Vaping is sweeping through our youth like wildfire. This year alone, social workers have seen more teens with vapes in hand than ever before. It’s not just a few — it’s almost everyone in some groups. At Care Corner, nearly all 300 young people they meet on the streets are vaping. Some are even using dangerous, drug-laced vapes. At MWS Girls’ Residence, half the girls admit to vaping this year — a sharp jump from last year.
Why do they do it? Stress, peer pressure, and the lure of sweet flavors draw them in. Friends pass vapes around like candy. Most think it’s safer than smoking. But it’s not.
Malcolm’s story is a warning. After failing his O-levels, he turned to vapes laced with etomidate, hoping for comfort. Instead, he faced blackouts and deep sadness, trapped by what he thought would help.
These clouds of smoke fill malls, train stations, and school corners — anywhere teens gather. But behind the haze are risks no one should face.
Our kids deserve better. Let’s clear the air, together.
The Scale of the Problem
Seven social service agencies report seeing more young people vaping, with a notable spike in early 2025. Some alarming statistics include:
- We Care Community Services has helped over 30 clients quit vaping in 2025 alone
- Care Corner reports almost all 300+ youth in their street outreach program are vaping
- About a third of these youth were abusing etomidate-laced vapes (Kpods) by August 2024
- At MWS Girls’ Residence, half of residents said they vaped in 2025, up from 35% in 2024
Why Youth Are Vaping
The article identifies several concerning motivations:
- Stress coping mechanism – Youth use vaping to deal with academic pressure and disappointment
- Social acceptance – Vaping has become normalized in peer groups, with over 75% of surveyed youth having more than five people in their social circles who vape
- Misconceptions – Many view vaping as a “safer alternative” to smoking
- Accessibility – The variety of flavors makes vaping appealing
- Gateway through relationships – Many are introduced by friends at school or boyfriends
The Health Risks
The case of Malcolm, an 18-year-old who used etomidate-laced vapes after failing his O-levels, illustrates the severe consequences. He experienced daily blackouts and worsening depression despite initially using vapes to cope with mental health issues.
Etomidate, meant only for medical procedures, can cause:
- Spasms and breathing difficulties
- Seizures
- Psychosis when vaped
Where Vaping Occurs
Despite being banned in Singapore, youth are vaping in various public spaces:
- Shopping malls
- Public transport (MRT stations and trains)
- School premises and nearby areas
- Staircases, toilets, and multi-story car parks
- Streets and public smoking areas
Government and Industry Response
Prime Minister Lawrence Wong announced during the National Day Rally that authorities will take tougher action against those selling etomidate-laced vapes. Shopping mall operators like Frasers Property and CapitaLand Investment are stepping up security patrols and CCTV surveillance.
The Land Transport Authority has warned that commuters caught vaping will be removed from public transport, with police involvement for those found intoxicated.
Support Services
Multiple organizations are now offering vaping cessation programs:
- We Care Community Services provides daily drop-in centers with counseling
- Allkin Singapore started vaping-related programs in 2024
- Care Singapore works with primary schools on intervention programs
The article highlights how this issue spans across different demographics – from high-achieving students to those with existing behavioral challenges – making targeted intervention more difficult. The normalization of vaping among youth peer groups appears to be a significant factor driving this trend.
Youth Vaping Crisis and Evidence-Based Therapeutic Solutions
I. The Scope and Severity of Youth Vaping
Global and Regional Trends
While recent US data shows half a million fewer youth reported e-cigarette use in 2024 compared to 2023 CDCTruth Initiative, the Singapore situation appears to be moving in the opposite direction, with social service agencies noting a spike in the first quarter of 2025.
