Nicotine Addiction

Why Stopping Nicotine Can Be Difficult

You want to stop smoking or vaping but still reach for nicotine. Perhaps withdrawal derailed a quit attempt, or a familiar routine keeps pulling you back. Nicotine addiction is a persistent pattern in which nicotine’s rewarding effects, learned routines, and withdrawal make use difficult to control despite harm or a desire to stop. Understanding both nicotine and habit helps explain that struggle.^[1][2]

Nicotine Use and Nicotine Addiction

Nicotine is a drug found in tobacco. It attaches to proteins in the nervous system called nicotinic acetylcholine receptors. Through these receptors, nicotine affects circuits involved in reward and learning, helping the brain connect nicotine use with particular sensations, situations, or routines.^[1]

Nicotine is used through smoked tobacco, e-cigarettes, smokeless tobacco, nicotine pouches, and nicotine replacement products. These products do not deliver nicotine in the same way, and they do not carry identical risks.^[3][2][4]

Dose and speed of delivery help shape nicotine’s addictive potential. Non-drug rewards also matter, including flavor, sensory effects, social settings, handling a device, and routines such as smoking during a break. This is why changing the nicotine source may not immediately erase the habits connected with it.^[2]

Use, Dependence, and Disorder

These terms overlap, but they are not interchangeable.

These descriptions explain related concepts rather than supply a diagnostic checklist. Withdrawal describes what happens after stopping nicotine. Addiction also involves the rewards and learned behaviors that maintain use. A clinician considers the broader pattern rather than treating withdrawal alone as a diagnosis.^[1][2]

“Tobacco use disorder” is especially important when discussing newer products. Assessment should consider cigarettes, e-cigarettes, heated tobacco, pouches, and other products without assuming they have identical consequences. It may also include harm-reduction goals when stopping nicotine completely is not immediately achievable.^[2]

Nicotine replacement therapy supplies nicotine as a smoking-cessation treatment rather than through burning tobacco. Its purpose and treatment evidence matter: reviews support it for helping people stop smoking, especially when a patch is combined with a faster-acting form such as gum. That benefit should be distinguished from the separate question of ongoing nicotine use.^[4]

Reinforcement and Loss of Control

Reinforcement means that a consequence makes a behavior more likely to happen again. Nicotine can produce positive reinforcement when its immediate effects feel rewarding. It can produce negative reinforcement when another dose temporarily relieves withdrawal discomfort.^[1]

With repeated exposure, the nervous system adapts. When nicotine is no longer present, withdrawal may develop. Relief from that withdrawal can then strengthen the cycle of taking nicotine again, alongside nicotine’s rewarding effects.^[1]

Nicotine use also becomes linked with ordinary situations and routines. These can become cues, reminders associated with using the product. Learned rewards help maintain use alongside nicotine’s drug effects, so understanding a quit attempt means considering both withdrawal and habitual behavior.^[2][5]

In a qualitative study led by University of California, San Francisco researcher Nhung Nguyen, young adults in California described their experiences in interviews. The study found that participants often connected vaping with routines such as work breaks or bedtime. They described habitual device handling, flavors, withdrawal, mental health concerns, cost barriers, and identity as factors affecting efforts to stop.^[5]

Because participants were recruited through availability rather than representative sampling and were motivated to quit, it identifies useful themes rather than estimating how often each issue occurs.^[5]

Questions About Control and Consequences

Difficulty controlling use, habitual behavior, withdrawal, and continued use despite consequences are worth discussing when seeking help. The following are conversation prompts drawn from the review and interview themes, not a validated diagnostic test.^[1][2][5]

Consider which questions fit your experience:

• Does using the product feel automatic rather than deliberately chosen?
• What happened during previous efforts to stop?
• Did withdrawal or cravings lead you back to use?
• Do device handling or appealing flavors make stopping harder?
• Are you continuing despite concerns about health or cost?
• Are you using nicotine to cope with mood concerns, and is it providing the relief you expected?

