Introduction and Episode Overview

 [00:00:00] 

Laurence Pratt: Hello and welcome to another episode of the ADHD Goals podcast. It has been a while since the last episode, but I promise you today’s episode is a big one. we’re gonna be talking about vaping and, nicotine. And, there’s research that’s continually suggests the link between ADHD and an increased nicotine and vape usage with people with ADHD being two to three times more likely to develop a nicotine dependence. And this is due to a number of factors associated with ADHD, such as impulsivity and a tendency towards novelty seeking, and ensure the constant release of dopamine from vape and cigarette smoking. Being extremely appealing to ADHD Brains. 

Guest Introduction: Dr. Mark Picot

Laurence Pratt: to talk about this topic today, I have a fantastic guest for you.

His [00:01:00] name is, Dr. Marc Picot, and he’s a practicing gp, a vaping expert, and the author of The Last Puff, A Practical Guide to Quitting Vaping for Good, which offers actionable strategies to help break free from nicotine dependence. So Marc, welcome to the show. How you doing?

Marc Picot: thank, I’m doing good. Thank you, Laurence. Appreciate for, for having me on. And, yeah, I’m looking forward to the podcast.

Laurence Pratt: Brilliant. Well, yeah, this is a topic that I know will appeal to a lot of ADHD listeners, and it’s something that appeals to me as well. I have had a nicotine addiction in the past, and it’s one, been one of the hardest things to overcome much more, much harder than smoking itself was. and I think we’ll probably get into some of the reasons as to why that is.

But yeah, so I’m really looking forward to getting into this chat today and finding out what we can do to help. 

Dr. Picot’s Personal Journey with Vaping

Laurence Pratt: I wonder if you could kick us off by just [00:02:00] telling us a little bit about, yourself, your background and why this topic is so big for you.

Marc Picot: Yeah, sure. So my name’s Dr. Mark Picot, but we can refer to me as Mark from here on out. so I am, a GP living in, Jersey in the Channel Islands.

Laurence Pratt: Huh.

Marc Picot: and I am an ex vapor. So my story began, about two and a bit years ago now. when I developed an episode of depression,

Laurence Pratt: and it was due to a number of reasons, but burnout from work was one of them.

Marc Picot: I subsequently developed what’s called, difficult to treat depression. So I went through a number of medications, several rounds of therapy and different forms of, treatment for depression. And I eventually found one medication that worked. Now, that medication gave me a side effect called akathisia, which [00:03:00] basically is, intense restlessness.

So both. physical, so moving around a lot, I just could not sit still. I couldn’t get through a meal without having to get up and move around at least five, six times, but also some really severe inner, agitation. Way worse than any form of anxiety that I’d ever had. and therefore I saw a specialist neurologist

Laurence Pratt: who prescribed me about five or six more rounds of different medications to treat this side effect.

Marc Picot: None of them worked, so I eventually did my own research and in an act of desperation, I found a paper on nicotine and about how patches helped improve this side effect among patients, with akathisia. So I tried it in the form of vaping. as I said, I was a desperate man in a desperate situation.

So my

Laurence Pratt: check you? You

Marc Picot: sure.

Laurence Pratt: vaped, you hadn’t vaped until this point?

Marc Picot: I’d never vaped, and [00:04:00] I was an occasional social smoker, but I was not,a regular smoker. No. So I never vaped, and occasionally smoked when I was out with alcohol. So it was the medicinal effect of nicotine that I was, looking for. And naively, I, didn’t think that I was, going to be so susceptible to the, addictive nature.

Even though it says quite clearly on the packaging, I don’t have any addictive traits or. Personality. so I thought I would try it and see if it helped. If it didn’t, then I’d stop. So I started off for the first few days just having a few puffs on your typical elf bar disposable back in the day.

and it didn’t really help. And, I thought, I’ll keep trying or maybe I need to do a little bit more often for it to help. And in the process, after one week, I found [00:05:00] myself vaping morning, evening, and night, and I was fully addicted, in the clinical sense. So I was craving it. I was, yeah, knowing it was not doing any good.

in fact, I’m of the strong opinion. It actually was making my depression worse. And, So I became addicted. 

Challenges in Quitting Vaping

Marc Picot: Now after six to eight months of, being addicted to vaping, I thought, I have to do something about this. I looked online, which I found that only the most basic of resources available.

there were scaremongering tactics going on, nothing of credible nature. So it put me off. I then went to my local quit smoking clinic and they basically turned me away. Said, we’re a smoking clinic only.

Laurence Pratt: Yeah.

Marc Picot: don’t help vapers. We’re not really, there’s not really much evidence behind it. We don’t really know.

so sorry we can’t help you. So [00:06:00] brilliant. so then I turned to mobile phone apps, to see if I could find one that helps. And the ones that were out there were really quite. Basic, and very non visually appealing and lacking any educational content about craving management, distraction techniques.

so I really found my own way. I did read the, Alan Car Easy Way Method, which is, I can see you smiling. You’re very familiar with it. Yes, it’s one of the most, popular and common, books and methods of quitting. and I found that very useful.

Laurence Pratt: Yep.

Marc Picot: and then I did quit. So to get to the end of the story, I managed to get to quit.

And because of the experience that I had, both of vaping addiction withdrawal, and importantly the scarcity of resources that were available, I turned it into a passion project to try and find out what I could, from the available evidence to be able to help people. And, What initially started [00:07:00] off as a passion project has now turned into a full-blown, pretty much full-time job, although I’m still working part-time, two days a week.

That’s mainly to fund what I’m doing around my, my vaping project and to try and help people to quit.

