Verified by 
Among the clamor over the ills of vaping and the genuine troubling issues it raises, often overlooked is the real concern that it’s another gateway drug feeding the addict’s brain and making their situation worse.
Thankfully, the recent public attention given to vaping is a much-needed step toward curbing the practice, particularly among vulnerable teens. Yet, it must be remembered that the allure doesn’t evaporate, and for countless users, the logical path is the black market.
By all accounts, back-alley-generated vaping products dominate the market and are assumed to be responsible in large part for the multiple illnesses linked to vaping, and most likely, the deaths as well.
Back-alley e-cigarette purchases will rule the day, fueled by perceptions of vaping as a fad, nothing serious. Appealing flavors and, as originally marketed, a “healthier” means to quit smoking offered a certain cache. To those younger users predisposed to drug use, vaping evolved as an appetizer to an inevitable deadlier meal. The cache became part of another reality that is so difficult to abandon, especially before the teenage brain is fully developed.
Consider what’s in those vapors—nicotine. According to experts, nicotine-laced vapors can reach the brain in roughly 10 seconds. Nicotine shares common characteristics with heroin, alcohol, or any drug in its ability to signal the release of dopamine that transmits, as one researcher put it, a “whatever-just-happened-felt-good” response to the brain and then trains it to demand a repeat of the action. The problem? Nicotine quickly leaves the body, but once it’s gone, the brain’s craving continues.
As a psychiatrist specializing in addiction, I have seen the well-traveled path from occasional nicotine use to nicotine dependence, the early use often associated with more frequent marijuana use as well as more dangerous substances.
Teens exposing themselves to nicotine often have more anxiety and depressive symptoms than those who do not. Research has consistently demonstrated a link between adolescent smoking and psychiatric problems: in particular, major depressive disorders and disruptive behavior disorders.
The eventual path to alcohol and drugs should surprise no one. Some studies have linked nicotine exposure to drug cravings. It has also been noted that nicotine use can increase the likelihood of relapse among people in recovery for substance use disorder. Possible explanations include that using nicotine may serve as a “drug cue” and relapse trigger.
On-again, off-again efforts to ban vaping do not seem to affect demand, albeit evaluating black market sales can be a futile exercise. A 2018 Monitoring the Future survey demonstrated soaring rates of e-cigarette use among American youth—a 90 percent increase in one year.
The Surgeon General issued an advisory last year that emphasized the importance of protecting children from a lifetime of nicotine addiction by addressing—immediately—the epidemic of youth e-cigarette use. Although vaping may not lead to major health problems, like lung cancer, there is another vaping-related epidemic—impairment in cognitive function and attention.
All drugs of abuse ultimately affect the same reward pathway. The long-term health effects are still being researched, and various substances have different pharmacological mechanisms, but clearly, the use of nicotine, regardless of how it is delivered, increases the risk of addiction.
We all must recognize that vaping is a bigger problem than most people realize—particularly those susceptible to alcohol and substance misuse. Beyond the ban on the product, it’s time to educate people on just how dangerous that glitzy packaging and “fun flavors” are.
