Why Vaping Is So Dangerous for the Adolescent Brain

The electronic cigarette, or e-cigarette, was invented by Chinese pharmacist Hon Lik in 2003. Inspired by the death of his father (a smoker) from lung cancer, Lik wanted to create a healthier alternative to smoking that would also make it easier to quit tobacco altogether.

The e-cigarette he came up with—and what most people still use today—includes a small battery that heats up and vaporizes liquid that contains nicotine and other substances. You then inhale or “vape” that vapor into your lungs. Twenty years later, more than 70 million people vape worldwide, including 2.5 million middle school and high school kids in the U.S.

True to Lik’s intentions, many people have quit smoking with help from e-cigarettes, almost always in combination with other quit strategies, nicotine patches or gum, and or counseling (more proven methods).

What began as a so-called healthier alternative to cigarettes mutated into a highly addictive and profitable product that is getting young people (by far the most frequent users in the U.S.) hooked at a very vulnerable age. An age—up to around 25—when their brains are still developing and therefore are highly prone to the changes in brain structure and chemistry that occur as nicotine addiction takes hold.

Once addiction does this dirty work on a young person’s brain, it often puts them at higher risk for other addictions as they move into adulthood. It is the classic “gateway drug” scenario.

How Nicotine Tricks the Brain

The brain’s reward center, comprised of the ventral tegmental area and the nucleus accumbens, is vital to our survival. It controls our incentive to eat, sleep, fall in love, avoid danger, feel pleasure, and everything else we must do to thrive as a species.

When a person starts using alcohol or other addictive drugs like nicotine, the nicotine starts taking the reward center hostage by literally changing its structure and chemistry. (This “hostage” effect is more pronounced and damaging in the developing brains of young people.) After a period of steady use, the brain gets tricked into thinking it needs nicotine as much as it needs food, sleep, shelter, and so on. At this point, you start craving nicotine as a way to feel pleasure. Your brain thinks you need it to survive.

When this happens with adolescents, they start choosing the false reward of nicotine over true rewards like getting good grades, doing well at sports, bonding with their friends and family members, listening to stimulating music, and all the normal activities that give young people pleasure. Kids may still do these things, and gain pleasure from them, but there’s a certain “crowding out” that occurs. In effect, nicotine takes over space in the reward center, and all day long the nicotine yells “me, me, me!”

A November 2022 survey study of more than 150,000 adolescents published in JAMA showed how e-cigarettes are powerfully addictive. As the researchers reported, more adolescent e-cigarette users start on their first nicotine product within five minutes of waking up than users of regular cigarettes and all other tobacco products combined.

The study’s introduction does not mince words, and they’re worth quoting: “Electronic cigarettes (e-cigarettes) are highly engineered drug delivery devices that create and sustain addiction. Early e-cigarettes did not deliver nicotine as efficiently as cigarettes because they delivered freebase nicotine that was hard to inhale. This situation changed with the 2015 introduction of Juul products, which added benzoic acid to the nicotine e-liquid to form protonated nicotine. Protonated nicotine increases addictive potential by making it easier to inhale quantities of nicotine that are difficult for naive users to achieve with cigarettes or earlier e-cigarettes. By 2018, Juul held 75 percent of the market.”

Meet the "New" Nicotine Peddlers

What’s maddening is that e-cigarette manufacturers likely knew what they were doing when they began targeting their products to adolescents. They were getting them hooked on nicotine so they would continue to buy their products.

This is despite knowing the long-term havoc this might cause to young people’s brains and behavior. These companies understood that they had a captive, susceptible audience that would respond positively to some of the same marketing tactics that had worked for cigarette manufacturers decades before: make it cool, manufacture it to be less harsh and more flavorful (flavored e-cigarettes remain the most popular), show celebrities using it, say it’s healthy (relative to cigarettes), package it in a slick device that looks like an Apple product, and make it easy to conceal and even smokeless—so mom can’t see the exhale coming out of your bedroom window.

Where Do We Go From Here?

As an addiction psychiatrist and medical doctor, all of this is quite upsetting to me. We had made such great strides with cigarettes among our adolescents. CDC data shows that the youth smoking rate's high-water mark of 36 percent in 1997 had fallen to 8.8 percent in 2017. This, of course, is when the e-cigarette craze was taking off for young people.

Vaping Essential Reads

E-Cigarettes: Godsend for Smoking-Cessation or Trojan Horse?

What to Do About Vaping Now That Teens Are Back to School

Given what we are experiencing at the addiction treatment center where I work, there’s no doubt that the explosion in e-cigarette-based nicotine addiction is already leading to spillover addiction to other drugs.

Here are two action items:

1. We need to get a handle on the nicotine addiction scourge, and part of that means holding e-cigarette manufacturers accountable for their exploitative behavior toward America’s youth. (Note: Juul is currently dealing with two massive lawsuits.) It is our responsibility as adults to make these companies act more responsibly, and demand compensatory action.
2. We need to do everything we can to help our young people make smart, informed decisions about e-cigarettes. They are not a healthy alternative to cigarettes. They contain a highly addictive substance (nicotine) we know about, and likely all sorts of other toxic substances we don’t yet know about.

Because e-cigarettes have been around for such a short time, little is known about their long-term health effects. But if past experience is our guide, there will be plenty of pain and sorrow to come.

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