felsher55:07

        Yes.

    19. AHAndrew Huberman55:07

        It can cause runaway excitability in the brain if t- too much is taken.

    20. BHBonnie Halpern-Felsher55:11

        Yeah.

    21. AHAndrew Huberman55:11

        Um, if 40 to 60% of kids are using e-cigarettes, um, and it's destructive to the lungs, uh, and it sounds like the brain as well, uh, where are all the young athletes? Are they the- the remaining, uh ...

    22. BHBonnie Halpern-Felsher55:27

        (laughs)

    23. AHAndrew Huberman55:27

        Are they the remaining fraction?

    24. BHBonnie Halpern-Felsher55:29

        Yeah, and- and I should say 40 to 60 is what schools are telling me, and that might just be using once in a while. We don't really know. Um, but-

    25. AHAndrew Huberman55:35

        But even kids just, like, I had to do PE class when I was in high school.

    26. BHBonnie Halpern-Felsher55:39

        Yeah.

    27. AHAndrew Huberman55:39

        You know, we had to run a few laps. W- I can't imagine doing that if your, um, if your lungs don't function properly.

    28. BHBonnie Halpern-Felsher55:47

        No, it is actually much harder, and teens will say that, and adults I know. I actually ha- uh, know an adult who said that w- when he went from smoking cigarettes to e-cigarettes, it actually was harder for him to exercise and to ride his bike and- and- and exercise and do other things on the e-cigarette compared to the cigarettes, uh, that the- the impact on the lungs is so strong. So you're right. It is probably hurting, uh, um, athletics right now, where actually there are some curriculums on athletes and- and vaping, and we're building one as well because there's a lot of concern. When you tell a teen, you know, "I'm worried about lung cancer in 20 years," "Eh, I don't care about 20 years from now." But you would tell a teen, "It's harder to run," they're more likely to listen

12. 56:32 – 57:48

    Sponsor: Waking Up

    1. BHBonnie Halpern-Felsher56:32

       to you.

    2. AHAndrew Huberman56:33

       I'd like to take a brief break and acknowledge one of our sponsors, Waking Up. Waking Up is a meditation app that offers hundreds of guided meditations, mindfulness trainings, yoga nidra sessions, and more. I started meditating over three decades ago, and what I found in the ensuing years is that sometimes it was very easy for me to do my daily meditation practice. I was just really diligent. But then as things would get more stressful, which of course is exactly when I should've been meditating more, my meditation practice would fall off. With Waking Up, they make it very easy to find and consistently use a given meditation practice. It has very convenient reminders, and they come in different durations. So even if you just have one minute or five minutes to meditate, you can still get your meditation in, which research shows is still highly beneficial. In addition to the many different meditations on the Waking Up app, they also have yoga nidra sessions, which are a form of non-sleep deep rest that I personally find is extremely valuable for restoring mental and physical vigor. I tend to do a yoga nidra lasting anywhere from 10 to 20 minutes at least once a day. And if I ever wake up in the middle of the night and I need to fall back asleep, I also find yoga nidra to be extremely useful. If you'd like to try the Waking Up app, you can go to wakingup.com/huberman to try a free 30-day trial. Again, that's wakingup.com/huberman.

13. 57:48 – 1:04:21

    “Just Say No”, Adolescent Defiance

    1. AHAndrew Huberman57:49

       We haven't talked too much about peer pressure or just social pressure. Um, I remember when I was a kid, it was in the Just Say No to Drugs-

    2. BHBonnie Halpern-Felsher57:56

       (laughs)

    3. AHAndrew Huberman57:57

       ... era. And, um, I remember seeing the television commercials with the eggs, like two, like, really beautiful raw eggs, and it'd say, "This is your brain," and then it was, "Is this your brain on drugs?" And it was frying. You know, it was-

    4. BHBonnie Halpern-Felsher58:08

       Mm-hmm.