Critical Statistics:
- Among students who reported current e-cigarette use in 2024, 38.4% reported frequent use and 26.3% reported daily use E-cigarettes: Facts, stats and regulations
- About 7 in 10 students who vape want to quit, and nearly two-thirds have tried to quit with some trying to quit 10 or more times Nicotine dependence intensifies among Minnesota teens who vape – MN Dept. of Health
- Studies show that close to 90% of adult daily smokers started before the age of 18 The Vaping Epidemic in Adolescents – PMC
The 10-Year-Old Phenomenon: Developmental Vulnerabilities
The fact that children as young as 10 are starting to vape is particularly alarming due to several developmental factors:
Neurobiological Vulnerability:
- Adolescent brain sensitivity to nicotine E-Cigarette Use Among Youth | Smoking and Tobacco Use | CDC is significantly higher than adults
- The adolescent brain continues developing until age 25, making it more susceptible to addiction
- Increases in youth vaping prevalence have been accompanied by greater levels of vaping dependence according to various indicators, including perceived addiction, urges to use, times vaping in a day, and time to first vape after waking Trends in vaping and nicotine product use among youth in Canada, England, and the US between 2017 and 2022: evidence to inform policy – PMC
Psychosocial Factors:
- Peer pressure and social acceptance seeking peak during early adolescence
- Limited impulse control and risk assessment capabilities
- Higher susceptibility to marketing and flavor appeal
II. Root Causes Analysis
1. Stress and Mental Health Crisis
The Singapore article reveals vaping as a maladaptive coping mechanism for:
- Academic pressure and failure
- Depression and anxiety
- Social stress and fitting in
2. Social Normalization
- Over 75% of surveyed youth have more than five people in their social circles who vape
- Peer introduction through school friends and romantic partners
- Misconception that vaping is “safer” than smoking
3. Accessibility and Appeal
- Variety of appealing flavors
- Easy concealment and discrete use
- Inadequate regulation enforcement
- Social media influence and marketing
4. Knowledge Gaps
- Limited understanding of addiction potential
- Unawareness of serious health risks, especially with etomidate-laced products
- Lack of awareness about cessation resources
III. Evidence-Based Therapeutic Solutions
A. Individual-Level Interventions
1. Motivational Interviewing (MI)
Motivational interviewing is an evidence-based approach that has been shown, when delivered by clinicians or trained counselors, to be more effective in increasing readiness to quit and in helping people quit smoking than brief advice or usual care Interventions for Smoking Cessation and Treatments for Nicotine Dependence – Smoking Cessation – NCBI Bookshelf
Implementation for Youth:
- Non-confrontational approach respecting adolescent autonomy
- Exploring ambivalence about vaping
- Building intrinsic motivation for change
- Addressing personal values and goals
Specific Techniques:
- Open-ended questions about vaping experiences
- Reflective listening to understand motivations
- Summarizing and affirming youth’s own reasons for change
- Rolling with resistance rather than confronting denial
2. Cognitive Behavioral Therapy (CBT)
Core Components:
- Trigger Identification: Mapping situations, emotions, and social contexts that lead to vaping
- Cognitive Restructuring: Challenging beliefs about vaping benefits and developing healthier thought patterns
- Behavioral Skills Training:
- Refusal skills for peer pressure situations
- Alternative coping strategies for stress management
- Urge surfing techniques for craving management
Youth-Specific Adaptations:
- Incorporating technology and gaming elements
- Shorter, more frequent sessions
- Visual aids and interactive materials
- Peer-focused scenarios and role-playing
3. Contingency Management (CM)
Clinical practice medications (including nicotine replacement therapy, bupropion, and varenicline) have been prescribed to this population with consideration of risk-benefit analysis when behavioral treatments are not sufficient Adolescent Tobacco/Nicotine Use and the Potential Role of Contingency Management-based Interventions – PubMed
Evidence-Based Approach:
- Immediate, tangible rewards for abstinence milestones
- Escalating reward schedules
- Integration with existing reward systems (family privileges, school incentives)
- Use of biochemical verification (CO breath tests, cotinine tests)
4. Family-Based Interventions
Multisystemic Therapy (MST) Principles:
- Addressing family communication patterns
- Parent education about vaping risks and signs
- Developing family-based monitoring and support systems
- Improving parent-teen relationships to reduce risk factors
B. Group-Based Interventions
1. Peer Support Groups
- N-O-T (Not on Tobacco) Programs: INDEPTH is an alternative for students who face suspension for violation of school tobacco, vaping, or nicotine use policies. Students participate in interactive, facilitator-led sessions in a school or community-based setting Helping Teens Quit Smoking and Vaping | American Lung Association
- Structured peer-led discussions
- Shared experience and mutual support
- Accountability partnerships
2. Group CBT Programs
- Cost-effective delivery model
- Peer learning and modeling
- Social skills development
- Reduced stigma through shared experience
C. Technology-Enhanced Interventions
1. Digital Therapeutic Platforms
Research protocols are being developed for delivering vaping cessation interventions to adolescents and young adults on Instagram, measuring biochemically verified 7-day point prevalence abstinence for nicotine vaping PubMed CentralBMC Public Health
Components:
- Mobile apps with tracking capabilities
- Gamified quit journeys
- Real-time craving management tools
- Peer support networks
- Educational modules
2. Text Messaging and Chat-Based Support
