Structural Conditions as Cause: Explaining the Rapid Rise in Youth E-Cigarette Use by Re-thinking Models of Addiction

Background: E-cigarette use has spread rapidly and widely among youth, to an extent that has surprised some researchers.Objectives: We suggest that this surprise is owing to a particular limitation in the dominant models of addiction - namely, a strong focus upon addictive substances as cause. We argue that the phenomenon at hand is easier to comprehend when less attention is placed upon preventing the use of specific substances and more upon what we identify as structural susceptibility to addiction instead.Results: Drawing upon neurobiology, history, public health theory, and social theory, we re-conceive addictive substances as mechanisms of escape from social structures that predispose whole societies to addiction.Conclusions/Importance: We argue that the surge in youth e-cigarette use in particular, as well as the phenomenon of addiction in general, are easier to comprehend if models of addiction are expanded to conceptualize the problem in its wider dimensions. We invite addictions researchers to join us in expanding the field's analytical view.