    5. AHAndrew Huberman58:08

       Nancy Reagan was the big-

    6. BHBonnie Halpern-Felsher58:09

       Right.

    7. AHAndrew Huberman58:10

       It was everywhere those, in that- in that time, you know, "Just Say No, Just Say No." In any case, um, there must be a lot of data indicating that what messages kids respond to. I was told, and I don't know if this is true, but I was told by a researcher, um, that the anti-smoking campaign that was effective in kids was not one that convinced them that smoking was bad for their health, but was one that, um, convinced them that it was, um, their purchasing and use of cigarettes that was making, uh, other people rich, and then, um, kind of demonizing those people that was effective. Kind of like show, uh, the commercials of- of these guys, um, you know, kind of cackling behind closed doors, you know, making fun of the- the people that were, um, in- in their words, um, you know, not bright enough to know that- that they were being taken advantage of. And then that set a- a kind of a psychological warfare between teens and these people that they perceived as, "I'm taking advantage of them for money."

    8. BHBonnie Halpern-Felsher59:14

       Right.

    9. AHAndrew Huberman59:15

       And that that was effective in getting them to smoke less, as opposed to telling them, "Hey, listen, smoking's really bad for your health."

    10. BHBonnie Halpern-Felsher59:21

        Right. Absolutely. So first of all, the Just Say No, not effective. Say- just having- s- saying Just Say No around any behavior to a teenager, whether it's tobacco, cannabis, cigarettes, um, and sex, does not work. It does not work, and for many reasons. First of all, teens are curious, and when you say, "Just Say No," "Why?" "Well, because it's bad for you." "Well, wait a second," exactly what you're saying, "Just telling me that it's bad for me, if you tell me I'm gonna get lung cancer or I'm gonna have lung disease or anything, and I tried the e-cigarette and I didn't have lung problems, and instead I actually liked it," then we look bad. We look like we're lying to teenagers. And instead, what we were talking about earlier, the- the feeling, the rush, the flavor, the taste, the perceived and real benefits outweigh the concerns over the risks as a teenager. So when we say to a teen, "Just Say No, don't," and they say, "Well, why?" "Well, your brain or your heart or your lungs or it's bad for you," they don't believe us. And- and we absolutely lo- lose credibility. So when we talk to teens, and this is based on decision-making research that I've been doing for 25 years, we have to help teens weigh the benefits and the risks. Now, I don't mean that we say, "Hey, it's good for you," or, "You're gonna like it." Certainly not. But if we only come from a risk model and a Just Say No model, that never works for teens. We need to help them understand the balance.And, and teens know that there are good things about using some drugs, real or perceived, and we can't lie to them on that. So, that gets to then how do we have those messages? And you're right. If we only harp on... And, and our research would show this too, the long-term health risks, the, your brain on, on drugs, those kinds of things that's so far in the future are the trach, you know? You're gonna have a trach if you smoke, but they're showing the 80-year-old and no 16-year-old even looks at somebody at that age or cares about somebody, that's so that other person, that, that's a problem. So, we need to talk about the social aspects that teens really care about. "You, you may get wrinkles." Although we don't know that so much with e-cigarettes, but, um, but the athletics, the things that are important to teens. Now, the campaigns that you're talking about are really effective as well, particularly the mass campaign, which level that we see social media campaign, which is, "Do you realize that the industry, e-cigarettes, tobacco, nicotine, cigarette, whatever you want to call it, is targeting you as a teenager on purpose? They want you as a smoker." I used to go to middle school students and say, before e-cigarettes, when cigarettes were of concern, and I, I love saying to, to young people, "400,000 adults are dying each year from a cigarette, from cigarette use. You're a replacement smoker." And it was great 'cause teens said w- we'd get really angry and say, "Wait, I..." This 12-year-old boy was so cute. "Wait, I don't want to be a replacement smoker, Dr. Bonni." It was a big deal to him. And, "I, I don't want to give money to the industry," and it's great. Channel that energy and get young people mad. That's what really worked. Showing that the seven dwarfs we call it, the seven CEOs of the to- big tobacco companies at the time said, "Nicotine's not addictive. Nicotine's not addictive. There, our cigarettes are not addictive," and that clearly they were lying to teens. You show that to a teen and explain how nicotine is addictive and they knew it, but they're trying to get you, works really well. And, and same thing with marketing. We, we have a whole lesson on marketing. "Do you think that that, that candy was for me as an, uh, middle-aged adult? It's for you." And that gets them mad 'cause they don't want to be duped. They don't want to be targeted. That is a much better message. Now, we still have to tell them about the health risks. We absolutely do. They still need the knowledge. They still need to understand what they're doing is unhealthy, but we can't do it in a lecturing way, and we can't do it in a way that makes them feel stupid. We can't tell them their brains are developing till 25 and therefore they're dumb. Our lessons on talking about brain are more like, "It's really cool that you're developing. It's why you can do dance. That's why you can sing better. You can learn language. There's so much that you could do that's really cool that I can't do right now. But because of that, that's why you're so much more likely to become addicted and the industry knew that, that's why they're targeting you." Those are the messages that work a lot better for teens.

