Malaysia has taken a significant step in tobacco control with the implementation of the Control of Smoking Products for Public Health Act 2024 (Act 852). The Act provides a comprehensive legal framework to regulate tobacco and vaping products, protect children and adolescents, restrict advertising and promotion, and reduce the long-term burden of nicotine-related disease.
Few would disagree with these objectives. Preventing nicotine addiction before it begins remains one of the most effective public health strategies available.
However, as psychiatrists, we view nicotine dependence through a slightly different lens. While legislation can regulate products and influence behaviour at a population level, addiction is ultimately a disorder of the individual. This raises an important question: Can addiction be overcome through legislation alone?
The answer is probably not.
Legislation changes the environment in which addiction develops. Treatment changes the individual living with addiction. Sustainable reductions in nicotine dependence require both.
Malaysia’s Changing Nicotine Landscape
Malaysia has made encouraging progress in reducing conventional cigarette smoking over the past decade through taxation, smoke-free policies, public education and smoking cessation programmes. However, this success has been accompanied by a rapid rise in electronic cigarette use, particularly among adolescents and young adults. National Health and Morbidity Survey (NHMS) findings and other local studies have identified vaping as an increasingly important public health concern, prompting the expansion of tobacco control legislation to include electronic nicotine delivery systems.
For many young Malaysians today, vaping—not cigarette smoking—is their first exposure to nicotine. Many have never smoked a conventional cigarette before developing nicotine dependence through electronic cigarettes. This represents a shift in how addiction begins rather than a disappearance of the problem itself.
Understanding Nicotine Addiction
Nicotine dependence is often misunderstood as a failure of willpower. In reality, decades of neuroscience have demonstrated that addiction is a chronic relapsing disorder involving changes in brain circuits responsible for reward, motivation and self-control.
Repeated nicotine exposure strengthens learned associations between vaping and everyday experiences. Over time, the behaviour becomes increasingly automatic. Individuals frequently report vaping while driving, studying, gaming, working, after meals or whenever they feel stressed. These situations gradually become conditioned cues that trigger craving, often without conscious awareness.
Eventually, nicotine is no longer used simply because it is enjoyable. It is used to avoid withdrawal, reduce discomfort or restore what feels like “normal”. This explains why many people genuinely want to quit but struggle despite repeated attempts.
Recognising addiction as a medical condition rather than a moral failing is fundamental to improving outcomes.
What Act 852 Can Achieve
The Control of Smoking Products for Public Health Act 2024 addresses many of the environmental factors that contribute to nicotine use. By regulating product availability, restricting promotion and strengthening enforcement, the legislation aims to reduce initiation, particularly among children and adolescents, while reinforcing the message that nicotine dependence is a significant public health issue.
These are important and evidence-based strategies. Population-level tobacco control policies have consistently reduced smoking prevalence worldwide, and extending similar principles to vaping products is a logical progression.
From a psychiatric perspective, prevention remains preferable to treatment. Every young person who never develops nicotine dependence represents a meaningful public health success.
Where Legislation Meets Its Limits
While legislation can reduce access to nicotine products, it cannot directly reverse dependence among those who are already addicted.
A university student who vapes before every lecture, a healthcare worker who relies on nicotine during stressful shifts, or an office worker who reaches for a vape whenever anxiety develops does not suddenly lose these conditioned behaviours because the law has changed.
The craving remains.
Withdrawal remains.
The psychological dependence remains.
History has shown that whenever demand persists despite reduced legal supply, unintended consequences may emerge, including informal markets, unregulated products and increasingly concealed patterns of use. Recognising these possibilities should not be interpreted as opposition to regulation. Instead, it highlights an important principle of addiction medicine: reducing supply should be accompanied by reducing demand through prevention, treatment and early intervention.
Why Psychiatrists Should Care
Psychiatrists encounter nicotine dependence not simply as a lifestyle behaviour but as part of a broader pattern of emotional and psychological distress.
Many patients report vaping to reduce anxiety, improve concentration, cope with occupational stress or manage difficult emotions. Some individuals with depression describe nicotine as providing temporary relief from low mood, while others with attention-deficit/hyperactivity disorder perceive improvements in attention and alertness. Although nicotine may offer transient symptomatic relief, it ultimately reinforces dependence while leaving the underlying psychological difficulties unresolved.
This distinction is clinically important.
If anxiety, depression, trauma or chronic stress remain untreated, restricting access to nicotine alone is unlikely to produce sustained recovery. Patients remain vulnerable to relapse or substitution with other maladaptive coping behaviours.
For this reason, nicotine dependence should not be viewed in isolation. Effective management requires a biopsychosocial approach that addresses biological dependence, psychological vulnerability and the social environment in which addiction develops.
Closing the Treatment Gap
Malaysia has invested considerably in tobacco control, but opportunities remain to strengthen nicotine dependence treatment.
Healthcare professionals should routinely ask patients about vaping alongside conventional cigarette smoking, particularly adolescents and young adults presenting with anxiety, depression, insomnia, poor concentration or repeated unsuccessful attempts to quit.
Brief interventions delivered in primary care can increase motivation to stop. Behavioural interventions such as motivational interviewing, cognitive behavioural therapy and relapse prevention remain effective components of treatment. When clinically indicated, pharmacological therapies should be offered as part of a comprehensive cessation programme.
Importantly, nicotine dependence should be recognised and treated early rather than only after significant medical complications have developed.
Conclusion
The Control of Smoking Products for Public Health Act 2024 represents an important milestone in Malaysia’s efforts to reduce nicotine-related harm. By regulating smoking and vaping products, the legislation strengthens prevention, protects young people and reinforces the message that nicotine addiction is a serious public health issue.
However, legislation alone cannot extinguish addiction.
Addiction resides not only in the product but also in the neurobiology of reward, the psychology of coping and the social contexts that sustain repeated nicotine use. While legislation shapes the environment, healthcare shapes recovery.
As psychiatrists, we recognise that lasting change requires more than restricting access. It requires early identification, evidence-based treatment, compassionate care and sustained support for those already living with nicotine dependence.
The true success of Act 852 will therefore be measured not simply by fewer vape products on shop shelves, but by fewer adolescents developing nicotine dependence, more Malaysians successfully quitting nicotine and a healthcare system equipped to treat addiction with the same seriousness as any other chronic medical condition.
Public health legislation can change population behaviour. Healthcare changes lives one patient at a time.
Malaysia needs both.
Written by,
Dr Hijaz Ridzwan
Assistant Professor & Psychiatrist
Department of Psychiatry, Kulliyyah of Medicine, International Islamic University Malaysia
References
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