- 24/7 accessibility for crisis moments
- Personalized messaging based on quit stage
- Integration with counselor support
- Automated check-ins and progress tracking
D. Pharmacological Considerations
Nicotine Replacement Therapy (NRT)
Nicotine Replacement Therapy (NRT) can be a useful tool in helping youth quit tobacco use Nicotine Replacement Therapy and Adolescent Patients
Youth Considerations:
- Reserved for heavily dependent adolescents
- Careful risk-benefit assessment
- Close medical supervision required
- Integration with behavioral interventions essential
Contraindications and Cautions:
- Not recommended for light or occasional users
- Potential for creating new nicotine dependence
- Need for cardiovascular screening
- Parent/guardian involvement required
IV. Comprehensive Treatment Framework
Phase 1: Assessment and Engagement (Weeks 1-2)
- Comprehensive Assessment:
- Vaping history and patterns
- Dependence severity using validated tools
- Mental health screening
- Family and social context evaluation
- Medical evaluation for etomidate exposure
- Engagement Strategies:
- Non-judgmental approach
- Collaborative goal setting
- Psychoeducation about addiction as a medical condition
- Hope installation through success stories
Phase 2: Active Treatment (Weeks 3-12)
- Individual Therapy (Weekly 50-minute sessions)
- Motivational interviewing techniques
- CBT skill building
- Relapse prevention planning
- Family session integration
- Group Support (Weekly 90-minute sessions)
- Peer support group participation
- Skills practice in group setting
- Social learning opportunities
- Family Involvement
- Bi-weekly family sessions
- Parent education programs
- Communication skills training
- Environmental modification planning
Phase 3: Maintenance and Relapse Prevention (Months 4-12)
- Reduced Frequency Contact
- Bi-weekly individual sessions
- Monthly group sessions
- 24/7 crisis support availability
- Relapse Management
- Rapid re-engagement protocols
- Learning from slip experiences
- Treatment plan modifications
- Long-term Support Systems
- Alumni support groups
- Peer mentorship programs
- Integration with school counseling services
V. Special Considerations for Singapore Context
Cultural Adaptations
- Integration of Asian family values in treatment
- Consideration of academic pressure as primary stressor
- Culturally appropriate peer support models
- Integration with existing social service networks
System-Level Recommendations
- School-Based Programs:
- Universal screening protocols
- Early intervention in educational settings
- Teacher and staff training programs
- Healthcare Integration:
- Primary care screening protocols
- Referral pathways to specialized services
- Integration with existing mental health services
- Community-Based Approaches:
- Mall and public space intervention programs
- Community youth worker training
- Public awareness campaigns targeting youth and families
Addressing Etomidate-Laced Products
- Specialized medical detoxification protocols
- Extended monitoring for neurological effects
- Integration with substance abuse treatment services
- Family education about signs of severe intoxication
VI. Outcome Measurement and Success Indicators
Primary Outcomes
- Biochemically verified abstinence rates
- Reduction in frequency and intensity of use
- Improvement in mental health symptoms
- Enhanced coping skills and stress management
Secondary Outcomes
- Academic performance improvement
- Family relationship quality
- Peer relationship changes
- Long-term health indicators
VII. Implementation Challenges and Solutions
Challenges
- Adolescent Resistance: Natural developmental tendency toward autonomy and risk-taking
- Peer Influence: Strong social pressures to continue vaping
- Accessibility: Continued availability of vaping products
- Stigma: Fear of punishment or judgment preventing help-seeking
Solutions
- Youth-Centered Approach: Involving young people in program design and implementation
- Harm Reduction Elements: Meeting youth where they are in their change process
- Integration with Existing Services: Leveraging current mental health and social services
- Policy Advocacy: Working toward systemic changes in availability and enforcement
The rise in youth vaping represents a complex public health challenge requiring multi-faceted, evidence-based interventions. Success depends on combining individual therapeutic approaches with family, school, and community-level changes, all adapted to the specific cultural and social context of Singapore’s youth population.
Youth Vaping Crisis and Evidence-Based Therapeutic Solutions
I. The Scope and Severity of Youth Vaping
Global and Regional Trends
While recent US data shows half a million fewer youth reported e-cigarette use in 2024 compared to 2023 CDCTruth Initiative, the Singapore situation appears to be moving in the opposite direction, with social service agencies noting a spike in the first quarter of 2025.
Critical Statistics:
- Among students who reported current e-cigarette use in 2024, 38.4% reported frequent use and 26.3% reported daily use E-cigarettes: Facts, stats and regulations
- About 7 in 10 students who vape want to quit, and nearly two-thirds have tried to quit with some trying to quit 10 or more times Nicotine dependence intensifies among Minnesota teens who vape – MN Dept. of Health
- Studies show that close to 90% of adult daily smokers started before the age of 18 The Vaping Epidemic in Adolescents – PMC
The 10-Year-Old Phenomenon: Developmental Vulnerabilities
The fact that children as young as 10 are starting to vape is particularly alarming due to several developmental factors:
Neurobiological Vulnerability:
- Adolescent brain sensitivity to nicotine E-Cigarette Use Among Youth | Smoking and Tobacco Use | CDC is significantly higher than adults
- The adolescent brain continues developing until age 25, making it more susceptible to addiction