    11. AHAndrew Huberman1:04:01

        Sounds like the, the key is to never undervalue the spirit of defiance in youth.

    12. BHBonnie Halpern-Felsher1:04:07

        Yeah.

    13. AHAndrew Huberman1:04:07

        And, and perhaps to, um, wager it, um, against these clearly destructive behaviors. Uh, to be honest, I'm shocked that, um, there's so much vape use and e-cigarette use. I mean, these numbers are staggering.

    14. BHBonnie Halpern-Felsher1:04:20

        Yeah.

14. 1:04:21 – 1:10:30

    Cannabis & Potency, Blunts, E-Cigarette Combinations

    1. BHBonnie Halpern-Felsher1:04:21

    2. AHAndrew Huberman1:04:21

       Maybe we could weave in a discussion about cannabis.

    3. BHBonnie Halpern-Felsher1:04:24

       Sure.

    4. AHAndrew Huberman1:04:24

       Uh, I did an episode about cannabis. Um, the landscape around cannabis has changed so much since I was a kid. It was highly illegal, uh, at least where I grew up. Um, now I think it's, um, been decriminalized certain places, still illegal elsewhere. I don't want anyone getting in trouble, um, as a consequence of not understanding what, you know, the laws in their area. Uh, and outright legal, pretty easy to get in a lot of the country. And, um, it's not clear that at least with individual use that it's being, um, you know, punished a- as fre- nearly as frequently as it used to be. So, the, you know, 10-word summary of, of the cannabis thing is that the ratio of THC to CBD is important. It is true that a lot of cannabis has much, much higher levels of THC now than in the past, although I'm told that high THC level cannabis always existed. Um, but it seems to be the concentration of THC that is of, let's just say concern w- as it relates to the potential development of psychosis, um, if there's a predisposition, um, as put in terms of the, uh, how addictive the cannabis is and so on and so forth, which is not to say that CBD is totally innocuous, but it seems to be like the THC concentration is the, kind of thing that, to mainly focus on. So, what do we know about cannabis? And here, we're going to assume cannabis with a reasonable to high level of THC in it. So, not pure CBD. Um, what do we know about vaping and e-cig use of cannabis specifically? Is it true that youth that are taking, um, nicotine by way of vape or e-cigarette then transition into using cannabis? Is it sort of a gateway into cannabis use? And how prevalent is cannabis use in kids age 10 to 21?

