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By Harold C. Urschel III, Enterhealth Chief Medical Strategist

While cigarette smoking has been on a downward trend for more than a decade, the use of electronic nicotine delivery systems (also known as electronic cigarettes, e-cigs, vapes, juuling, mods), known as “vaping,” is a trend that continues to rise with no signs of slowing down anytime soon. In fact, major companies including Phillip Morris (the makers of Marlboro cigarettes and others) are now getting into the e-cig arena.

The reasons behind the rise in popularity of e-cigs are many, but the main factors behind their meteoric rise to prominence include their low cost compared to traditional cigarettes, reusability, a myriad of flavor options, and the false perception that they are less harmful than traditional tobacco cigarettes. Unfortunately, all of these reasons are also behind the alarming rise in the use of e-cigs by youth and adolescents.

Why is this trend so alarming? Because if there is one subset of the population that is harmed most by nicotine – regardless of the delivery system – it’s young people.

What Are the Effects of Nicotine?

Without going into too much detail, nicotine works by mimicking neurotransmitters the body naturally produces, attaching to the receptors responsible for a number of functions, including muscle movement, breathing, heart rate, learning and memory. Stimulating these receptors also causes the release of other neurotransmitters and hormones which can affect a person’s mood, appetite, memory, learning ability and more.

Due to the flood of similar (or to your brain, identical) neurotransmitters, the body stops producing them naturally and reduces the number of receptors in the synapses. At this point, the brain is now reliant on a constant intake of nicotine to maintain normal function, which is the new state of a nicotine-addicted brain.

If nicotine use decreases or stops, the brain now produces an inadequate supply of neurotransmitters, and there are too few receptors to function properly anyway, so the user will likely experience very uncomfortable withdrawal symptoms. These can include shakiness and trembling, sleeping problems, increased appetite and weight gain, irritability, and fatigue.

The good news is that if a person stops using nicotine, the number of receptors and their sensitivity to naturally produced neurotransmitters will eventually return, but only after prolonged abstinence.

Nicotine’s Toxic Effects on the Developing Brain

While it is still under debate, most researchers now agree that for the majority of people (there is always individual variation), the brain is still developing into their mid-20s. Moreover, research from the University of Rochester Medical Center (URMC) shows that teen and adult brains actually work differently.

Generally speaking, healthy adults think with their prefrontal cortex, the part of the brain responsible for rational thought. Teens and young adults, on the other hand, tend to process information with the amygdala, the part of the brain that handles emotion, with only minimal input from their prefrontal cortex. This is because the connections between the amygdala (emotion) and the prefrontal cortex (rational thought) are still forming, often at different rates. In addition, the amygdala is also one of the parts of the brain responsible for forming “reward-system” pathways. All of this means that adolescents tend to be more motivated by rewards, less averse to risks, and more easily influenced by peers.

Nicotine use in adolescence has also been shown to lead to higher levels of dependence by exerting neurotoxic effects in the prefrontal cortex, interfering with normal cognitive development, executive functioning and inhibitory control. All of these changes make it more difficult for the adolescent brain to learn and remember new concepts. These effects are especially pronounced during stressful or emotionally intense times and are most noticeable when nicotine use begins during early adolescence.

The major implication of these facts is that teens and young adults are more sensitive to the addictive properties of nicotine. In fact, some studies have shown that adolescents report symptoms of nicotine dependence even at extremely low levels of consumption. Furthermore, evidence shows that once these reward-system pathways are established, the brain is more likely to develop similar pathways with other substances of abuse, making the person particularly susceptible to becoming addicted to cocaine and methamphetamine.

How Enterhealth Can Help

Nicotine addiction can be difficult to overcome. The National Institute on Drug Abuse (NIDA) reports that every year, approximately 35 million smokers try to quit, but only about 15 percent are actually successful. People experiencing withdrawal symptoms from nicotine commonly experience irritability, powerful cravings, depression, difficulty sleeping, anxiety, heightened appetite, as well as trouble concentrating or remembering things.

However, there are ways to increase your chances of kicking the habit for good. Most experts agree the best methods combine medication – whether it’s nicotine replacement therapy (transdermal patch, gum, lozenges, etc.) or another medication such as Chantix – with behavioral therapy.

Enterhealth Ranch and The Enterhealth Outpatient Center of Excellence both offer a number of different smoking cessation methods and behavioral therapies that utilize the latest science-based tools, medications and therapeutic techniques. In the Enterhealth smoking cessation program, you not only get access to the latest scientific methods to make it easier for you to stop successfully, you also get access to addiction-trained psychiatrists and therapists via our innovative, easy-to-use telehealth web interface. This affords patients convenient and confidential access to this care from the comfort of their own home. Additionally, our approach of creating individual treatment plans for each patient means we can pair the best possible methods and medications with each patient to get the best possible outcome.

Call 800.388.4601 or visit to learn more.

Even if you do not choose to pursue smoking cessation with Enterhealth, we encourage anyone who is addicted to nicotine to seek help, and many smoking-cessation products can be purchased over the counter. To see the full list of FDA-approved smoking-cessation methods, click here.