- Increases in youth vaping prevalence have been accompanied by greater levels of vaping dependence according to various indicators, including perceived addiction, urges to use, times vaping in a day, and time to first vape after waking Trends in vaping and nicotine product use among youth in Canada, England, and the US between 2017 and 2022: evidence to inform policy – PMC
Psychosocial Factors:
- Peer pressure and social acceptance seeking peak during early adolescence
- Limited impulse control and risk assessment capabilities
- Higher susceptibility to marketing and flavor appeal
II. Root Causes Analysis
1. Stress and Mental Health Crisis
The Singapore article reveals vaping as a maladaptive coping mechanism for:
- Academic pressure and failure
- Depression and anxiety
- Social stress and fitting in
2. Social Normalization
- Over 75% of surveyed youth have more than five people in their social circles who vape
- Peer introduction through school friends and romantic partners
- Misconception that vaping is “safer” than smoking
3. Accessibility and Appeal
- Variety of appealing flavors
- Easy concealment and discrete use
- Inadequate regulation enforcement
- Social media influence and marketing
4. Knowledge Gaps
- Limited understanding of addiction potential
- Unawareness of serious health risks, especially with etomidate-laced products
- Lack of awareness about cessation resources
III. Evidence-Based Therapeutic Solutions
A. Individual-Level Interventions
1. Motivational Interviewing (MI)
Motivational interviewing is an evidence-based approach that has been shown, when delivered by clinicians or trained counselors, to be more effective in increasing readiness to quit and in helping people quit smoking than brief advice or usual care Interventions for Smoking Cessation and Treatments for Nicotine Dependence – Smoking Cessation – NCBI Bookshelf
Implementation for Youth:
- Non-confrontational approach respecting adolescent autonomy
- Exploring ambivalence about vaping
- Building intrinsic motivation for change
- Addressing personal values and goals
Specific Techniques:
- Open-ended questions about vaping experiences
- Reflective listening to understand motivations
- Summarizing and affirming youth’s own reasons for change
- Rolling with resistance rather than confronting denial
2. Cognitive Behavioral Therapy (CBT)
Core Components:
- Trigger Identification: Mapping situations, emotions, and social contexts that lead to vaping
- Cognitive Restructuring: Challenging beliefs about vaping benefits and developing healthier thought patterns
- Behavioral Skills Training:
- Refusal skills for peer pressure situations
- Alternative coping strategies for stress management
- Urge surfing techniques for craving management
Youth-Specific Adaptations:
- Incorporating technology and gaming elements
- Shorter, more frequent sessions
- Visual aids and interactive materials
- Peer-focused scenarios and role-playing
3. Contingency Management (CM)
Clinical practice medications (including nicotine replacement therapy, bupropion, and varenicline) have been prescribed to this population with consideration of risk-benefit analysis when behavioral treatments are not sufficient Adolescent Tobacco/Nicotine Use and the Potential Role of Contingency Management-based Interventions – PubMed
Evidence-Based Approach:
- Immediate, tangible rewards for abstinence milestones
- Escalating reward schedules
- Integration with existing reward systems (family privileges, school incentives)
- Use of biochemical verification (CO breath tests, cotinine tests)
4. Family-Based Interventions
Multisystemic Therapy (MST) Principles:
- Addressing family communication patterns
- Parent education about vaping risks and signs
- Developing family-based monitoring and support systems
- Improving parent-teen relationships to reduce risk factors
B. Group-Based Interventions
1. Peer Support Groups
- N-O-T (Not on Tobacco) Programs: INDEPTH is an alternative for students who face suspension for violation of school tobacco, vaping, or nicotine use policies. Students participate in interactive, facilitator-led sessions in a school or community-based setting Helping Teens Quit Smoking and Vaping | American Lung Association
- Structured peer-led discussions
- Shared experience and mutual support
- Accountability partnerships
2. Group CBT Programs
- Cost-effective delivery model
- Peer learning and modeling
- Social skills development
- Reduced stigma through shared experience
C. Technology-Enhanced Interventions
1. Digital Therapeutic Platforms
Research protocols are being developed for delivering vaping cessation interventions to adolescents and young adults on Instagram, measuring biochemically verified 7-day point prevalence abstinence for nicotine vaping PubMed CentralBMC Public Health
Components:
- Mobile apps with tracking capabilities
- Gamified quit journeys
- Real-time craving management tools
- Peer support networks
- Educational modules
2. Text Messaging and Chat-Based Support
- 24/7 accessibility for crisis moments
- Personalized messaging based on quit stage
- Integration with counselor support
- Automated check-ins and progress tracking
D. Pharmacological Considerations
Nicotine Replacement Therapy (NRT)
Nicotine Replacement Therapy (NRT) can be a useful tool in helping youth quit tobacco use Nicotine Replacement Therapy and Adolescent Patients
Youth Considerations:
- Reserved for heavily dependent adolescents
- Careful risk-benefit assessment
- Close medical supervision required
- Integration with behavioral interventions essential
Contraindications and Cautions:
- Not recommended for light or occasional users
- Potential for creating new nicotine dependence
- Need for cardiovascular screening
- Parent/guardian involvement required
IV. Comprehensive Treatment Framework
Phase 1: Assessment and Engagement (Weeks 1-2)
- Comprehensive Assessment:
- Vaping history and patterns
- Dependence severity using validated tools
- Mental health screening