    5. BHBonnie Halpern-Felsher1:06:24

       First of all, you're right. I mean, THC levels we're seeing, today's joint is about 10 joints when I was a teen. Uh, so the, the dramatic increases in the potency right now that we're seeing around THC and then you get something like dabbing, which is about 80% THC versus 20 to 30% of, of the more mainstream products that we have on the market. When I say mainstream, I mean like, uh, uh, joints or, or e-cigarettes. So, the potency has gone up dramatically and it is of concern. So, depending on the, the study, you're gonna see anywhere from 10 to 20% of teens as saying that they're using some form of cannabis, either smoked or in the form of a joint or a blunt. And for those who don't know, a blunt, a lot of people don't realize, is a combination of both tobacco and cannabis. So, it's, it's a cigar leaf or some people buy a cigar and pull out the tobacco and put in the cannabis, or they'll just get the cigar leaf and, and roll the, the fl- cannabis flower. Then you're getting both the kind of the double whammy and the chaser, the high of both, of nicotine and THC.So, we're seeing a fair number of... And it, and it's interesting, even though teens are not smoking cigarettes, they're still using joints, which is interesting. Uh, but very quickly increasing, uh, is e-cigarettes with cannabis in there. You could buy a cannabis style e-cigaretarate, and that's been around for a long time-

    6. AHAndrew Huberman1:07:53

       Mm-hmm.

    7. BHBonnie Halpern-Felsher1:07:54

       ... with v- volcano vaporizers and specific cannabis vaporizers. That's not new, but it's become much, much more popular. But now, we're also seeing teens buy a nicotine e-cigaretarette, inhale half of it, and then add the n- the cannabis wax or oil to it, and then basically get the combination. I had one young, young teenager, probably 12, 13, 14-year-old young man who said, "Yeah, I, I got a cherry nicotine vape, and I inhaled half of it." He probably didn't use the word inhale, but, "I used half of it, and then I added in some cannabis oil, and now I had a cherry-flavored cannabis nicotine device." So, we're seeing that more and more, and even though you're not technically supposed to, and the manufacturers of nicotine e-cigarettes will say, "Don't open them and add stuff," a simple YouTube video will teach you how to do it, um, and unfortunately, the videos are not using gloves, and benzoic acid is covering your skin and things like that. But-

    8. AHAndrew Huberman1:08:56

       Which is bad for-

    9. BHBonnie Halpern-Felsher1:08:57

       ... which is bad. (laughs)

    10. AHAndrew Huberman1:08:57

        Does it go transdermally? Does it go through the skin?

    11. BHBonnie Halpern-Felsher1:08:59

        Uh, uh, supposedly it does. Yeah. Yeah. Which is

    12. NANarrator1:09:01

        But if-

    13. AHAndrew Huberman1:09:02

        ... silly. ... if the benzoic acid is going transdermally, uh, presumably when one inhales off one of these pods, they're also bringing benzoic acid into the lungs.

    14. BHBonnie Halpern-Felsher1:09:10

        Correct.

    15. AHAndrew Huberman1:09:10

        And, um, uh, hopefully people realize this from our episodes on breathing, but if not, uh, I'll just make it clear now that when you breathe in a substance, uh, you know, a, uh, airborne substance into your lungs, because of the, um, interface between the vasculature, the blood supply, and the lungs, I mean, basically things pass from the lungs into the blood supply very, very readily.

    16. BHBonnie Halpern-Felsher1:09:32

        Very quickly.

    17. AHAndrew Huberman1:09:33

        And then, if those things are able, they'll cross the blood-brain barrier.

    18. BHBonnie Halpern-Felsher1:09:37

        Correct.

    19. AHAndrew Huberman1:09:38

        Yeah.

    20. BHBonnie Halpern-Felsher1:09:38

        Correct. And it only takes about 7 to 10 seconds to go through the whole system and into the brain too, so it's a very fast process. So, yes, so teenagers are definitely, uh, vaping or using cannabis e-cigarettes, and the, the problem is, you know, f- for one, teens will think it's healthier than just, like, nicotine cigarettes. They think it's healthier than combustible. I mean, yes, you're not burning it, but you're still inhaling and you still are inhaling... There seems to be the propylene glycol, the glycerin, the flavorants, all the aldehydes, even if it's just, just a, an cannabis e-cigaretarette. So, there's a lot of concern there. And then addiction is still huge. It's a huge issue when you're talking about cannabis, the same reasons that we talked about with nicotine, the brain development and so on.

