With the rise of tobacco harm reduction (THR) products—including vapes, heated tobacco and pouches—nicotine has increasingly come under attack. Nicotine is dependence-forming, but not the primary cause of harm in traditional combustible tobacco. THR products now offer adults a safer way to consume this naturally occurring, non-intoxicating stimulant.
Yet misinformation persists. In the bad old days, when deadly cigarettes were the unrivaled source of nicotine, public health groups chose to demonize the drug for the desirable goal of discouraging smoking. Today, however, the public health campaign against nicotine harms adults seeking safer alternatives to smoking—and millions of neurodivergent people who now benefit, or could benefit, from nicotine’s cognitive effects.
Adults with forms of neurodiversity (e.g., ADHD) smoke at four-to-six times higher rates than the general “neurotypicals” population. The lead hypothesis is that they are self-medicating. Nicotine helps them. Many adults who smoke or use THR products do so for the positive effects on anxiety. Nicotine releases dopamine and serotonin, which can elevate mood and ease anxious feelings. One study found nicotine acts as an “antidepressant” for many.
Nicotine also enhances attention and working memory, offering potential benefits for conditions like attention-deficit/hyperactivity disorder (ADHD), schizophrenia and autism spectrum disorder (ASD). Public health professionals routinely prescribe stimulants to individuals with ADHD to manage symptoms—and individuals with ADHD are more likely to smoke. A study in Pharmacology Biochemistry and Behavior found that nicotine patches improved cognitive performance in several ADHD-related domains among non-smoking young adults.
Some estimates suggest up to 90 percent of individuals with schizophrenia smoke. Nicotine use appears to offer them measurable benefits.
People with schizophrenia are also significantly more likely to smoke. Some estimates suggest up to 90 percent of individuals with schizophrenia smoke, compared to 11 percent of United States adults in 2023.
Nicotine use appears to offer them measurable benefits. A 2017 Nature Medicine study concluded that nicotine may be a therapeutic strategy for treating schizophrenia. It helps restore activity in the prefrontal cortex. One author said the findings provided “compelling biological evidence that a specific genetic variant contributes to risk for schizophrenia, defines the mechanism responsible for the effect, and validates that nicotine improves that deficit.”
A 2024 study examining the “impact of smoking on clinical symptoms after antipsychotic treatment” assessed 145 male patients and found that those who smoked “showed greater improvement in negative symptoms” than those who did not smoke. No one would advise such patients to smoke, of course; safer nicotine use is a different matter.
Nicotine has also shown promise for individuals with ASD. The authors of a 2015 study in the Journal of Autism and Developmental Disorders, for instance, found that a transdermal nicotine patch reduced the need for emergency medications. They concluded that nicotine “may safely reduce aggression and irritability in people with ASD.”
Decades of deliberately demonizing nicotine for the purpose of discouraging smoking now make this a difficult pill to swallow.
Nicotine use also plays a role for people with substance use disorders (SUD), who are far more likely to smoke than the general population, often using cigarettes or THR products to complement—or replace—substances like opioids or alcohol. Nicotine can serve as a neurochemical bridge to help manage cravings and withdrawal symptoms.
Given the high prevalence of smoking among neurodivergent people and those with SUD—and emerging evidence of nicotine’s therapeutic effects—public health agencies and regulators should support innovation in THR products that deliver nicotine without the dangers of combustion.
However, decades of deliberately demonizing nicotine for the purpose of discouraging smoking now make this a difficult pill to swallow. It is difficult, too, to consider the possibility that a large proportion of the 2.3 percent of US teens who now vape nicotine frequently may have diagnosed or undiagnosed ADHD or other conditions. So difficult that no researcher has asked and tested this basic, obvious question.
Vapes and other THR products provide a gateway out of smoking while offering symptom relief for many neurodivergent adults. And they are easier to obtain than prescription drugs, particularly for people who have limited or no access to health care.
Numerous public health bodies have concluded that nicotine vapes are significantly less harmful than combustible tobacco. The US Food and Drug Administration has authorized some THR products—including vapes, heated tobacco and flavored nicotine pouches—after determining they are “appropriate for the protection of public health.”
Still, misinformation lingers, including among medical professionals who could help reduce smoking by encouraging neurodivergent patients, or those with SUD, to switch to safer alternatives.
It’s time for public health leaders and policymakers to rethink nicotine, embrace tobacco harm reduction and support vulnerable adults who rely on nicotine for therapeutic and cognitive benefits.
Photograph (cropped) by L.V. Olavi Rantala via Flickr/Creative Commons 2.0
The author was formerly employed by the Foundation for a Smoke-Free World (now Global Action to End Smoking), which previously provided grants to The Influence Foundation, the nonprofit behind Filter. Filter‘s Editorial Independence Policy applies.