Bring your answers to a care discussion. The aim is to describe what makes stopping difficult and what support you want, rather than diagnose yourself from a list.^[2][5]

Dependence Assessment and Screening

A useful starting point is to name the actual products involved and say whether their nicotine content is known. Product-specific questions matter because some people who vape are unsure whether they use nicotine, and different nicotine products have different consequences.^[6][2]

To prepare for a discussion, consider bringing notes about:

• The tobacco or nicotine products you use, including combinations
• Whether you know the nicotine content
• Routines and situations connected with use
• Withdrawal concerns and what happened during previous quit attempts
• Health concerns, perceived benefits, and treatment-cost barriers
• Cannabis vaping alongside nicotine vaping
• Whether your goal is quitting, switching away from smoking, or exploring options

Include nicotine use in a discussion of your health and treatment goals. Products, routines, withdrawal, and barriers to quitting can all matter when deciding what support to try.^[2][5]

Screening measures are questionnaires used to organize assessment. If you receive a score, ask what it measures, which products and populations it was tested in, and what further assessment is needed. A prevalence survey should not be read as a diagnostic test.^[3][6]

Self-report also has limitations, particularly when product labels are unclear. In a Norwegian adolescent study, 12% of those reporting vaping at the first assessment were unsure whether their e-cigarette contained nicotine.^[6] This illustrates why vaping prevalence and nicotine exposure are not interchangeable measures.^[6]

Avoid treating product counts as interchangeable measures of dependence. The tobacco use disorder review identifies nicotine dose, delivery speed, and non-drug rewards as relevant to addictive potential, but it does not provide a conversion between cigarettes, vaping, and pouches. A practical question is: “How will you assess my use of this particular product?”^[2]

Nicotine Use in the United States

The 2025 National Survey on Drug Use and Health measured nicotine and tobacco use among U.S. people age 12 or older. These are reports of product use, not counts of people with nicotine addiction. The categories overlap, so they should not be added together.^[12]

In the 2025 NSDUH, 6.9% of people age 12 or older reported daily cigarette smoking in the past month.^[12] The corresponding 2024 estimate was 7.7%.^[12] The survey marked the decline as statistically significant.^[12] A population trend does not explain why a particular person continues smoking or which treatment they need.^[12]

U.S. Youth Tobacco Use in 2024 and 2025

The 2024 National Youth Tobacco Survey included 29,861 students in 283 U.S. middle and high schools.^[7] Current use meant using a product on at least one of the previous 30 days. Any tobacco-product use was reported by 10.1% of high school students and 5.4% of middle school students.^[7]

Across both school levels, 5.9% reported current e-cigarette use.^[7] These are estimates of product use, not nicotine addiction. The survey relied on self-reports, had a 33.4% response rate, and may not represent young people outside the surveyed school settings.^[7]

A newer analysis of the 2025 National Youth Tobacco Survey reported past-30-day tobacco-product use among 7.2% of U.S. middle and high school students.^[19] E-cigarettes were the most-used product at 5.2%, followed by nicotine pouches at 1.7%.^[19] These survey estimates describe product use, not diagnoses of nicotine addiction.^[19]

Nicotine and Product-Related Harm

Nicotine drives much of tobacco’s addictive potential, but nicotine exposure and smoking are not the same hazard. Burning tobacco creates a combustible product. Cigarettes, cigars, and pipes made up most reported adult tobacco use in 2021 and were identified in the national report as the leading source of tobacco-related illness and death.^[3]

Alternative products have different consequences, and those consequences should not be assumed to equal those of cigarettes. A product can avoid combustion yet still expose a person to nicotine, reinforce dependence, or introduce product-specific harms. “Less harmful than smoking” also does not mean harmless.^[2]

Comparing Common Delivery Approaches

The comparison below separates product-related harm from evidence that a product helps people stop smoking.