15. 1:10:30 – 1:14:11

    Psychosis, THC & Adolescence

    1. BHBonnie Halpern-Felsher1:10:31

       Psychosis. Just a lot, a lot to think about here. Psychosis. Um, there's actually some scientists now who are, are really strongly saying it's not s- uh, associated, it's causal, that if you are predetermined to have a mental health issue, psychosis, schizophrenia, then e- e- starting to use or using cannabis can actually trigger and cause you to become psychotic. Um, I don't totally understand the mechanism yet. I don't think we totally do yet, but that there seems to be more than just, "Eh, it might happen." And it seems to be right in that older adolescent/young adult timeframe that it is happening, so s- around the same time that the brain's developing, um, and we're hardwiring the rest of our brain, that that change is happening from, from a neur- neuronal c-

    2. AHAndrew Huberman1:11:18

       Mm.

    3. BHBonnie Halpern-Felsher1:11:18

       ... connection perspective. Um, it's-

    4. AHAndrew Huberman1:11:21

       My understanding... Sorry to interrupt.

    5. BHBonnie Halpern-Felsher1:11:22

       Yeah. Yeah. Please.

    6. AHAndrew Huberman1:11:22

       But my understanding is that, indeed, um, the use of high THC cannabis in youth, in particular male youth-

    7. BHBonnie Halpern-Felsher1:11:31

       Right.

    8. AHAndrew Huberman1:11:32

       ... predisposes, and you're saying might even be causal toward the development of psychotic symptoms-

    9. BHBonnie Halpern-Felsher1:11:38

       Correct.

    10. AHAndrew Huberman1:11:39

        ... in late teens, early 20s.

    11. BHBonnie Halpern-Felsher1:11:41

        Correct.

    12. AHAndrew Huberman1:11:41

        And that some of those cases, um, are ones in which the psychosis is irreversible.

    13. BHBonnie Halpern-Felsher1:11:48

        Correct.

    14. AHAndrew Huberman1:11:49

        Um, is it sometimes the case that somebody exhibits psychotic symptoms as the consequence of using THC and the psychotic symptoms resolve, or is it, uh, you know, some sort of circuit switch that is then permanent?

    15. BHBonnie Halpern-Felsher1:12:04

        You know, it's a good question. I honestly don't really know the answer to that, of what, what percentage. Um, the, the few cases I know of in, in talking to the psychiatrist, uh, would say that it, that it's causal and it may be permanent. Now, it could be, it could be managed. It doesn't mean that somebody is going to be having psychotic episodes all the time. I mean, certainly can be managed and certainly we would say, "Please don't continue to use," uh, would be very important. But whether it's completely reversible is something that I'm not sure of, uh, somebody more versed in this. But we... You know, what you do in, in your research and what I know is, you know, changes to the, to the n- neural circuitry is not changeable. You know, when we hurt our, uh, brain cells, that is not something that we could recover from. So, that is very much concerning.

    16. AHAndrew Huberman1:12:50

        Yeah. As in... As adults, there are very few new neurons added to the brain. Um, there is significant plasticity and recovery of function in some cases, both by virtue of traumatic brain injury... Um, certainly, people can get over, uh, certain behavioral patterns, and that no doubt involves plasticity, but it, it takes work. And, um, and when it comes to addiction, uh, there's evidence that some of the reward circuitry can adjust, but, um, again, it, it takes, um, adherence to sp- specific things in order to make that happen. Um, I'm very concerned about this, uh, potentially causal relationship, but certainly correlation between high THC containing cannabis and psychosis, um, mostly because we already have, uh, a serious problem with psychosis on the planet. A lot of people don't realize that, you know, approximately 1% of the world's population...... has schizophrenia. Th- and by the way, I have to be careful with the language nowadays, you know, "has schizophrenia" or "is schizophrenic" or all that, that language gets murky.

