Vaping and Nicotine Addiction: A Growing Concern for Young Adults

The Vaping Epidemic Among Young Adults

The rise of electronic cigarettes has produced the most rapid increase in youth and young adult nicotine addiction in a generation. Between 2017 and 2023, e-cigarette use among young adults aged 18 to 24 grew dramatically, driven by sleek product design, appealing flavors, aggressive social media marketing, and a widespread misperception that vaping is harmless. In Southern California, where trend adoption tends to occur early, vaping prevalence among young adults exceeds national averages.

The nicotine delivery systems in modern vaping devices are engineered for maximum addictive potential. Products like JUUL popularized the use of nicotine salts, a chemical formulation that allows extremely high nicotine concentrations (50 mg/mL or higher) to be inhaled without the harshness of freebase nicotine. A single JUUL pod contains approximately the same amount of nicotine as 20 traditional cigarettes, and many young users consume one or more pods daily.

At Trust SoCal, we have observed an increasing number of young adults seeking help for nicotine dependence alongside other substance use issues. Vaping addiction is frequently minimized or overlooked in clinical settings, yet the neurological impact of high-dose nicotine dependence on the young adult brain is significant and can complicate recovery from other substance use disorders.

How Nicotine Addiction Develops Through Vaping

Nicotine is one of the most addictive substances known. It activates nicotinic acetylcholine receptors in the brain, triggering dopamine release in the reward pathway and producing feelings of pleasure, alertness, and stress relief. The extremely efficient nicotine delivery of modern vaping devices means that dependence can develop remarkably quickly, sometimes within days of regular use in susceptible individuals.

The developing brain, which continues to mature until approximately age 25, is particularly vulnerable to nicotine's addictive effects. Nicotine exposure during this developmental period permanently alters the brain's reward circuitry, creating enhanced susceptibility to addiction not only to nicotine but to other substances as well. Research has demonstrated that young people who become nicotine-dependent through vaping are significantly more likely to subsequently use alcohol, marijuana, and other drugs.

The behavioral aspects of vaping reinforce the chemical addiction. The hand-to-mouth ritual, the immediate reward, the social bonding with fellow users, and the widespread availability of devices create a multi-layered reinforcement pattern. Many young vapers report using their devices dozens to hundreds of times per day, far exceeding the frequency of cigarette smoking and producing more sustained nicotine exposure.

Health Risks of Vaping Beyond Nicotine Addiction

While vaping is sometimes promoted as a safer alternative to smoking, this comparison overlooks the significant and increasingly documented health risks unique to e-cigarette use. The 2019 outbreak of EVALI (E-cigarette or Vaping Product Use-Associated Lung Injury) hospitalized 2,807 people and killed 68 across the United States, demonstrating that vaping can cause acute, life-threatening lung damage.

Beyond EVALI, chronic vaping exposes users to a complex mixture of chemicals including propylene glycol, vegetable glycerin, flavoring compounds, heavy metals (lead, nickel, tin), and volatile organic compounds. When heated and aerosolized, these ingredients produce harmful byproducts including formaldehyde, acrolein, and acetaldehyde, all known respiratory irritants and potential carcinogens. The long-term health consequences of inhaling these substances daily remain unknown because the products have not existed long enough for longitudinal studies.

Cardiovascular effects of vaping include increased heart rate and blood pressure, endothelial dysfunction (damage to blood vessel linings), increased arterial stiffness, and oxidative stress. Emerging evidence suggests that chronic vaping may increase the risk of heart attack and stroke through mechanisms independent of traditional cigarette smoke exposure. For young adults who perceive no health risk, these findings represent a critical knowledge gap.

• EVALI: acute lung injury requiring hospitalization, sometimes fatal
• Chronic bronchitis and increased respiratory infection susceptibility
• Cardiovascular damage including endothelial dysfunction and increased blood pressure
• Exposure to heavy metals including lead, nickel, chromium, and manganese
• Formaldehyde and acrolein exposure from heated propylene glycol
• Impaired immune function and wound healing
• Potential long-term cancer risk from chronic carcinogen exposure
• Nicotine-related effects: insulin resistance, reproductive harm, impaired brain development

Signs of Vaping Addiction in Young Adults

Identifying vaping addiction in young adults can be challenging because the behavior is often normalized within peer groups and the devices are designed to be discreet. However, the signs of nicotine dependence from vaping follow predictable patterns that parents, partners, and friends can learn to recognize.

The most telling sign is the inability to go without the device for even short periods. Individuals with vaping addiction will become anxious, irritable, or distracted if they cannot access their device for an hour or more. They may wake during the night to vape, reach for the device immediately upon waking, and feel unable to concentrate or manage stress without nicotine. Spending increasing amounts of money on vaping products and becoming defensive when others express concern about their use are additional indicators.

Physical signs may include chronic cough, shortness of breath during physical activity, frequent headaches, and dental problems including gum inflammation and dry mouth. Some users experience nicotine-related symptoms including dizziness, nausea, and heart palpitations, particularly when using high-concentration products.

Nicotine Withdrawal and Quitting Strategies

Nicotine withdrawal produces a constellation of symptoms that, while not medically dangerous, are uncomfortable enough to drive the majority of unaided quit attempts to failure within the first week. Withdrawal symptoms begin within 4 to 24 hours of the last use and typically peak between days 2 and 4, with most physical symptoms resolving within 2 to 4 weeks. Psychological cravings may persist for months.

Common withdrawal symptoms include intense cravings, irritability and anger, anxiety, difficulty concentrating, depressed mood, increased appetite, insomnia, and restlessness. For individuals who have been vaping high-nicotine products multiple times daily, the intensity of these symptoms can be comparable to withdrawal from other addictive substances and should not be dismissed as trivial.

Evidence-based quit strategies include nicotine replacement therapy (patches, gum, lozenges), prescription medications (varenicline/Chantix, bupropion/Wellbutrin), behavioral counseling, and smartphone-based cessation programs. Combining pharmacological and behavioral approaches produces the highest quit rates. For young adults with co-occurring substance use issues, addressing nicotine dependence as part of comprehensive addiction treatment is recommended.

Getting Help for Vaping and Nicotine Addiction

While nicotine addiction from vaping may not carry the same acute overdose risk as opioids or the same organ damage as alcohol, it represents a genuine substance use disorder that affects quality of life, physical health, and mental well-being. For young adults who also use other substances, nicotine dependence can complicate the recovery process and increase relapse risk for other drug and alcohol use.

Trust SoCal's treatment programs in Orange County address nicotine addiction as a component of comprehensive substance use treatment. Our clinical team recognizes that nicotine dependence, particularly among young adults, often coexists with other substance use patterns and mental health conditions that require integrated treatment approaches. We offer individualized treatment planning that accounts for all substances of use, not just the primary presenting concern.

If you or a young adult in your life is struggling with vaping addiction, especially in combination with other substance use, contact Trust SoCal at (949) 280-8360 for a confidential assessment. Recovery from nicotine addiction is achievable, and evidence-based treatments can significantly improve quit rates and long-term health outcomes.