- Family and social context evaluation
- Medical evaluation for etomidate exposure
- Engagement Strategies:
- Non-judgmental approach
- Collaborative goal setting
- Psychoeducation about addiction as a medical condition
- Hope installation through success stories
Phase 2: Active Treatment (Weeks 3-12)
- Individual Therapy (Weekly 50-minute sessions)
- Motivational interviewing techniques
- CBT skill building
- Relapse prevention planning
- Family session integration
- Group Support (Weekly 90-minute sessions)
- Peer support group participation
- Skills practice in group setting
- Social learning opportunities
- Family Involvement
- Bi-weekly family sessions
- Parent education programs
- Communication skills training
- Environmental modification planning
Phase 3: Maintenance and Relapse Prevention (Months 4-12)
- Reduced Frequency Contact
- Bi-weekly individual sessions
- Monthly group sessions
- 24/7 crisis support availability
- Relapse Management
- Rapid re-engagement protocols
- Learning from slip experiences
- Treatment plan modifications
- Long-term Support Systems
- Alumni support groups
- Peer mentorship programs
- Integration with school counseling services
V. Special Considerations for Singapore Context
Cultural Adaptations
- Integration of Asian family values in treatment
- Consideration of academic pressure as primary stressor
- Culturally appropriate peer support models
- Integration with existing social service networks
System-Level Recommendations
- School-Based Programs:
- Universal screening protocols
- Early intervention in educational settings
- Teacher and staff training programs
- Healthcare Integration:
- Primary care screening protocols
- Referral pathways to specialized services
- Integration with existing mental health services
- Community-Based Approaches:
- Mall and public space intervention programs
- Community youth worker training
- Public awareness campaigns targeting youth and families
Addressing Etomidate-Laced Products
- Specialized medical detoxification protocols
- Extended monitoring for neurological effects
- Integration with substance abuse treatment services
- Family education about signs of severe intoxication
VI. Outcome Measurement and Success Indicators
Primary Outcomes
- Biochemically verified abstinence rates
- Reduction in frequency and intensity of use
- Improvement in mental health symptoms
- Enhanced coping skills and stress management
Secondary Outcomes
- Academic performance improvement
- Family relationship quality
- Peer relationship changes
- Long-term health indicators
VII. Implementation Challenges and Solutions
Challenges
- Adolescent Resistance: Natural developmental tendency toward autonomy and risk-taking
- Peer Influence: Strong social pressures to continue vaping
- Accessibility: Continued availability of vaping products
- Stigma: Fear of punishment or judgment preventing help-seeking
Solutions
- Youth-Centered Approach: Involving young people in program design and implementation
- Harm Reduction Elements: Meeting youth where they are in their change process
- Integration with Existing Services: Leveraging current mental health and social services
- Policy Advocacy: Working toward systemic changes in availability and enforcement
The rise in youth vaping represents a complex public health challenge requiring multi-faceted, evidence-based interventions. Success depends on combining individual therapeutic approaches with family, school, and community-level changes, all adapted to the specific cultural and social context of Singapore’s youth population.
Youth Vaping Crisis: Scenario-Based Analysis and Treatment Protocols
I. Critical Scenarios from Singapore’s Youth Vaping Epidemic
Scenario 1: “The Academic Pressure Casualty” – Malcolm’s Profile
Background: 18-year-old private O-level candidate using etomidate-laced vapes daily from wake to sleep, experiencing blackouts and worsening depression.
Risk Factors:
- Academic failure and shame
- Peer introduction to substance use
- Depression and anxiety diagnosis
- Escalating use pattern with severe consequences
- Family crisis intervention required
Treatment Protocol:
Immediate Phase (Weeks 1-4): Crisis Stabilization
Medical Assessment:
- Comprehensive neurological evaluation for etomidate exposure
- Cardiac monitoring due to etomidate’s anesthetic properties
- Mental health crisis assessment with suicide risk evaluation
- Detoxification support with medical supervision
Therapeutic Interventions:
Week 1-2: Daily intensive outpatient program (6 hours/day)
- Individual MI sessions (daily 45 minutes)
- Group therapy focusing on academic stress management
- Family crisis counseling sessions
- Psychiatric evaluation for depression/anxiety treatment
Week 3-4: Transition to structured recovery
- CBT introduction focusing on cognitive distortions about academic failure
- Mindfulness-based stress reduction for anxiety management
- Gradual reintroduction of academic activities with support
- Peer support group participationActive Treatment Phase (Months 2-6):
Individual Therapy Focus:
- Cognitive Restructuring: Challenging beliefs like “I’m worthless because I failed” → “Setbacks are temporary learning opportunities”
- Alternative Coping Skills: Progressive muscle relaxation, breathing techniques, physical exercise
- Academic Anxiety Management: Study skills training, test anxiety reduction, realistic goal setting
- Relapse Prevention: Identifying high-risk situations (exam periods, academic stress)
Family Component:
- Parent education about academic pressure in Singapore context
- Communication skills training for discussing academic expectations
- Family therapy addressing shame and disappointment dynamics
- Developing supportive rather than punitive responses to academic challenges
Scenario 2: “The Social Conformist” – Primary School Group Vaping
Background: 25 upper primary girls (ages 10-12) with behavioral issues including vaping, introduced through peer networks for social acceptance.
