Is hookah a drug? What's really in the hookah bowl

Hookah myths & facts Part 3

“Is that hookah a drug?!” If your mom has ever sent you that text while you were sitting in a lounge, you know what we're talking about. To older people hookah looks suspicious: a cloud of smoke no cigarette could make, a glass base with water bubbling in it, a hose passed from hand to hand. So let's see who's right. What's really in the hookah bowl, what happens in your head after a few puffs, and what psychiatrists and the law have to say about it.

Where the “hookah is a drug” idea comes from

Many parents know hookah from movies and holidays, not from the café across the street. Seeing one up close for the first time, it looks like someone's smoking something stronger than tobacco. There's a lot of thick smoke, the smell is neither cigarette nor pipe, and the whole setup with the glass base and the hose looks like a scene from the kind of movie where nobody is smoking tobacco. Add the fact that a beginner gets lightheaded after a few puffs, and the “getting high” story writes itself.

That thick cloud, by the way, isn't a sign of anything strong. Most of what you see is glycerin. Germany's Federal Institute for Risk Assessment (BfR) measured that unburned glycerin is the main component of the so-called tar in hookah smoke. Plenty of concert fog machines run on glycerin too. A thick cloud tells you how much glycerin is in the tobacco and how hot the bowl is. It says nothing about how strong the tobacco is.

What's really in the bowl

Hookah tobacco looks nothing like cigarette tobacco. It's moist, sticky and smells like fruit, because only about a third of it is tobacco. The other 70 percent is molasses or honey, glycerin and flavoring, according to figures cited in a 2023 paper in BMC Public Health. That's where its Arabic name comes from: maassel, meaning “honeyed”.

The mix in the bowl doesn't burn. The charcoal sits on foil or a heat management device and only heats the tobacco. That releases flavor, nicotine and glycerin vapor from the tobacco, and carbon monoxide from the charcoal. The hookah they bring you at a lounge is packed with this tobacco straight from the pack. There's no weed or hash anywhere in this story.

How it works at a lounge. When you order a flavor, say double apple or lemon mint, the hookah master opens a pack of that flavor, packs the bowl and adds the coals. If you're not sure what goes where, check out the hookah in 3D, part by part.

So why does your head spin?

This is the part that worries mom the most, and not without reason. After a few puffs, especially if you don't smoke often, your head can spin, your pulse jumps and your body feels a bit “light”. The culprit is nicotine.

A 2014 study from Washington State University shows it nicely. Twenty-two young people who smoke hookah occasionally smoked twice, in random order: once regular tobacco with nicotine, once a nicotine-free herbal mix, with the same charcoal and the same flavors, double apple and watermelon. With nicotine, the head rush rose sharply during the session and their pulse sped up. With the herbal mix the feeling barely moved, even though the charcoal was the same. An interesting detail: there was actually more carbon monoxide in their breath after the herbal mix, so “tobacco-free” doesn't mean safe.

So the brief head rush in the first few minutes is nicotine. If the spinning lasts, or you get a headache or feel sick, that's a different story, and the carbon monoxide from the charcoal is to blame. Step outside and take a break. Why there's so much of it is covered in the first part of the series, on how many cigarettes one hookah really is.

Does hookah alter your mind?

This is the heart of mom's question. A drug, in the everyday sense, alters your mind: hallucinations, a trance, losing control of yourself. Psychiatrists have a specific diagnosis for that state, intoxication, and their manual, the DSM-5, describes it separately for each substance.

That list includes alcohol, cannabis, hallucinogens, opioids and stimulants. And coffee: drink too much and psychiatrists record it as caffeine intoxication. Tobacco isn't there. For tobacco the manual knows use disorder and withdrawal, but not intoxication. Nicotine can wake you up or calm you down and it speeds up your pulse, but it doesn't change what you see and it doesn't take away your control. When there's too much of it, the body answers with nausea, sweating and a pounding heart. No visions.

What the law says

In Serbia “drug” is also a legal term. The Law on Psychoactive Controlled Substances covers only the substances on a list set by the health minister, which follows the United Nations conventions. The latest list is from July 2024. Nicotine isn't on it, which is why cigarettes are sold at every kiosk.

By law, hookah tobacco is a tobacco product, like cigarettes, with the same restrictions: it can only be sold to adults, and the same smoking rules apply in bars and cafés as for cigarettes. Hookah at a lounge is no gray area. It's tobacco on the menu.

Where mom has a point

If we were keeping score, you'd be ahead by now. But mom isn't wrong about everything. Nicotine is addictive, and hookah has it: after 45 minutes of hookah there's as much in your blood as after one cigarette. A Cochrane review, one of the strictest kinds of review in medicine, notes that hookah can cause dependence like other forms of tobacco.

The same Washington study showed something less pleasant too. People who smoke hookah once a month smoked longer and took more puffs with nicotine than with the herbal mix. The authors see it as a sign that smoking “for the nicotine” shows up even before real dependence.

Then there's the carbon monoxide from the charcoal and the smoke that the water doesn't clean, which we covered in part two, does the water in a hookah filter the smoke. When mom says it isn't healthy, you've got nothing to argue with.

What's true and what isn't

How to explain it to your mom

1. Show her the pack. Most of them list the ingredients: tobacco, molasses or sugar, glycerin, flavoring. That's faster than any argument.
2. Explain the dizziness. Nicotine, brief, and it passes. If it lasts, it's the charcoal, and that's when you step outside.
3. Give her the point on addiction. Hookah isn't for every day, and not for an hour and a half without a break.
4. Show her you're careful. Shorter sessions, natural charcoal, a well-ventilated lounge, your own mouthpiece. Details are in the beginner's guide.
5. Send her this post. The score is 2:1 for you, and one point stays hers.

FAQ

This is not medical advice. Sources: a paper on the composition of hookah tobacco in BMC Public Health (2023), Shishani et al., Washington State University (Addictive Behaviors, 2014), Schubert et al., BfR (Toxicology Letters, 2011), the DSM-5 manual of the American Psychiatric Association, Serbia's Law on Psychoactive Controlled Substances and the rulebook on the list (Official Gazette 58/2024), the Cochrane review on hookah.