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Hookah are always in The Den and can sometimes be used on admin events, which happen usually on Sundays.

Using a hookah successfully will remove 1 level of madness and will give several thousands of Inspiration. It's safer to use the hookah for around 5 seconds to not smoke "too much" and get nothing.

Using a hookah will put it on a 24hr cooldown, even if you've failed in using it for whatever reason.