“Addiction is a disease of decision-making,” said Bechara. “The majority of people have intact brain mechanisms of decision-making that keep them resilient to succumbing to an addiction. The question is, who is more vulnerable and how do we best determine that?”

“It’s not always easy attributing substance-use disorders to a cause of death,” says Rebecca Trotzky-Sirr, medical director of urgent care at L.A. County-USC Medical Center, which has one of the largest and busiest emergency rooms in the country. “A person can die from liver failure after years of drinking alcohol. Or have heart disease that came from a prior history of smoking methamphetamine, even when they have not used in a long time.”

Adam Leventhal, director of the USC Institute for Addiction Science, said "this a cross-sectional study taken at a single snapshot in time," which makes it "very difficult to draw any conclusions about any causal relation between e-cigarette use and combustible cigarette use."

Adam Leventhal, director of the USC Institute for Addiction Science and professor at the Keck School of Medicine of USC, in a statement said, “While many children try e-cigarettes, not all become regular users. Teens who use e-cigarettes may be more inclined to continue vaping rather than just temporarily experiment with e-cigs. Whether or not children continue vaping is important -- the longer and more frequently you vape, the more you're exposing yourself to toxins in e-cigarette aerosol and put yourself at risk for nicotine addiction.”

“There’s a lot more prescribing of opioids by nurses and physician assistants, where they are state-by-state allowed to prescribe them,” says Sarah Axeen, the study’s author and assistant professor of research in the department of emergency medicine at the Keck School of Medicine of USC. “That hasn’t been highlighted in the same way [as physicians’ prescribing practices].”

“Addiction is a disease of decision-making; the majority of people have intact brain mechanisms of decision-making that keep them resilient to succumbing to an addiction,” says Antoine Bechara, lead author on the report and a psychological scientist at the University of Southern California. “But a small percentage have a weakness in this mechanism and they are rendered more vulnerable.

"Whether or not children continue vaping is important -- the longer and more frequently you vape, the more you're exposing yourself to toxins in e-cigarette aerosol and put yourself at risk for nicotine addiction," Leventhal said in a university news release.

"We know that sales of 'pod-mod' style e-cigarette products, such as Juul, with high nicotine concentrations and fruit and minty flavors, are climbing," said researcher Adam Leventhal, director of the University of Southern California Institute for Addiction Science. "Young adults overwhelmingly prefer e-cigarette flavors not present in regular cigarettes."

In adults, e-cigarettes may serve as a substitute for combustible cigarettes. Earlier models of e-cigarettes predicted a decrease in the risk for nicotine addiction compared with traditional cigarettes. However, the most popular “pod mod” products tend to contain high levels of nicotine that maintains if not reinforces the addiction.

USC investigators suggest that mindfulness may be the key to substance abuse treatment. Research suggests that the practice of mindfulness may be able to enhance treatment and recovery from addiction.

Young people who vape are more likely to use marijuana, according to a study published Monday. The findings, researchers say, support the theory that nicotine rewires the developing brain, changing how people respond to and crave addictive substances.

"It's great that it's moving in the right direction," says Adam Leventhal, director of the University of Southern California's Institute for Addiction Science. "It's important that the public and policymakers recognize that the addiction crisis is unfortunately still alive and well. It's just shifting."

“Prescription opioids and heroin activate the brain’s pleasure circuit in similar ways,” said senior author Adam Leventhal, a professor of preventive medicine and psychology and director of the USC Institute for Addiction Science at the Keck School of Medicine of USC. “Teens who enjoy the ‘high’ from prescription opioids could be more inclined to try other drugs that produce euphoria, including heroin.”

Nearly 400,000 people in America died from opioid overdose from 1999-2017. USC experts believe they can stem the tide.

However, use of fentanyl is likely to grow in San Francisco and Los Angeles, as people get accustomed to it and begin to prefer its more intense high, says Ricky Bluthenthal, a professor of preventive medicine at the Keck School of Medicine of the University of Southern California, who researches injection drug use.

“The data in this most recent study suggest a need for policies to extend restrictions on cartoon-based marketing of cigarettes to include marketing for e-cigarettes,” Allem said. Additional study authors include Tess Boley Cruz, Jennifer B. Unger, Josseline Herrera and Sara Schiff, all of the department of preventive medicine at the Keck School.

However, use of fentanyl is likely to grow in San Francisco and Los Angeles, as people get accustomed to it and begin to prefer its more intense high, said Ricky Bluthenthal, professor of preventive medicine at the Keck School of Medicine of the University of Southern California, who researches injection drug use.

But nicotine and caffeine aren’t chemically similar, not really. When I covered the health effects of nicotine last year, I asked Adam Leventhal, director of the USC Health, Emotion, and Addiction Laboratory, how the two drugs compared. “They’re apples and oranges,” he told me, citing a long list of distressing nicotine withdrawal symptoms like anxiety, depression, irritability, and hunger.

Initial studies with young adults show dramatic drops in stress, cravings, impulsivity and risk of relapse after practicing mindfulness.

“These findings did not provide strong evidence of transition away from cigarette smoking as a potential public health benefit of e-cigarette use,” Jessica Barrington-Trimis, of the Keck School of Medicine at the University of Southern California in Los Angeles, told Reuters. “Collectively, findings from this paper suggest that e-cigarette use may result in an overall adverse impact of the public health of youth and young adults.”

“The dispute is primarily disciplinary—although it is taking on metaphysical proportions given the inability or unwillingness of Doleac and colleagues to acknowledge the validity of other methodologies or to reflect constructively on the weakness of their own methods,” says Ricky Bluthenthal, professor of preventive medicine at the University of Southern California. “Ignoring findings from other methodological approaches is uncommon in public health. We are multidisciplinary by necessity and training.”

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During the past 10 years, a “dramatic shift” has occurred in the tobacco product marketplace, with e-cigarettes, hookah tobacco water pipes and small cigars gaining significant heft in sales — especially among this young population, noted an editorial that accompanied the study by Adam Leventhal and Jessica Barrington-Trimis of the University of Southern California’s Keck School of Medicine.

"Some music can glamorize addiction and substance abuse. There's a difference between speaking out about your troubles and glamorizing that lifestyle," said Adam Leventhal, the director of USC's Health, Emotion & Addiction Laboratory. "There's a belief in some communities that you're just supposed to be strong and handle your business and not talk about it or that it's somehow your fault. These ideas have been perpetuated for generations, in part by media and through social circles."