Risk Factors:
- Early initiation age (increased addiction vulnerability)
- Group dynamic reinforcement
- Developmental need for peer acceptance
- Behavioral problems suggesting underlying issues
Treatment Protocol:
Assessment and Triage (Week 1-2):
Individual Assessments:
- Developmental screening for emotional/behavioral disorders
- Family functioning evaluation
- Peer relationship analysis
- Academic performance review
- Trauma history screening
Group Risk Stratification:
- High Risk: Daily users with family dysfunction
- Moderate Risk: Weekend/social users with peer pressure issues
- Low Risk: Experimental users with strong family supportDifferentiated Treatment Approach:
High-Risk Group (8-10 girls):
- Individual CBT: Weekly 45-minute sessions focusing on emotional regulation
- Family Therapy: Bi-weekly sessions addressing family dysfunction
- School-Based Support: Daily check-ins with school counselor
- Intensive Group Program:
Session Structure (90 minutes, twice weekly): - Check-in and mood monitoring (15 minutes) - Skill building activity (30 minutes) - Peer support sharing (30 minutes) - Planning and commitment (15 minutes)
Moderate-Risk Group (10-12 girls):
- Group-Based MI: Weekly sessions exploring ambivalence about vaping
- Peer Resistance Training: Role-playing scenarios for saying no
- Family Engagement: Monthly family education sessions
- School Integration: Teacher training for early identification and support
Low-Risk Group (5-7 girls):
- Brief Intervention: 4-session educational program
- Parent Education: Workshop series on prevention and monitoring
- Peer Leadership Training: Converting to positive peer influence
- Follow-up Monitoring: Monthly check-ins for 6 months
Scenario 3: “The Vulnerable Resident” – Girls’ Home Setting
Background: 15 out of 30 residents (ages 15-21) in care facility vaping, often introduced by boyfriends, viewing it as safer than smoking.
Risk Factors:
- History of trauma and family dysfunction
- Institutional care setting challenges
- Romantic relationship influences
- Limited healthy coping mechanisms
- Previous exposure to risk behaviors
Treatment Protocol:
Milieu-Based Treatment Approach:
Environmental Modifications:
- Smoke-free campus policy enforcement with therapeutic rather than punitive responses
- Structured daily routines with meaningful activities
- Peer mentorship programs pairing successful quitters with current users
- Staff training on trauma-informed vaping cessation approaches
Individual Treatment Components:
Weekly Individual Therapy (60 minutes):
- Trauma-informed CBT addressing underlying emotional dysregulation
- Relationship skills training focusing on healthy vs. unhealthy influences
- Identity development work beyond romantic relationships
- Future planning and goal setting for independent living
Specialized Interventions:
- EMDR for trauma processing if indicated
- DBT skills groups for emotional regulation
- Substance abuse counseling for poly-substance use
- Reproductive health education linking to vaping risksGroup Programming:
- Daily Community Meetings: Processing vaping incidents therapeutically
- Weekly Recovery Support Groups: Peer-led with staff facilitation
- Life Skills Training: Including relationship skills and communication
- Creative Expression Therapy: Art, music, writing for emotional outlet
Scenario 4: “The Public Transport Aggressor” – 19-Year-Old at MRT
Background: Young adult vaping on public transport, becoming aggressive with staff when confronted, indicating possible intoxication and impulse control issues.
Risk Factors:
- Public setting indicating normalization of use
- Aggressive behavior suggesting possible substance effects
- Authority conflict indicating deeper behavioral issues
- Legal consequences creating additional stress
Treatment Protocol:
Crisis Intervention Approach:
Immediate Response:
- De-escalation techniques by trained transport staff
- Medical evaluation for intoxication levels
- Mental health crisis assessment
- Legal advocacy to divert from criminal justice to treatment
Assessment Phase:
Comprehensive Evaluation:
- Substance use disorder assessment using validated tools
- Mental health screening for co-occurring disorders
- Impulse control and aggression assessment
- Social functioning and support system evaluation
- Cognitive assessment for etomidate-related impairmentTreatment Planning: Individual Therapy Track:
- Aggression Management: CBT techniques for impulse control
- Substance Use Treatment: Intensive outpatient program participation
- Social Skills Training: Appropriate responses to authority and conflict
- Cognitive Rehabilitation: If etomidate exposure has caused impairment
Legal Integration:
- Court-mandated treatment participation
- Progress reporting to legal system
- Community service integration with recovery activities
- Therapeutic jurisprudence approach linking legal compliance with recovery
II. Comprehensive Treatment Framework by Age and Risk Level
Early Adolescent Protocol (Ages 10-14)
High-Intensity Track (Daily use, behavioral problems):
Week 1-4: Stabilization Phase
- Daily intensive programming (3 hours after school)
- Individual therapy (2x weekly, 45 minutes)
- Family therapy (weekly, 60 minutes)
- Medical monitoring for withdrawal
- School liaison and accommodation planning
Week 5-12: Active Treatment
- Individual CBT (weekly, 45 minutes)
- Group skills training (weekly, 90 minutes)
- Family sessions (bi-weekly, 60 minutes)
- Academic support integration
- Peer mentorship assignment
Month 4-12: Maintenance
- Individual therapy (bi-weekly, 45 minutes)
- Group participation (weekly, 90 minutes)
- Family check-ins (monthly)
- School-based support continuation
- Crisis intervention availabilityModerate-Intensity Track (Weekend use, peer pressure):
Week 1-8: Skills Building Phase
- Group MI sessions (weekly, 90 minutes)
- Family education workshops (4 sessions)
- Individual consultation (bi-weekly, 30 minutes)
- School counselor coordination
Month 3-6: Reinforcement Phase
- Group maintenance sessions (bi-weekly)
- Family follow-up (monthly)
- Individual booster sessions (monthly)
- Peer resistance skills practiceMid-Adolescent Protocol (Ages 15-17)
Treatment Tracks by Complexity:
Complex Cases (Trauma, mental health, poly-substance use):
- Residential treatment consideration for severe cases
- Intensive outpatient with trauma-informed care
- Psychiatric integration for co-occurring disorders
- Extended family therapy for systemic issues
- Vocational training integration for future planning
Standard Cases (Vaping primary concern):
- Weekly individual and group therapy
- Family engagement with cultural adaptation
- Academic support and stress management
- Healthy relationship education
- Community service learning opportunities
Late Adolescent/Young Adult Protocol (Ages 18-21)
Autonomy-Respecting Approach:
Assessment and Engagement (Month 1):
- Comprehensive substance use evaluation
- Mental health and trauma screening
- Educational/vocational goal assessment
- Relationship and social functioning review
- Motivational interviewing for change readiness
Treatment Planning (Month 2):
- Collaborative goal setting with client leadership
- Harm reduction vs. abstinence goal negotiation
- Integration with existing life responsibilities
- Crisis planning for high-risk periods
- Support system development and activation
Active Treatment (Months 3-9):
- Individual therapy (weekly initially, tapering to bi-weekly)
- Young adult group therapy (weekly)
- Optional family involvement based on client preference
- Educational/vocational support integration
- Relationship counseling if partner influence involved
Transition Planning (Months 10-12):
- Independent living skills if needed
- Long-term recovery planning
- Alumni network connection
- Ongoing support system maintenance
- Crisis prevention and management planningIII. Cultural and Contextual Adaptations for Singapore
Academic Pressure Integration
Treatment Modifications:
- Scheduling around academic calendar and exam periods
- Integration with school counseling services
- Parent education about academic expectations vs. health
- Study skills training as part of recovery programming
- Academic achievement redefinition in therapy
Specific Interventions:
Academic Stress Protocol:
1. Psychoeducation about pressure-performance relationship
2. Cognitive restructuring of academic perfectionism
3. Time management and study skills training
4. Alternative identity development beyond academics
5. Family therapy addressing academic pressure dynamicsFamily Dynamics Considerations
Asian Family Values Integration:
- Respect for parental authority while encouraging communication
- Face-saving approaches to treatment engagement
- Intergenerational trauma processing when relevant
- Extended family involvement when appropriate
- Community elder consultation in severe cases
Treatment Adaptations:
- Family sessions conducted with cultural sensitivity
- Use of cultural metaphors and concepts in therapy
- Integration of traditional values with recovery goals
- Shame reduction approaches specific to cultural context
- Honor-based motivation techniques
Social Context Modifications
Peer Pressure Unique to Singapore:
- High-density living and peer visibility
- Academic competition and stress relief seeking
- International influence and Western lifestyle adoption
- Technology integration and social media influence
- Economic pressure and luxury good accessibility
IV. Outcome Measurement and Success Indicators
Short-term Goals (3-6 months):
- Abstinence Metrics: 30-day point prevalence abstinence verified biochemically
- Harm Reduction: Decreased frequency and quantity of use
- Functional Improvement: Academic performance stabilization
- Mental Health: Reduced depression and anxiety scores
- Family Function: Improved communication and reduced conflict
Long-term Goals (12-24 months):
- Sustained Recovery: 6-month continuous abstinence
- Academic Achievement: Grade improvement or educational progress
- Social Development: Healthy peer relationships and activities
- Family Healing: Restored trust and communication
- Life Skills: Independent functioning and future planning
Success Case Examples:
Malcolm’s Recovery Trajectory:
Month 1: Medical stabilization, daily program engagement
Month 3: 30-day abstinence, depression improvement
Month 6: Academic re-engagement, family relationship repair
Month 12: PSB Academy enrollment, sustained recovery
Month 24: Educational goal achievement, peer mentorship rolePrimary School Group Outcomes:
3 months: 80% reduction in group vaping incidents
6 months: 15 of 25 girls maintaining abstinence
12 months: Peer leadership development in 10 girls
24 months: Academic and behavioral improvement sustainedThis comprehensive approach recognizes that youth vaping in Singapore represents not just individual addiction issues but complex interactions between academic pressure, social dynamics, family expectations, and developmental needs. Treatment success requires addressing these multiple levels simultaneously while respecting cultural values and individual developmental stages.
The Vapor Between Us
Wei Ming stared at the small device hidden in his pencil case, its sleek silver surface catching the fluorescent light of the study room. Around him, his classmates hunched over their assessment books, preparing for the upcoming O-Level examinations. The familiar weight of expectation pressed down on his shoulders like the humid Singapore air outside.
“Eh, Ming, you okay or not?” whispered his friend Raj from the next table, noticing Wei Ming’s distracted expression.
Wei Ming quickly closed his pencil case. “Yeah, just tired lah.”
But he wasn’t just tired. The vanilla-scented vapor that had become his secret companion over the past six months felt like the only thing that could quiet the storm in his chest—the anxiety about his Physics grades, his mother’s disappointed sighs when he brought home anything less than an A, the way his father worked sixteen-hour days at the shipping company so Wei Ming could attend supplementary classes.
During the break, Wei Ming found himself in the school’s back stairwell with three other students. The ritual was always the same: a few quick puffs, the sweet artificial taste, and for a moment, the crushing pressure would lift. They called it their “study break,” though none of them opened a book during these stolen minutes.