    17. BHBonnie Halpern-Felsher1:13:53

        Right.

    18. AHAndrew Huberman1:13:53

        But meet the diagnostic criteria for schizophrenia, I think is a safe way to put it. Um, so if one is then adding to that number of people exhibiting or, and suffering from psychotic symptoms that prevent them from having, uh, functional work lives, et cetera, that, that's, that's an issue.

16. 1:14:11 – 1:23:05

    Quitting Nicotine & Cannabis; Physical & Social Withdrawal Symptoms

    1. AHAndrew Huberman1:14:11

       Um, how difficult is it for these adolescents and teens to quit vaping and e-cigarettes and cannabis? I mean, um, can they quit just by s- deciding? Are there programs? Are they all going into, um, you know, recovery programs? Are there recovery programs in schools? I mean, how successful are they in stopping?

    2. BHBonnie Halpern-Felsher1:14:36

       It's really difficult. And, and maybe I'll talk about nicotine first. And, and the same would be true for cannabis, but a little bit less extent. I mean, both are addictive. A- and interestingly, not a lot of people realize that cannabis is addictive. About one in six teens or people who are using, particularly under the age of 25, do become addicted. So-

    3. AHAndrew Huberman1:14:55

       They don't realize that it's addictive.

    4. BHBonnie Halpern-Felsher1:14:56

       They don't realize it's addictive.

    5. AHAndrew Huberman1:14:57

       The argument I often heard was, "It's not as bad as alcohol," which is a, um, kind of a lame argument. I understand why people default to that, but, I mean, getting hit by a car might not be as bad as getting hit by a train. Um-

    6. BHBonnie Halpern-Felsher1:15:13

       Yeah.

    7. AHAndrew Huberman1:15:13

       ... but-

    8. BHBonnie Halpern-Felsher1:15:13

       Yeah.

    9. AHAndrew Huberman1:15:13

       ... I don't, I wouldn't even look at that analogy as accurate.

    10. BHBonnie Halpern-Felsher1:15:16

        Yeah.

    11. AHAndrew Huberman1:15:16

        There's just different, um, levels of destructive, different types of destructive. Um, yeah, these "Not as bad as blank" doesn't really seem to, to work.

    12. BHBonnie Halpern-Felsher1:15:27

        No, no. And, and, you know, I often say, people say, "Well, why'd you start studying tobacco?" I mean, there is no safe level of tobacco use, period. Yes, we have very few 30-year-olds who suddenly pick up a cigarette and become addicted. You know, at that point, y- y- your development of your brain... Now, can... If you use regularly, are you still going to hurt your lungs and, and heart and stuff like that? Absolutely. The brain changes may not be there in the same way. But most people don't pick up a cigarette or an e-cigarette for the very s- first time in their 30s or 40s and, and on. So absolutely, it's addictive and, and it is probably the most difficult-to-quit, uh, drug that's out there. Whereas alcohol, we don't see... I mean, yes, we have alcoholism. I'm not downplaying that. It's a huge issue in this country. It's a huge issue on this planet. But you're not going to have people in two weeks, three weeks suddenly say, "I'm addicted to alcohol." You are going to with nicotine and you are with cannabis an- to some extent as well. So yes, uh, nicotine is incredibly addictive and we have so many teens who are addictive, addicted to nicotine through e-cigarettes and really struggling to get off of it. I gave a talk recently to a group of parents and they said, "This is all great information, Bonnie, but how do I help my kid?" And I just felt awful because there's not a lot that we have. So taking a few different things. First of all, we don't have... There are some programs, there are inpatient programs, absolutely, showing some, some positive-

    13. AHAndrew Huberman1:17:02

        Inpatient programs.

    14. BHBonnie Halpern-Felsher1:17:03

        There are actually some inpatient programs and-

    15. AHAndrew Huberman1:17:04

        But those are going to be expensive or require that people have insurance that will cover that.