Laurence Pratt: there’s a lot of things that I, what you mentioned there that I wanna pick up on and, also I’ll try and get back to them. So you mentioned, you, you went through that process of trying to do some research, on it. And,as everybody knows, when you Google stuff, the, there’s a tendency to almost, indicate to, to Google what it is that you want to find out.

and it just provides you with that information. and I think when it comes to vaping, you. Two very different types of information that you could get for two different audiences. So there’s an audience of people that perhaps smoke cigarettes. And therefore, the news about vaping, it’s [00:08:00] gotta be positive.

It says, well, it’s, this is much better than, cigarette smoke. So vaping is good. And then you’ve got the people who are addicted to vaping, perhaps their kids, and parents who, who want to know. And then there’s a whole bunch of vaping information that says it’s so bad. it, I can understand that it becomes very difficult to then under, know what is the truth about vaping and what are the actual facts.

and I think, the truth is it doesn’t seem to be, there doesn’t seem to be enough information about trials that, that say what the truth is about the long-term effects of it. And I wonder if you have anything that you might be able to share with us on that about what you found out?

Marc Picot: we

Research and Studies on Vaping

Marc Picot: ll, what I found out at the time was, as you said, very little. it’s actually quite astonishing that vapes have been around commercially within the UK since around 2014 ish. And, so when I was going through withdrawal, it would’ve been 2023, so we’re talking [00:09:00] nine years on. There was really no good data to say within these nine years we have found out that vapes are,Unhealthy in this way, or they’re not unhealthy, there’s no evidence to suggest that they, increased risk of X, y, and Z. There, there literally was no date, nothing. There were a few scanty, trials done that were of, just ’cause the trial is published, it doesn’t, that doesn’t mean it is of good quality.

there were a few trials done and they were a pretty poor quality, low number of patients. The methodology behind them was poor. So the honest answer is that there was nothing back then. And even up until very recently, there still remain just scanty amount of evidence, which is astonishing when you think of it that this, supposed medicinal product, which has been [00:10:00] around for over a decade now has not been studied.

To see what its effects on the human body are. And when we think that the, if we look at the statistics, around 8% of the UK population vape daily, so we’re talking around the 5 million mark. So that is a hell of a lot of people who are vaping. There’s 86 million in the whole world

Laurence Pratt: that vape regularly.

Marc Picot: That is an astonishing amount for, researchers across the globe in including the uk, not to actually study it to see what its effects on the human body are so that we have some reasonable conclusions as to the harm profile that vaping has.

however, there is a recent study been done. That is, what is called a [00:11:00] meta-analysis.

So I don’t know your understanding and,I apologize if I’m teaching you how.

Laurence Pratt: go for it. But explain it for the audience so that 

Marc Picot: familiar.

for the, so for the audience, a meta-analysis means it’s a study of a large group of studies.

Laurence Pratt: it is a study of studies basically, and we have a ranking list in, medicine or,research that goes from what’s called anecdotal evidence, which is just a doctor says that they’ve seen a case of say, lung disease from smoking.

Marc Picot: That’s at the very lowest level. Now, at the top level comes a meta-analysis. Now what that does is look at studies of. other studies and not just about their outcomes, but they actually look at how well the study was done, what the outcomes were, the sample size, so [00:12:00] IE the number of people involved, and then they come out with an overall conclusion based off all these studies about the outcomes.

So in summary, there was a meta-analysis done of, a hundred over a hundred studies on vaping. So I said there wasn’t much done, but the actual quality of that evidence and what we call power of that evidence, as in how well does this study correlate with the conclusion. So a high. Power study means that it’s got lots of numbers of people in.

We can say for almost certainty that this is the result. So I’m not gonna go any more intel to save any more confusion, so apologies if I’ve lost some people. but basically it reviewed 107 studies now it came out with [00:13:00] some conclusions, about vaping and its risks. Now these studies just, as a disclaimer, were what were called observational studies.

So they were taking it a snapshot in time.

Laurence Pratt: Now, what we need from vaping is what’s called longitudinal studies. So basically to start at 0.0 and then follow people for 10 years

Yeah.

Marc Picot: more. And. What happens, and there is a study being done at the moment in the UK on a hundred thousand people, but that’s in children.

so there’s progress being made. So I digress. 

Health Risks and Legislative Actions

Marc Picot: basically the outcomes were, is that vaping increases the risk of stroke by a third

Laurence Pratt: Yeah.

Marc Picot: cardiovascular disease [00:14:00] by, about a third again. So we’re talking about heart attacks and heart failure.COPD. So by that I mean chronic, bronchitis or emphysema by about a half.

So just under a half. And asthma by a quarter. So these were the studies of this findings. And again, just there’s a point and at the end of each research paper, the authors say what the limitations of the studies are. And one is that you, they can’t prove that there’s causation there. They can prove that there’s a correlation there.

So there’s definitely a link, but does it actually cause these, these long-term chronic [00:15:00] illnesses we’re not a hundred percent sure and we can’t quite prove it

Laurence Pratt: now. That’s where the longitudinal studies come in, and that’s where you are much more likely to prove causation.

Yeah.

Marc Picot: But it was a big study because it was presented at the European Society of Cardiology Congress, which is attended by about 33,000 people from all over the world with interesting cardiology.

So it was a major study, that basically has prompted, some commentary, expert commentary by people like the European Society of Cardiology. So it is, very reputable,organization to say that they want vaping banned for good. The who, which is not the band, but the World Health Organization are very much against vaping, and they would like to see [00:16:00] it banned for good as well.

well,

and so

Laurence Pratt: I thought,

Marc Picot: there is.

Laurence Pratt: I thought we were, it was it this year in June where the government, banned, the single use, vapes and, immediately you just, they just stuck a rechargeable USB socket on the end, and it’s no longer single use, so carry on selling them.

