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Vaping creates and maintains real nicotine dependence by hijacking the brain's reward system.

Whether e-cigarettes are uniquely addictive compared to cigarettes is a question still being researched.

Communities and schools have a role in preventing youth dependency.

Public opinion shifts quickly in our post-digital era. E-cigarettes were only available in the United States for about eight years before they started to fall out of favor. As of 2014, more than half of Americans consider vaping at least as harmful as smoking (Malt et al., 2020). Compared to the roughly six decades before cigarettes crossed the 50-percent harm-awareness threshold, that’s lightning fast.

However, there is still work to do. About 7.2 million Americans believe vaping is harmless, and 57 million more believe it’s less harmful than smoking. The truth is, we don’t know every aspect of how harmful aerosolized nicotine is compared to freebase nicotine. But we do know it isn’t harmless.

Despite a shifting public opinion, we continue to see the portion of American adults who vape increasing year over year (Vahratian et al., 2025). Many try to quit (Rosen & Steinberg, 2019), some succeed (Sakhuja et al., 2025), and many more intend to quit (Palmer et al., 2023).

What Is Stopping E-Cigarette Users From Quitting?

We already know nicotine is addictive. When a person consumes nicotine in any form, it binds to the body’s nicotinic acetylcholine receptors, stimulating dopamine release in the nucleus accumbens. This region of the brain is our reward system’s “boss,” and that dopamine release drives reinforcement, eventually leading to dependency if consumption is repeated over time.

Unique Addictive Properties?

But researchers think there may be something special about the addiction potential of aerosolized nicotine salts as a delivery mechanism. A 2019 study found that e-cigarette users and dual users had higher nicotine dependency scores compared to those of smokers (Jankowski et al., 2019).

Another study, which found that vaping triggered greater nucleus accumbens activation than smoking, concluded that this could, in fact, make e-cigarettes an effective smoking cessation method, potentially “rewarding” users away from smoking (Grundinger et al., 2025). This harm-reduction approach may be valid in theory, but when nearly all of the products available in the United States are smuggled, we can’t be sure we aren’t simply trading one set of harms for another.

The nature of addiction is such that users often continue long after they stop wanting to, because withdrawal is physically, emotionally, and mentally torturous. Nicotine withdrawal is known to bring:

Mental health changes

It’s all temporary, but the discomfort is very hard for people to sit with when they know exactly what will put a quick stop to it. In that moment, the substance seems like medicine rather than the poison it has been.

Is e-cigarette withdrawal any worse than withdrawing from other nicotine products? Paradoxically, it seems not. In fact, one study found that people quitting e-cigarettes reported........

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