    16. BHBonnie Halpern-Felsher1:17:08

        Absolutely, and they take weeks. And then you're taking a young person out of their natural environment, out of their school, out of their friends, stigmatizing, which hopefully we're not stigmatizing drug use anyway, but, you know, you take a, a young person at 12, 14, 16, you put them in another place, that's very difficult on them. And if part of why they're using in the first place is stress, you're just enhancing that. Outpatient programs, w- we have some things, but the problem is we don't have the best recommendations because we don't have great research. So, for example, nicotine replacement therapy, the patch. First of all, it's not authorized for use by the FDA. It's not been approved by the FDA for anybody under 18. And yet, we have a lot of teenagers who are addicted. We just don't have the right studies and they haven't gone to the FDA for that approval. Now, a lot of doctors are using nicotine patches f- and prescribing them for somebody under 18. It's considered off-label, but you still can do it, and most people would recommend it. The, the problem is... And, and I don't mean problem with using them. I have no problem with, and I've often suggested to... And I don't treat. I, I want to make sure that I'm not misquoted there either. I don't directly treat and see patients myself. But based on the evidence and the American Academy Pediatrics recommendations, we should be using the, a patch with those under 18. But then the question is, how much? If a nicotine patch is about 21 milligrams of nicotine and a teenager's using 40 milligrams in a day, do you give two patches? And I've had some doctors say, "Wow, that's a lot of nicotine." I say, "Well, they're using a lot of nicotine." What I've heard some, uh, my adolescent medicine colleagues have suggested is one patch and then supplement with gums and suckers and lozengers. Not as a starting. I don't mean like what we're seeing with, with some, uh, pouches out there, like Zyn, as a starter. I don't mean that. I mean as a, uh, a form of treatment.

    17. AHAndrew Huberman1:19:12

        As a way to wean them off?

    18. BHBonnie Halpern-Felsher1:19:13

        As a w-

    19. AHAndrew Huberman1:19:13

        So reducing the dosage over time?

    20. BHBonnie Halpern-Felsher1:19:15

        Correct, correct. And, and th- now, but then they also don't have the, the hand-to-mouth piece that we see that is difficult. So gum... Uh, in this case, I mean non-nicotine gum, just chewing regular gum. Um, I've heard teenagers say that their, that their withdrawal lasts three to four minutes, so they have a... One teenager said, "I have a playlist on my phone that's each song is three to four minutes, and when I start to feel the withdrawal, I pop the music in my ears and I go do something and I listen to the song." And by then, that uncomfortable feeling is over. I've heard teens say that they'll run, that there's many different things that they'll do, um-... chewing on a toothpick, not a nicotine toothpick, but just a toothpick. Um, other ways to really get their mind off of that feeling is really important, but we also have to know with adults and cigarettes, it can take 7 to 11 tries. So, we can't expect... Until they're fully off of a cigarette, we can't expect a teenager to quit overnight. We-

    21. AHAndrew Huberman1:20:18

        Especially with the social pressure, and again, sorry to interrupt, but I think that-

    22. BHBonnie Halpern-Felsher1:20:21

        No, no, no.

    23. AHAndrew Huberman1:20:21

        ... the 7 to 11 tries, um, I did an episode on, on nicotine, and I talked about smoking a bit, and most people fail.

    24. BHBonnie Halpern-Felsher1:20:28

        Most people fail.

    25. AHAndrew Huberman1:20:29

        They relapse. It's very, very difficult to quit smoking. People that do it and stick to it are real heroes of the process. Uh, it's not, not easy. Um, but that's with a heavy incentive, you know, immediate health issues, sometimes it's financial, um, et cetera. With kids, it feels like all, all the pressures are pushing in the opposite direction-

    26. BHBonnie Halpern-Felsher1:20:51

        Yeah.

    27. AHAndrew Huberman1:20:51

        ... because it's socially rewarded. They get that, you know, elevation of mood and focus, and there's just oh so much, um, driving them to, you know, continue using.