Marc Picot: pretty much hit the nail on the head. So the legislation changed, and it was based upon environmental waste, basically because disposable vapes and batteries in them, people were just chucking them on the floor. Lobbing away vapes, disposable vapes have to be disposed of, manually. So people have to pick the lithium batteries out.

they were causing leakage into, waterways. And the way they got that legislation passed wasn’t actually on. Anything to do with, the activating itself, but was on the effect on the environment.

Laurence Pratt: Now, they changed the law that they had to be [00:17:00] refillable, rechargeable, reusable. So of course, to be rechargeable, stick a port on the bottle on the bottom to be reusable.

Marc Picot: All you have to do is they, and they now come with these little pods,

Laurence Pratt: Yeah.

Marc Picot: pods. Once you’re done with them, you put in your new little pod. They look the same, they’re marketed the same, they’ve got the same nicotine in them, the same vape juice in them. For all intents and purposes, they’re exactly the same.

And, vape companies have well and truly got one overrun The government on this one.

Laurence Pratt: and they’re priced exactly the same. So despite the fact that they are rechargeable and reusable, people are just gonna buy them as single use because it doesn’t affect their pocket,

Marc Picot: and the cost to actually buy the new prefilled pods is [00:18:00] you buy them two at a time. is roughly the same as the cost of buying a new vape

Laurence Pratt: So our people got, they’re gonna keep it and I’m, I strongly suspect not. yeah. So I think the impact that it has on the environment may be marginal.

Marc Picot: There may be some effect, but the impact it’s gonna have on people using those disposable vapes is gonna be negligible to none.

Laurence Pratt: Yeah.

Marc Picot: yeah.

Laurence Pratt: So you mentioned that, from the studies that are available and some of the insights that have come from those,you’ve mentioned some of the, well, let’s call them like, like the physical side effects of maybe sort of long-term illness, which, when read out, you know, it, it should be cause for concern. but as you and I know, and the listeners know if you have ever smoked or vaped the. Short term release or, perceivable benefit to you in that moment to create,reduce a [00:19:00] cravingis far more impactful than the threat of, what the long term effects are. You say, well, I’ll quit before that becomes a problem. and I suppose really what is happening there is more how our brain perceives what, what nicotine and vaping is doing for us. 

Nicotine’s Impact on the ADHD Brain

Laurence Pratt: I wonder if we can talk about, how the brain works, and how, and more specifically, how the ADHD brain is far more susceptible to, vaping, and nicotine addiction.

Marc Picot: Sure. um,you’re exactly right. One of the things I didn’t mention, is the me. So that was the physical, risks and the mental health risks. Which are far more studied because of the fact of smoking’s been around for a long period of time, and there is good evidence that smoking causes increased risk of mental health, about twofold.

Things like depression, anxiety, OCD, what [00:20:00] in smoking causes that the only psychoactive component IE the part of it that acts on the brain is nicotine. So therefore we can translate those findings across to vaping.really, and this is again, is a really, this is really quite famous study. I, I don’t, I was not gonna go into too many statistics and data and stuff.

I really don’t wanna confuse people. But, there’s a really famous study that showed that if you quit smoking. Again, we’ll keep in mind that the only drug, the only psychoactive component in smoking is it’s nicotine

Laurence Pratt: vaping. It has the same effect on someone who is depressed

and taking an antidepressant drug.

Marc Picot: So a lot of people are scared of stopping vaping when they’re depressed because it, obviously, some of the withdrawal symptoms may be low [00:21:00] mood, anxiety, et cetera, but actually stopping it will have a beneficial effect.

Laurence Pratt: So let’s move on to, vaping, nicotine and the ADHD brain. Laurence, I, you would be called what we would say in medicine as an expert patient.

Marc Picot: So expert patients are patients that know as much. Or pro, probably more than the doctors that they see. and we tr tend to, trust what they’re saying and be guided by, their, their expectations or their ideas. so yeah, so you know a lot more about ADHD

Laurence Pratt: probably me. and and that’s not, I’m not ashamed to say that.

Marc Picot: a the ADHD brain,basically the, the pathology or the abnormality behind the A DHC brain is, implicated in two brain [00:22:00] chemicals. So dopamine is the common known one, but also one called. Noradrenaline, which is basically a breakdown product of adrenaline.

Laurence Pratt: Yeah.

Marc Picot: Now these are both produced within the brain, and particularly the part of the brain that’s affected by ADHD is the front of the brain called the prefrontal cortex, and it’s implicated in what we called executive, function.

Laurence Pratt: Yeah,

we talk on the podcast, we talk a lot about executive function,the listeners are quite familiar about the language, of

Marc Picot: okay.

Laurence Pratt: Okay. so you’ll know about executive function. So that is obviously the area of the, that’s implicated by, ADHD now, so I won’t go into that any further detail. so nicotine. What [00:23:00] are the effects of nicotine on the brain? Well, as you said, nicotine causes a temporary and short-lived spike in dopamine release.

Marc Picot: By temporary, it has about, it has a half-life, meaning the time it takes the body to get rid of half of the drug of only two hours, so it’s in the body for two hours. By inhaling it within two hours, half of it’s gone, and that’s where you get the cravings and the withdrawal symptoms starting.

Laurence Pratt: So basically you get a spike in dopamine.

Marc Picot: So that gives you that instant reward, which is what people with ADHD are seeking. It helps to settle their A-D-H-D-A-D-H-D symptoms because ADHD. basically the path pathology is low dopamine, as we just [00:24:00] said. So it, it both improves ADHD symptoms and it helps reduce any cravings or withdrawal.

Laurence Pratt: Yeah.

Marc Picot: Now noradrenaline, is about attention focus.

Again, it produces a temporary spike in noradrenaline, which helps people with ADHD. But again, it’s temporary and when it wears off, of course, that causes the cravings. Now, in the short term, of course, it produces an improvement in ADHD symptoms, so people will be calmer, less hyperactive, more focused.

