Nicotine, tobacco, and vaping

Nicotine is the addictive substance in cigarettes, cigars, chewing tobacco, nicotine pouches, and most vapes. Many people who use nicotine want to quit, and many try several times before it sticks. Repeated attempts are a normal part of quitting, not a sign it will never happen.

Vaping

E-cigarettes and vapes deliver nicotine without burning tobacco. Many products contain high levels of nicotine, and frequent use throughout the day can produce strong dependence — including among teens and young adults who never smoked. Quitlines and quit programs help with vaping too.¹

DSM-5-TR uses tobacco use disorder; ICD-11 classifies disorders due to use of nicotine. Vaping products that contain nicotine can lead to the same dependence.

Nicotine dependence is diagnosed by the same pattern as other substance use disorders: difficulty controlling use, craving, continued use despite harm, tolerance, and withdrawal.

• Nicotine reaches the brain within seconds, making each use a strong learning event.
• Use is repeated many times a day, tying it to almost every routine — coffee, driving, breaks, stress.
• Starting in adolescence increases the likelihood of long-term dependence.

Nicotine activates nicotinic receptors in the brain, triggering dopamine release in reward circuits. With regular use, the brain adds and adjusts receptors, so withdrawal begins quickly when nicotine levels fall — which is why many people need nicotine soon after waking.

• Withdrawal: irritability, restlessness, trouble concentrating, increased appetite, and strong urges.
• Cues are everywhere because use was linked to so many daily moments.
• Stress relief: nicotine relieves its own withdrawal, which can feel like relieving stress.

• Using within minutes of waking
• Feeling irritable or anxious when you can't use
• Using more over time
• Trying to quit and returning within days
• Using despite a health condition that nicotine makes worse

Smoking damages almost every organ and causes heart disease, stroke, lung disease, and many cancers. Vaping is generally considered less harmful than smoking for adults who switch completely, but it is not harmless, and nicotine affects adolescent brain development.

• Nicotine is legal and socially accepted, so its grip is easy to underestimate.
• Weight gain and stress during quitting worry many people; they can be planned for.
• Slips are common. Most people who quit for good had earlier attempts.

• Pick a quit date within the next two weeks.
• Identify your most automatic uses and plan replacements.
• Combine coaching with medication — together they work better than either alone.
• Tell people and remove products from your home, car, and bag.

Free coaching is available through state quitlines at 1-800-QUIT-NOW, and through Smokefree.gov text programs.¹ The CDC notes that quitlines can help people build a plan and increase their chances of quitting.²

FDA-approved quit medications include nicotine replacement therapy (patch, gum, lozenge, inhaler, nasal spray), varenicline, and bupropion. A doctor or pharmacist can help you choose; some are available without a prescription.

1. Call 1-800-QUIT-NOW (1-800-784-8669) or, in Spanish, 1-855-DÉJELO-YA (1-855-335-3569).¹
2. Ask a pharmacist about nicotine replacement.
3. Throw away cigarettes, pods, and lighters.
4. Use Craving Support when an urge peaks.

• Offer support, not lectures — they likely already know the risks.
• Ask what would help: a smoke-free home, distraction during cravings, patience with irritability.
• Celebrate effort, including attempts that did not last.