    28. BHBonnie Halpern-Felsher1:21:03

        Absolutely right. One of the things that we do in our program to help teens quit is we talk about social withdrawal, and it was actually one of our... We, we have a, a wonderful group of 40 youth who work with us. We call it our Youth Action Board, or YAB, or Reach Lab YAB. Uh, our YABs say that we need to talk about social withdrawal, not just physical, because of exactly what you're talking about. They may not be able to go to that party at, uh, on a Saturday night where they know their friends are vaping because it'll... A- and we know the brain cues up that they'll see, or smell, or, or witness somebody using an e-cigarette, and those cues will happen, and they'll want to use it. So, they actually have to isolate themselves from their friend group who was using. So, it's very difficult. So, really setting up your social milieu, really setting up your friends who are not using, really trying to talk, uh, and, and have your family around you, and I really tell parents, "It's not the time to get pissed off with your kids for using. It's the time to really help them. Let's be in this together." And often, I say, "The reason why they're using is their fault." Let's go back to the beginning of our conversation about marketing, and, and that they're being targeted, and teens didn't even know what was hitting them, what was going on. So, let's not be mad at them. Let's be sympathetic and help. So, they need the combination of nicotine replacement. They need to change their milieu. They need to have s- healthy snacks, some water, and, and exercise, and all kinds of things around them. And they may also need cognitive behavioral therapy or some other therapy to really get them. It's not going to be a one-stop. Uh, we need to work with them. And that's the same with cannabis, by the way. This is just any drugs. And I just feel so bad. It is such a problem right now. When we built our curriculums, same thing I said I was doing middle and high school and never thought I'd do elementary, and we have an elementary curriculum. I thought I was only gonna do prevention. We now have inter- intervention and moving towards cessation. That's how many young people are just struggling right now.

17. 1:23:05 – 1:30:08

    Social Pressures, Quitting Vaping, Environment Concerns

    1. AHAndrew Huberman1:23:05

       When I was in high school, there seemed to be a phenomenon of, uh, you know, certain behaviors allowed kids to have some social clout, um, by virtue of, I guess they used to call it holding. Like, if someone had weed or if somebody, um... Yeah, if they had weed, then it sort of gave them a position in the social structure. Oftentimes, the, um, kids that, you know... I mean, I was friendly and knew most people in my high school class, um, you know, and a, a few of them were kind of, like, less socially engaged than others, but then at some point midway through high school, one of them was, like, start showing up with weed at parties or something, and suddenly, like, they had, like, a social clout. Um, and it was kind of interesting to see how, you know, having paraphernalia, having nicotine, or cannabis, or whatever it is sort of, um, uh, I think has long been a, kind of like an instant, um, sort of, uh, route to inserting oneself into a social structure, which is obviously unhealthy. I'm not, I'm not promoting this.

    2. BHBonnie Halpern-Felsher1:24:12

       Yeah.

    3. AHAndrew Huberman1:24:12

       And then it is social, right? There's a, there's sort of an instant substrate for communication. When I was growing up, I worked at a skateboard shop, and on my break, I would go behi- in the shop, there was a little alley there. We'd skateboard. There was this little bump, and... But occasionally, like, um, employees would share a c- share a cigarette, or you'd ask someone for a cigarette. This, this was kind of a way of bridging social gaps. Um, so again, I, I feel like it's so hard to be a teenager. There's so much (laughs) going on internally and externally, and everything you're talking about, you know, in terms of the, the negative health effects, the paraphernalia, the marketing, the taste, the addictive qualities of it, et cetera, um, just start to pile on, all these, these challenges to, to staying away from it. But a big one seems to be the kind of instant, um, social cred that one gets when they, uh, participate in something that other people are participating in. Because f- for instance, like a sport, like if there's a pickup basketball game, you, you have to play reasonably well to get into, get into the game. Otherwise, you're... It's not gonna be easy. Or you have to be very bold.

Episode duration: 2:31:24