That’s in the short term, it will improve the core symptoms of ADHD. N

Dopamine Receptors and ADHD Medication

Marc Picot: ow, in the long term, what happens is that the [00:25:00] nicotine causing these big spikes in dopamine will actually will blunt the dopamine receptors so they’re not so sensitive to dopamine anymore. So the actual dopamine, natural dopamine that’s produced, the dopamine receptors, they don’t, they’re not so sensitive to it, so they don’t, absorb it into the brain.

Laurence Pratt: And same with the noradrenaline as well, just to pick up on that, so the dopamine receptors over time with, nicotine use less to receiving dopamine is.

Marc Picot: Correct. Yeah,

Laurence Pratt: right. Okay.

Marc Picot: correct.

Laurence Pratt: so just to sort of translate that into sort of,if there’s regular listeners of the podcast, then I, I do talk about, dopamine receptors a lot and the fact that within the [00:26:00] ADHD brain, there are fewer dopamine receptors than there are in a neurotypical brain, meaning that we have, we are less able to refuel that, part of our brain that deals with executive functions, allows us to focus, allows us to make, prioritization organization, all these sorts of things.

So we’re already at a disadvantage when it comes to rebooting our dopamine. And so what is happening is that. Over time with nicotine use, you’re feeling like you’re getting an ADHD boost, like, it’s improving those symptoms, but what’s really happening that over time it’s actually making those fewer dopamine receptors that you have less able to recharge with dopamine over time.that’s crazy. ’cause I mean, one, one of the other things as well, I mean, that we’ve mentioned before, in, in terms of like the dopamine baseline. So you talk about the, like the spike that, nicotine and [00:27:00] caffeine and alcohol that they, those can have. is that also what happens is, if you give like a child like a really sugary drink that. they’ll have like this big spike, but then after that big spike there comes a massive crash. and that goes, lower than where you were in the first place. And whilst we think that we are getting, an improved sense of how we feel like we’re actually, again reducing our dopamine, baseline, which is effectively what we’re, where we’re at a disadvantage as already. So it’s, it is mad how the brain can trick us into thinking, no, this is what we need, this is what we need.

Marc Picot: And that is both the implications of addiction in general. So in people with without ADHD like myself, addiction in general will trick you into thinking that’s what you need. it, it produces those cravings, those, not impo well, you get I impulsive in a way in that you have [00:28:00] to go out and buy one even though you know it’s gonna cause you harm.

and the withdrawal symptoms. so I would add one further thing to what you just said, Laurence. Soit, your dopamine receptors are all, already low,Over time chronic use, you, your symptoms are likely to get worse because of dopamine receptor blunting. Secondly, you are more susceptible to withdrawal symptoms because of the baseline levels of dopamine.

And thirdly, for those of you, and I dunno if you aren’t Laurence and, people with ADHD on medication, it has an implication. The implication being is that, nicotine basically affects the way that ADHD medications work. So, ADHD medications in the main, obviously inc both increased baseline levels of dopamine and more [00:29:00] adrenaline, and help release, from the synapses basically.

So the brain connections now. Nicotine obviously is blunting these receptors and it’s stopping the dopamine and noradrenaline that the medication is helping produce from taking up the, the, uh,the neurotransmitters, the chemicals. Sorry for a second there. So what’s the implication?

Well, people may find that because the medication isn’t as effective, the ultimate, well the ultimate thing to do is obviously to quit, but it takes from the time of quitting, it takes about three months for a person’s baseline dopamine to return back to normal. so obviously a baseline person for someone with ADHD is different than someone without ADHD.

It [00:30:00] is three months. So the point I’m getting to is that you may notice, or you may indeed, with involvement in the psychiatrist, notice that your medication is being less effective

Laurence Pratt: and that you may need an alteration in dose IEA higher dose because it’s not working as well as it used to. so that is a third implication,

Yeah.

Marc Picot: but obviously quitting is gonna be the ideal.

The Struggle of Quitting Vaping with ADHD

Laurence Pratt: But again, it’s gonna be much harder for someone with ADHD because the symptoms of withdrawal from vaping or nicotine in particular. Are the symptoms of ADHD. So you are restless, you can’t focus, you’ve got the emotional symptoms of mood swings,anxiety, et cetera. poor focus and productivity, et cetera.

Marc Picot: So it [00:31:00] is even harder for people with ADHD to quit nicotine because,the underlying, effects of withdrawal, are those of ADHD. But of course, your baseline levels are lower enough already, so it’s even harder. yeah, I understand why you said that quitting was one of the, most difficult things that you’ve done.

Laurence Pratt: In order towill you need willpower effectively. that’s the thing that you’re gonna need the most. And one of the executive functions that,someone with ADHD is, lacking in, is, impulsivity or the ability to,stop impulsive behavior. and what’s happening when you are vaping is that you are,you are following you, you are, reacting to those impulses. And as we sort of discussed, like before we came on air, It’s not like smoking where, maybe you live in a household where people don’t want you to smoke.

So [00:32:00] it, it is easy to not smoke all the time because you know it’s gonna make a smell in the house. But with vaping, you can smoke in the, you can vape in the house and people aren’t gonna smell it. They might not smell it on your clothes. You may even have it by your bed. And you wake up in the middle of the night and you vape. And people often to talk about, willpower, you’ve gotta exercise it like you, you do in the gym. and it gets stronger over time. If you have been vaping chronically where you, your willpower is zero, then it’s gonna be extremely hard to, muster up that willpower in order to start the process of quitting.

Marc Picot: Yeah, so Will willpower is very important. I would absolutely agree with you on that. but it’s gonna take a lot more than willpower alone. So again, from smoking, we know that people who use willpower alone, only 5% of them will be success. And then [00:33:00] 95% will, will. Or either not be successful, will have an earlier relapse.

