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Although they dont become addicted immediately, there are 2 stages that usually precede addictionthese include tolerance and dependence

WHO Report on the Global Tobacco Epidemic, Addressing new and emerging products

The outcome included in the meta-analysis was other cancers of the pharynx

Figure 7 Analysis of differentially abundant microbial phyla in these four groups of samples revealed a significantly higher abundance of Bacteroidetes and Fusobacteria in the tumor site of OSCC samples compared to the contralateral healthy site, which can be interpreted as an inflammation-associated change in microbiome composition (Li and Ma, 2020)

You can start hitting it directly after putting on the coals as Al-Fakher gets going quick but it is recommended to start with 2-3hookah coalsdepending on the size of thehookah bowlyou are using and work your way up if you want more heat