Why vaping is so addictive, according to doctors

It’s more than nicotine that keeps you coming back for more.

Amanda Capritto
5 min read
Red haired woman using an electronic cigarette and a smart phone in the countryside

Scientists don't have as much data on e-cigarettes as they do on conventional cigarettes, but there's reason to believe many of the same health risks apply. 

Jon Cartwright / Getty Images

As the use of traditional cigarettes slows down -- 14% of American adults smoke cigarettes, down from 20.9% in 2005 -- another form of nicotine delivery rises. E-cigarettes -- which were once praised as the healthier alternative to cigarettes when they first appeared on the market back in the early 2000s -- may not be a stepping stone to quitting for good like many people once thought.

Health professionals and public officials have started voicing concern over nicotine vaporizers like the Juul for many of the same health risks that conventional cigarettes pose: lung damage, brain alterations, heart disease, and more

It's true that e-cigarettes don't contain many of the chemicals and substances found in traditional cigarettes (namely, tobacco), but they still contain the extremely addictive substance nicotine, which is difficult to quit no matter the vessel. Even Juul's own CEO recognizes the risk of addiction: In a recent interview with CBS This Morning, he said "don't vape" if you don't have a preexisting relationship with nicotine.

Read more: Juul sued for marketing to minors | FDA calls out Juul for marketing vapes as safer than cigarettes | A timeline of vaping deaths and illnesses

How addictive is vaping, really?

Doctors, psychologists, and other health professionals always recommend treating addiction with a multifaceted approach, but no one can argue with the fact that nicotine is addictive. So addictive, in fact, that the National Institutes of Health call it as addictive heroin and cocaine.

When a person inhales nicotine, it gets absorbed into the blood and starts affecting the brain in just 10 seconds. Nicotine disrupts the normal relationship between a neurotransmitter (chemical communicator) called acetylcholine (ACh) and the receptors that acetylcholine attaches to. Without that interruption, ACh plays an important role in muscle contraction, memory, cognition and more. 

When nicotine attaches to ACh receptors in place of ACh, it triggers a number of chemical reactions that result in temporary feel-good sensations. Those sensations include relaxation, alertness or focus, calmness and euphoria. But those sensations are short-lived, usually subsiding within minutes, because your body removes the substance so quickly -- just two hours after ingesting nicotine, about half will already be gone

Vaping Increases Among Teens

No matter how you inhale nicotine -- regular cigarette or e-cigarette -- it's still an addictive substance.

Portland Press Herald/Getty

Nicotine's pleasurable effects combined with its short half-life leave people feeling like they need another dose soon after the first one. This results in a vicious cycle of addiction. 

Dr. Lawrence Weinstein, chief medical officer of American Addiction Centers, told CNET that it seems as though quitting e-cigarettes is going to present much of the same challenges that come with quitting conventional cigarettes.

"Inhalation of nicotine will increase dopamine production regardless of the vessel used," Dr. Weinstein said. "The up and down of dopamine levels is what motivates an individual to smoke," which is why health officials are realizing that e-cigarettes aren't the stepping stone to quitting after all. 

Read more: FDA investigating 120-plus reports of seizures after vaping | A timeline of vape-related deaths and illnesses

A vaping addiction is about more than the nicotine

Nicotine is addictive, yes. But there are other reasons why people become addicted to e-cigarettes, reasons that have to do with a person's environment, social and family settings, mental health, coping mechanisms, and other factors.

"Cravings are both mental and physical," Dr. Kevin Gilliland, Psy.D., executive director of Innovation360, wrote to CNET. He explains that we physically feel the desire to get nicotine and that, "Our brains are connecting the dots by seeing something (an ad for Juul) and expecting a response (smoking). It's what we call a habit." 

Similar to the advertisement example Gilliland offers, people who use e-cigarettes may crave a puff when they're in certain settings, such as sitting outside after eating lunch with your buddies at work, drinking at a bar or relaxing with your morning coffee. 

It all depends on what environments, people and physical actions and items a person has associated with e-cigarettes, but the end result is always the same, says Gilliland. Put yourself in a habitual situation, and you'll crave the missing part of that situation. In this case, the missing piece is an e-cigarette.

Aside from actual physical settings, emotions are a huge driver in addiction (to anything, not just e-cigarettes). For example, if you associate ice cream with happiness and comfort, there's a good chance you'll use ice cream as a way to feel better when you're down. The more you do that, the more you depend on ice cream to help your body release feel-good hormones like dopamine and serotonin. 

The same concept goes for e-cigarettes. If e-cigarettes make you feel better when you feel sad, stressed or otherwise emotionally uncomfortable, and you use e-cigarettes as a coping mechanism, you'll begin to turn to your e-cigarette whenever you feel those uncomfortable emotions.

Read more: Secondhand vaping: The latest vaping health risk


In addition to nicotine, emotions and environment also play a factor in addiction.

Martina Paraninfi / Getty Images

Other reasons e-cigarettes may be addictive

Chemicals and habits aside, some health professionals think e-cigarette use is rising for reasons related to aesthetics and effort. 

Dr. Rajy Abulhosn, medical review officer for Confirm BioSciences, said he thinks part of it has to do with marketing and advertising -- a thought not so off-the-wall considering that e-cigarette companies like Juul and Myle Vape have been hit with FDA warning letters about sales to youth and requests for company marketing documents.

But the biggest difference is ease of use, Abulhosn said, using Juuls as an example. 

"One Juul pod is the equivalent of 20 cigarettes, or one pack," Abulhosn said. "But usage of a Juul pod with its simple puffing system is much easier than removing a single cigarette, finding a match or lighter, lighting a cigarette, excusing yourself to an outdoor area and then spending 15 to 20 minutes puffing a cigarette 20 times in a day."

Additionally, Abulhosn continues, "... Some users just never got the hang of the whole inhale/exhale process. Some didn't like the smell of cigarettes. Others found it inconvenient to find a match or go somewhere that would allow cigarette use. Juul removes all those barriers [and] makes it simple enough that even kids can use [its] product."

Risks of e-cigarette use during adolescence 

Public health officials are particularly concerned about the use of e-cigarettes by children, teens and even young adults. Not only are younger people's bodies more susceptible to nicotine poisoning, but the brain doesn't fully develop until around age 25. 

Nicotine has been found to disrupt brain development because, while the brain is in maturation phases, it's uniquely vulnerable to the damaging effects of nicotine. Specifically, nicotine seems to impact the prefrontal cortex, an area of the brain responsible for critical skills and functions like memory, reward processing and logic.

A significant portion of people who use e-cigarettes are under the age of 25, Dr. Weinstein told CNET, which means their brains have yet to reach full development and they are susceptible to lifelong complications like lack of impulse control and emotional regulation. 

"It is understood that nicotine is an addictive drug, but that fact is made worse when the age of introduction is factored in," Dr. Weinstein said. "The age of exposure is a critical determinant of dependence and ability to cease use."

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.