So it is about developing healthier coping strategies rather than vaping. So a lot of people will vape because of stress or to help with underlying mental health issues like anxiety or low mood. They might do it just purely out of boredom.they might do it because it’s become a habit more than an actual pleasure.

as you said, it’s because it’s so more accessible. The constant hand to mouth action is in itself something that people find very difficult to break. They don’t know what to do with their hand anymore, because it’s so ingrained in their brain, what do I do with my hand?

Understanding Non-Nicotine Vapes

Laurence Pratt: And I actually know several people that are addicted to.

Marc Picot: Non-nicotine vapes. So they’ve got down to zero [00:34:00] and they’re stuck vaping. 0% Nick, 0%, vapes because they, it’s just the habit. It’s just like, it’s something that calms them. so it is learning about healthier coping strategies, to address the underlying root cause of why you are vaping,

Laurence Pratt: it for them?

Marc Picot: So then, try and find some hobbies. Trying to try and find something to entertain you. That’s, so that’s a really broad answer, but obviously it can be narrowed down if it’s stress learn stress management and coping strategies, as increasing,the dopamine in your day.

short bursts of exercise or, me and you both have dogs, Playing with a pet, there’s a little spike in dopamine. so it’s all these things that just naturally boost dopamine. So willpower, yeah, very important. You’re not gonna succeed if you think this is gonna be easy. but developing those healthier adaptive coping strategies is also incredibly important.

Laurence Pratt: so you [00:35:00] mentioned, in that boredom, stress and habits and I wanted to touch upon on the habitual nature of it, as you sort of mentioned. 

The Chimp Paradox and Habit Formation

Laurence Pratt: in a lot of times during the, ADHD goals podcast I’ve mentioned, I dunno if you’re familiar with, the Chimp Paradox. it’s basically this concept that talks about system one and system two of the brain. the prefrontal cortex is the part of the brain that, that,manages the executive functions quite well, and it make, makes decisions like adulting decisions that, that we need to get through our day. And then in the absence of that, we’ve got this autopilot, which is our chimp brain in this analogy. And that basically is our fight flight and freeze mechanisms. it’s there, it’s much stronger to react, because it needs to save our life effectively, but it’s also very efficient when it comes to habits. so for example, if you are learning to drive. If you’ve never driven before, it’s gonna be, it is gonna take a lot of attention and brain power. after a month or a, six months or a [00:36:00] year after passing your test, it’s becomes na, it becomes a habit and it transfers from, the one system into the other system where it becomes something that becomes a habit. and therefore, with ADHD, because we haven’t got enough dopamine to power that prefrontal cortex the whole time means we’re most of the time really, the chimp is on. Autopilot. And so when we create bad habits, we are susceptible to the fact that the chimp is in charge.

and it, and what’s gonna help us is not fighting against the habit, the bad habit, but maybe trying to use the chimp that we’ve got because it’s gonna be there all the time, and maybe replace it with good habits,and teaching it that this new habit can actually, us. and maybe so understanding, like you say, stress and boredom, analyzing our behaviors and try and see if we can target specific things and replace those [00:37:00] behaviors with better ones.

Marc Picot: Yeah, sure. Yeah. That I’m aware of that book’s written, I can’t remember what he’s saying. Peter. Peter,

Laurence Pratt: Peters. Yeah.

Marc Picot: even Peter, so he’s a, he’s a sport, sports psychiatrist.

Laurence Pratt: Yeah.

Marc Picot: Yeah. So

Laurence Pratt: with Ronnie Sullivan and

Marc Picot: he’s where everyone, Sullivan. Yeah. And the British cycling team, et cetera. So yeah, I’m aware of the shrimp paradox. yeah, I read it.

He helped me actually in the question.

Laurence Pratt: Yeah.

Marc Picot: anyway, yeah, so you’re exactly right. 

Cognitive Behavioral Strategies for Vaping

Marc Picot: with vaping it’s, there’s There’s two things I wanna talk about here is your thoughts, and the second bit is your behaviors. So obviously, you know I’m talking about a cognitive behavioral model.

Laurence Pratt: so when you are bored, for example, so the first thing you do is reach for your vape. So it’s about thinking, or you may even be on autopilot as you said, but it’s about recognizing what your triggers are. So if it’s boredom, [00:38:00] that’s your trigger. Your queue is to then reach for the vape. So what we need to do is reset that and go right, trigger, I’m bored.

Marc Picot: Then think of alternative strategies, right? So what I’m bored right now, what can I do differently other than reach for my vape? Can I go outside and just do a 20 minute walk? Can I call a friend? Can I do a little bit of work? Can I read sketch? Anything other than reaching for your vape? So it is about identifying your own individual triggers and then coming up with alternative, coping strategies.

So it may not be,boredom, don’t really know how to describe it, but say stress or anxiety. That’s more of a, a cognitive thing or an emotional cue. So it’s thinking, I’m really stressed right now, or I’m really anxious of panic. I need to [00:39:00] vape. it’s about then in that situation, it’s about reframing those thoughts, thinking, right, okay.

I’m feeling really stressed and anxious right now. Okay. My normal behavior is going to be reach for the. How can I reframe my thought to try and help reduce my stress and anxiety that I either don’t need to reach for the vape at all, or I can carry out one of these behavioral act activations that is more of a healthier coping strategies coping.

So it’s about identifying your triggers are really important, and then replacing them with cope, healthy coping strategies, whatever that may be for you. So it is obviously very important to tailor it to each individual person.

Laurence Pratt: So it’s essentially short term tactics. long term tactics as in, when you get that [00:40:00] urge, what, what are you going to do in the short term that instant to, to fight the urge. But then over the longer term, and you use the word reframing,is sort of just educating your subconscious about what’s happening.

and that reminds me about, you talked about, the book, the Alan Carr method. 