“My sister caught me yesterday,” mumbled Priya, a usually studious girl from the express stream. “She threatened to tell my parents.”
“Aiyah, just tell her it’s not cigarettes what,” said Marcus, though his bravado couldn’t hide the worry in his eyes. “It’s just flavoring.”
Wei Ming said nothing, but he thought about his grandmother, who had moved in with them last year. Ah Ma had survived the Japanese Occupation, raised five children while his grandfather worked as a coolie. Sometimes he caught her looking at him with such hope in her weathered eyes, and he wondered what she would think if she knew about the device in his bag.
The turning point came on a Thursday afternoon. Wei Ming’s chemistry teacher, Mrs. Lim, asked him to stay after class. He braced himself for another lecture about his declining performance, but instead, she closed the door and sat across from him.
“Ming, I’ve been teaching for twenty years,” she began, her voice gentler than he’d ever heard it. “I’ve seen students carry all kinds of burdens. Some visible, some not.”
Wei Ming’s hands fidgeted with his calculator. “Teacher, I don’t understand.”
“You’re a bright boy. Always have been. But lately, you seem… distant. And I’ve noticed you disappearing during breaks.” She paused. “I’m not here to punish you. I’m here because I remember what it felt like to be sixteen and feel like the world was sitting on my chest.”
The confession came in broken sentences. The stress, the sleepless nights, the way the vaping seemed to create a small pocket of calm in his overwhelming world. Mrs. Lim listened without judgment, occasionally nodding.
“You know,” she said finally, “my nephew went through something similar. Different substance, same feeling of drowning. We found him help—not just to quit, but to learn other ways to handle the pressure.”
Mrs. Lim connected Wei Ming with the school counselor, Ms. Sarah, a warm woman who had trained specifically in adolescent addiction and understood the unique pressures facing Singapore students. But more importantly, she helped Wei Ming understand that his struggle wasn’t a personal failure.
“In Singapore, we have this culture of excellence,” Ms. Sarah explained during one of their sessions. “It drives innovation and success, but it can also create tremendous pressure on young people. What you’re experiencing—using vaping to cope with stress—it’s more common than you think.”
The path forward wasn’t simple. It involved family counseling sessions where Wei Ming’s parents learned to recognize signs of academic stress and to create space for conversations beyond grades. His father, initially skeptical, began sharing stories of his own struggles as a young man working to support his family.
“I never wanted you to feel the pressure I felt,” his father said during one particularly honest conversation. “But maybe I created a different kind of pressure instead.”
The school implemented changes too. Ms. Sarah worked with the administration to create “pressure valve” sessions—structured break times where students could engage in stress-relief activities. They brought in speakers who talked about mental health, achievement, and finding balance. The back stairwell where Wei Ming used to vape became a meditation corner with plants and comfortable cushions.
Raj, who had watched his friend’s transformation with curiosity, eventually asked Wei Ming about the changes he’d noticed.
“You seem more… present,” Raj observed. “And happier, even though exams are coming.”
Wei Ming smiled. “I learned that the feeling I was chasing with vaping—that moment of calm—I can get it other ways. And those ways don’t make me feel guilty or scared about getting caught.”
He had discovered breathing techniques that worked during exam anxiety. He’d started talking to his parents about his fears instead of hiding them. Most importantly, he’d learned that academic success didn’t have to come at the cost of his mental health or integrity.
The story spread quietly through his social circle. Priya found courage to talk to her sister, who helped her find support. Marcus connected with a sports program that gave him a different outlet for stress. The small group that used to gather in the stairwell began meeting in the school’s new wellness room instead, sharing study tips and supporting each other through difficult periods.
On the day of his first O-Level exam, Wei Ming sat in the examination hall feeling nervous but clear-headed. In his pencil case, where the vaping device used to hide, he now kept a small card with his grandmother’s photo and a breathing exercise Ms. Sarah had taught him.
As he opened his examination booklet, Wei Ming thought about the journey that had brought him here—not just the academic preparation, but the personal growth. He had learned that strength wasn’t about bearing pressure alone, but about building connections and finding healthy ways to navigate stress.
The vapor that once seemed like his only escape had been replaced by something more substantial: a network of support, coping strategies that actually worked, and the understanding that his worth wasn’t determined solely by his academic performance.
Years later, as a university student studying to become a counselor himself, Wei Ming would often think about that moment of choice in Mrs. Lim’s classroom. How a teacher’s compassion, a counselor’s expertise, and his family’s willingness to change had created space for him to grow beyond the coping mechanism that had once felt so necessary.
The story wasn’t unique to Wei Ming. Across Singapore, educators, families, and mental health professionals were recognizing that youth vaping often masked deeper issues—academic pressure, social isolation, family expectations, and the natural turbulence of adolescence. The solution wasn’t just about eliminating the behavior, but about creating environments where young people could develop genuine resilience and healthy ways to navigate the complex world they inhabited.
In the end, Wei Ming learned that the most powerful change happened not when he stopped vaping, but when he started believing he deserved support, understanding, and the space to be imperfect while still being loved and valued. That realization didn’t just transform his relationship with substances—it transformed his entire approach to life.
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