The Allen Carr Method Explained

Laurence Pratt: and I remember reading that and I wonder if you could de describe it to me, but it’s very much like a reframing, the cover to cover is talking about what’s going on, why people smoke. And it’s quite an interesting psychological, read about why people smoke.

And it, it really, it keeps going. It keeps going and keeps going.

Marc Picot: so the Allen car method is, um.a really quite a unique method because, it actually, encourages you whilst you are reading the book to actually carry on smoking or vaping. but whilst you are reading the book, it’s teaching you about what you’re gonna do when you [00:41:00] set a quick date to stop.

Laurence Pratt: it says in the meantime, you vape away.

Marc Picot: Really? what it,and it actually talks about, again, it talks about these two sort of, I can’t remember exactly what it describes, but these two characters similar to the Chimp paradox. one is more of your, a bigger voice and one is more the internal voice. the bigger voice is the kind of like the nicotine speaking and the internal voice is like your own and what,And it is quite an interesting way of doing it. ’cause it actually, it, it teaches you by the time you get to your quit date to really actually hate, vaping. He really want, he really pushes it that you hate vaping. it’s disgusting every time you pick up a vape, it’s, it is really pushed in that kind of sense that you are reframing that it’s no longer a friend or a temporary relief.

it’s an absolute enemy.

Laurence Pratt: Yeah.

Marc Picot: so [00:42:00] that’s the way that the Allen Carr method works. And it is a willpower method because it’s a cold Turkey method when you get to your quit date. and then you carry out the, psychological techniques that, they describe in the boat basically. 

Laurence Pratt: it is as a sort of reframing exile. I really recommend it because it does make you think as you’re reading it, like the longer it goes on, you’re like, this is completely stupid. Smoking of vaping is

Marc Picot: Yeah. Yeah.

Challenges with Quit Clinics

Laurence Pratt: but, just to go back to something you said at the beginning and we, you talked about, the quick clinics, and them really only being available for smokers.

I mean, I did it as well. I went, I contacted my doctor and said, I want to quit vaping. And then they put me through, and this is the thing, you get passed off to another de department of somewhere else and they don’t know that you’ve asked that you wanna stop vaping. So there you get an interview there and they say, oh, well you wanna stop vaping?

Well, we just recommend people vape because we assume you’re trying to stop smoking. And then they go, well, there’s nothing [00:43:00] really we can do about it. so what? What was your experience with that? and then how does that lead into to, what you’ve, put together as a help for to stop, quit vaping.

Marc Picot: Yeah. so as I, as I, we discussed before, we’re on areas that I live in. In the Channel island. So it’s really quite a small place. So we only have one stop smoking clinic and they were the ones that I approached and I had exactly the same experience as you, Laurence, is that they said, well, we a smoking clinic.

the reasons they came up with was some were practical reasons, like, well, we don’t know much about vaping. so sorry. We can’t really help others. Were more of a bureaucratic reasons like, oh, we’re only funded or commissioned for smoking. we can’t help vapers. ’cause then our smoker wait list will go up.

So they turn me away. across the whole of the uk there is a handful. When I say a handful, I’m probably only aware of [00:44:00] literally a handful of,

Laurence Pratt: probably about five. I know that there’s one in bath. I think there’s one in Sheffield. there’s the only one for children, specialized in children, and that’s in all the hay in Liverpool.

Marc Picot: So they are very few and far between. So this is why I sort of, wanted to start what I was doing. 

Introducing Vape Escape

Marc Picot: so I run, I founded a,this project called Vape Escape. so basically I wanted to provide, some services and and products for those looking to vape. So my website itself has got lots of, helpful and credible resources on there.

so links to external resources that people can look at for advice and education. And I think education is actually really important without the underlying education and an awareness. then I think people will continue to vape. So once you’ve got that, then you can move on to the actual treatment phase.

I write blog posts regularly, at least once a week, so there’s lots of blog posts on there. Not just for people [00:45:00] looking to quit vaping, but for parents of children, for schools, for healthcare professionals. and up to date evidence I summarize as well. So there’s lots of information up on there.I’ve authored, as you said, a book called The Last Puff, which is an ebook, but it’s also out on Amazon.

so that was basically, I came, I’ve come up with my own sort of Alan Carr method because there’s nothing really,of substance. so there’s this combin combination of CBT, a bit of, Acceptance and, commitment therapy and their bit of sort of mindfulness based CBT and a bit of a mishmash of, I just put something together, but I, it worked for me.

And, after speaking to countless vapers, I was just getting their personal stories about, and identifying the underlying problem. I also have an online course that I’ve written as well, that people can access on my website, which is vape scape.org [00:46:00] uk. I work

Laurence Pratt: in the show notes.

Marc Picot: perfect. Okay.I, do coaching myself.

So I coach individuals. and I also work alongside a team of five therapists that, addiction therapists. and I’ve personally trained them about vaping itself ’cause. Not many therapists are aware. the final thing, and the thing I’ve been working on for a long time is my mobile phone app, which is soon to launch in two to three weeks.

It’s already been approved in a Google store just waiting for approval by Apple. and that will be out very soon available to download. yeah, so people can check that out and it’s like a, a pocket digital tool that they can have with them. it’s got instant craving management advice on, there’s about 15 to 20 different techniques that people can use.

again, it’s got an education resources hub. it’s basically [00:47:00] a mini version of my website. and then there’s things like motivational trackers on there, and a, a community like a, almost like a little Reddit with some subreddit on there as well.

so yeah, that’s basically what I’m doing at the moment.

Laurence Pratt: it’s become a full-time, job for me essentially. So it is, it sounds very much like, and I think we’ve sort of touched upon areas of it here is that, and it’s very similar to sort of ADHD coaching in terms of coaching the executive functions because. ADHD affects your brain, and your brain is the control system for your entire body and thoughts and processes. because, nicotine addiction is affecting,as executive functions and your brain in reality when it comes to overcoming those or quitting those, it’s not isolating one thing and just saying, this is what I need to work on, and if I do that, it’s gonna be fine.

It’s, [00:48:00] you have to really look at it, and I say this word with air quotes holistically, as in you need to look at your whole, all your triggers, all your life, all your situations, and come up with different solutions for each context in order to pull together, in order to overcome and quit. Like, like you say, like the Allen Carr reframing is just one part of it, reducing those thoughts over time. Partnered with, what am I gonna do in the moment, the track, the tracking element is to give you a bit of a boost and a motivation to say,I’m winning.

Marc Picot: Yeah.

Laurence Pratt: then the support mechanism of other people there to, maybe just sort of help and accountability, which is all very similar to sort of, A

Marc Picot: Yeah.

Laurence Pratt: executive function coaching.

Marc Picot: I was gonna say, I was gonna, you took the words right outta my mouth. So yeah, the support network you have around me is incredibly important. in, in the app for example, you can buddy up with someone, so that provides some accountability. so providing accountability and coaching is very [00:49:00] important.

so yeah, so it’s,it’s a combination of what to do in the moment IE when you get a craving, versus what to do in the long term. So what is your underlying why? So what is, why do you want to quit identifying that? a lot of people want to quit either because they want to break free from the clause of addiction.

some people,are worried about health concerns. So it’s identifying why, and then identifying, root causes. So are you overly stressed? Are you overly anxious? Are you isolated, lonely, and bored? And it’s identifying those root causes that then trigger you to want to vape. So yeah, so it’s the short term fixes, the longer term fixes.

The Dual-Pronged Approach to Quitting

Marc Picot: And then lastly is separating it into two things is the nicotine dependency, [00:50:00] but also the hand to mouth mechanism as well. And I can’t emphasize how important that is. So I call it the dual pronged approach. So learning things that you can do with your hand to break that. And it is literally ingrained in the motor cortex of your brain.

I think they’ve even done functional MRI scans that shows that people, it lit, it’s lit up that your,

the area that’s involved with your dominant arm.

Laurence Pratt: can start picking your nose.

Marc Picot: Picking your nose is one thing you could do that you, you could, yeah. I

Laurence Pratt: your

Marc Picot: something else,

Laurence Pratt: more acceptable than

Marc Picot: Yeah.

Laurence Pratt: a meeting?

Marc Picot: But you know, there’s a few examples.

and the other thing is, it’s about oral fixation. So things like people, have, toothpicks, string gum or even just a straw, with your hands having a stress ball or having some, [00:51:00] beads, or a short term amount of gaming, for example, which occupies both your mind and your hands.

’cause you are focused on whatever. Game that you’re playing,

Laurence Pratt: sketching ’cause again, or drawing or, because that’s both mind and hand, mind and body. So it is, it’s about those two things. yeah, it’s, it is basically in summary, it’s a complex and, and, difficult to beat addiction.

Marc Picot: nicotine is the third most addictive drug after heroin and cocaine. So it’s, no, it’s no, minor substance to overcome.

Laurence Pratt: Yeah.

And especially for,the listeners of your podcast and yourself, Laurence. But ADHD, it’s even more difficult to overcome ’cause of, your, the underlying, Pathology Yeah.

Marc Picot: or cause of what causes ADHD, which is in keeping with the withdrawal effects from nicotine.

Laurence Pratt: Yeah.I [00:52:00] was gonna mention you mentioned that hand to mouth thing and earlier you mentioned sort of, the zero nicotine vapes. one thing that’s really helpful for me was, there’s like this fum a few, I dunno how it’s. Pronounced, but it’s basically, it, there’s no but it, you breathe in air through it, like, like a straw and

Marc Picot: things in it,

doubles as a clicky thing.

Laurence Pratt: ’cause you can, there’s an A SMR thing there,

Marc Picot: Okay. Yeah.

Laurence Pratt: so it does help you do stuff with your hands, but like, like you say, like fidget tools and stuff.

Marc Picot: Yeah.

Laurence Pratt: but yeah, it’s still, but maybe it’s better sort of during the initial trying to, give up, where you’re still doing that hand to mouth.

And then over a longer period of time where you’re, like drawing, having your hands busy, but doing, not putting it to your mouth, the drawing exercises. It’s, yeah. That’s really great.

so listen, mark, it’s been a fantastic. chat and I’m really sort of excited about the fact that your app is gonna be available very [00:53:00] soon.

I’m, I’d love to take a look at it when it’s available, and, and, yeah, that would be brilliant. But, yeah. So what else is in store for you over the coming months after the launch of the app? Is there anything else the wings.

Marc Picot: so I just want to improve on, I’m actually going through a campaign at the moment on my visibility around schools. so in particular tackling vaping amongst youth. I’m piloting all my services that I’ve just named within schools. So locally, we’ve got about 11 secondary schools, sixth form higher education.

I am looking at piloting all my services that I’ve mentioned, plus going in person, giving seminars or workshops to teachers, teaching them about how to address vaping if found. Doing, going to parents to Teachers Association, speaking to parents, but how can they can help their child, if they’re caught [00:54:00] vaping.

Vaping Among Youth and ADHD

Marc Picot: So I’m going on a,a youth drive, trying to increase the availability of help to, to youth, to overcome vaping because, there, there’s some shocking statistics there. 25% of, 18 year olds vape regularly. and when we say vape regularly, it wasn’t defined any more granular than that.

Laurence Pratt: But if you vape regularly, the third most addictive drug you are most probably gonna be doing it daily. 25% of 18 year olds with a plastic brain that doesn’t stop growing until the age of 25,is really not a good thing. was gonna ask you about that and surprised we haven’t touched upon it until now, but you know that, we are looking at, and to just talk about, vaping and ADHD and,the youth is that it’s reported that, ADHD diagnoses are going up, and that’s for lots of reasons, because we are getting better at,detecting it.

the diagnosis criteria has broadened. There’s more studies [00:55:00] about how,ADHD shows up in females. so the platform for having ADHD has grown, but also we’re in a, we’re in a part of our time where that dopamine baseline crashing. got far more, more things that are affecting that. as in, people scrolling on their phones and, reducing impulsivity, we’ve got vaping, et cetera. So what I’m trying to say is it’s very difficult to understand what is an increase in an actual increase in ADHD diagnosis, as well as the effects on a neurotypical brain of things that will cause executive dysfunction.

Like we’ve just said, crash in a dopamine baseline will have the same effect on a neurotypical brain and it will mimic what ADHD looks like.

Marc Picot: Yeah.

Laurence Pratt: therefore what we’re seeing is maybe an a rise in a lot of people having ADHD because we know what ADHD is, but also a rise in people [00:56:00] having what looks like ADHD

Marc Picot: And also I’m trying to go back to the thing that you just mentioned is. What effect is that having on a, on a child’s brain where they are attacking their, executive dysfunction or the dopamine crashing.

what if it was a neurotypical brain to start with and then they go through all, these bad habits like scrolling on, on their phones and vaping, is that gonna have a lot long lasting effects 

Laurence Pratt: I.

Marc Picot: there’s definitely good level of evidence that it indeed creates symptoms that are similar to, ADHD. So impulsivity, but also it cau can cause them cognitive, deficits.

It can cause loss of focus, productivity, poor academic performance, mental health problems, and,a gateway effect. by gateway effect, we mean a gateway effect to smoking, not to illicit substances. there’s weak evidence about illicit substances, but to smoking. Funnily enough, in the [00:57:00] UK they haven’t proved this gateway effect, but.

Everywhere else in the world, pretty much including Australia, where they showed it’s three times more likely. Ireland, Scotland, sorry, let’s say England, they haven’t proved it. and America, they, it’s shown that it leads onto this gateway effect where people who children who vape actually, start smoking.

which is a pretty disastrous. so yeah, as I said,the brain continues to grow to the age of 25 and children in particular, because they’re attracted to these point of sales vapes, the disposable ones that are now non-disposable because you’ve attached to. To them, they are the highest legal content of nicotine that you’ve got in there.

So they, their brains are soaked in nicotine, and as I said, it, it leads onto these problem cognitive problems. [00:58:00] academic, poor academic performance, and leading onto things like truancy, behavioral issues. so yeah, it really does cause, cause problems,and long lasting problems as well.

Laurence Pratt: in terms of. terms of the fact you mentioned before that, nicotine dulls the dopamine receptors, and I just thought that, I wonder if whilst that brain is growing, if it’s dulling the dopamine receptors, that it’s not giving that brain enough chance to develop,its infrastructure as it should.

And therefore somebody who is a neurotypical had a neurotypical brain

Marc Picot: the time they’ve fully grown brain, it’s not grown as much as it should have. and therefore it sort of mimics the fact of what it would’ve been like if they had biological sort of ADHD in the first place.

Yeah, the, my honest answer to that would be I’d have to go away and look it up. I know. It’s, nicotine in youth is associated with a whole range of symptoms. Whether, whether they’ve actually, pinned them down to specifics [00:59:00] like ADHD,I don’t know, but it, I mean, it would make sense, although in the neurotypical brain,Endogenous levels of, dopamine and a dopamine receptor sensitivity return back to the normal within three months. obviously something with ADHD, both of those, well, your receptors are lower in number and, but your dopamine levels are lower, so your baseline is obviously,not typical.

yeah. So I would have to go away and look that one up.

Laurence Pratt: I think also just as a fi final thing, it’s not just the biology, at that age, we are, we’re all products of our childhood and whilst, nicotine has a, an effect on the biology, what it’s doing to our impulsivity and our patterns of behavior,

Marc Picot: those patterns of behavior that we’re teaching ourselves in our childhood, they’re gonna stick around for a long time.

And so that, like you were saying, that gateway element, that’s, it’s gonna. Set us off on the wrong foot, pretty quickly. and that’s takes a long time to, to work through.[01:00:00] Yeah,yeah. I mean, you go, I mean, I’ve had lots of therapy and seen, psychiatrists,I’m sure many of your listeners have as well. the very first thing they start off with is they go all right back to the start and start asking you about your childhood. so you know, your development and because of how critical it is to, how it shapes you as a, as an adult.

vaping in, as a child in youth,and the patterns of behavior that you may adopt as a result while you’re doing it. yeah, may well have long lasting implication.

Final Thoughts and Resources

Laurence Pratt: Well, thank you, Marc. It has been a fascinating chat and as I think we could chat for hours more on this, but yeah, to the listeners, I recommend that you head on over to vape escape.org.uk. Check out his website, it is for individuals and for organizations as well. And do keep a close eye on when that app is dropping in the various app stores.

And, yeah. Thank you so much, for coming on the show. It’s been a pleasure to chat with you.

Marc Picot: My pleasure. [01:01:00] Thank you very much.

Laurence Pratt: All right, take care. Thank

Marc Picot: Thanks.

Laurence: Well there, we have it. Thank you so much for listening this far. If you want to hear more episodes, then please subscribe on YouTube or whatever podcast platform you use. It really helps us spread the word. So if you know anyone, this episode could help, then please share it with your friends. If you want to follow me on social media, I am on Instagram at ADHD underscore goals. And you can find me on Facebook too. If you want to get into touch with the show, then you can email me at hello@adhdgoals.co And finally, if you’re struggling to manage your ADHD and you would like me to be your coach, then please head over to my website and get in touch. Until next time. Bye for now.