Cochrane is an international nonprofit organization that produces systematic reviews, structured assessments of research on a question. An overview of its 2021–2023 tobacco addiction reviews found that nicotine e-cigarettes helped people stop smoking.^[4]

Secondary analyses also found reductions in biomarkers of potential harm among people who switched from smoking to vaping or reported dual use. Biomarkers are measurable substances or body changes that may indicate exposure or possible harm. They are not the same as proof of long-term health outcomes.^[4]

A systematic review estimated that 54% of participants given nicotine e-cigarettes in smoking-cessation studies were still using them at six months or later.^[8][4] Results varied substantially between studies. Stopping smoking and stopping nicotine use are different outcomes.^[8] The review found insufficient evidence to determine how flavors in e-liquid (the liquid used in e-cigarettes) relate to smoking cessation.^[4]

A 2026 Cochrane review found high-certainty evidence that nicotine e-cigarettes help more people stop smoking than nicotine replacement therapy. This finding concerns smoking cessation, not proof that vaping is harmless or that nicotine use ends. The review studied regulated nicotine products and called for larger, longer studies of harms.^[17]

Nicotine Withdrawal

Nicotine withdrawal is the collection of symptoms that may occur when a physically dependent person stops nicotine. It reflects adaptation to repeated exposure, not a measure of commitment to quitting.^[1]

Common withdrawal symptoms include:

• Irritability or frustration
• Anxiety
• Depressed mood
• Increased appetite
• Impatience
• Difficulty sleeping
• Restlessness

These symptoms are described in the diagnostic framework cited by a review of nicotine addiction. The same review reports that symptoms generally peak within the first week and then subside over the following three to four weeks. Individual experiences can vary.^[1]

Craving was also reported in the California qualitative study. Young adults described cravings, irritability, tiredness, mood changes, headaches, and disrupted eating or sleep when trying to stop vaping nicotine or cannabis. These interviews document participant experiences. They do not establish how frequently each symptom occurs in all people who quit.^[5]

The National Cancer Institute describes withdrawal as usually worst during the first week, often peaking in the first three days and declining during the first month. Some symptoms can last for several months. A difficult day outside the typical pattern is a reason to discuss support, not assume that everyone follows the same schedule.^[20]

Withdrawal and Longer-Term Urges

A typical withdrawal timeline is not a deadline for every craving to end. Familiar routines can continue to prompt urges after early physical symptoms ease. If an earlier quit attempt became difficult at work, before bed, or around other people who vape, build support for those situations into the next plan.^[1][2][5]

What Can Increase the Risk of Returning to Use?

Consider both nicotine-related and situational influences when planning. The California qualitative study identified withdrawal, habitual use, product accessibility, device and flavor appeal, mental health coping, identity, and treatment cost as barriers. These findings suggest topics to discuss. They do not quantify how much each factor raises the risk of returning to use.^[5]

Health concerns, performance goals, and a desire to quit sometimes supported change in the same study. These themes can help you plan, but they cannot predict an individual outcome.^[5]

A return to use does not erase what was learned during an attempt. It can reveal a trigger, an untreated withdrawal problem, or a mismatch between the plan and the person’s circumstances.

Why a Quit Attempt Does Not Follow a Fixed Schedule

A typical withdrawal timeline cannot promise when every urge will end. Physical withdrawal and familiar routines can both matter, so a difficult day does not by itself mean your effort has failed.^[1][5]

Likewise, symptom relief after nicotine use does not necessarily show that nicotine treated an underlying anxiety or mood condition. Some young adults reported using vaping to cope with mental health concerns while also reporting that it did not relieve anxiety or depression. That qualitative finding raises an important question, but it does not establish causation.^[5]

Adult Smoking Cessation Treatment

Behavioral support and medication are evidence-based approaches to tobacco cessation, meaning stopping tobacco use. The World Health Organization’s adult treatment guideline covers both approaches for healthcare providers in clinical and community settings. It is international guidance rather than a U.S.-specific care pathway.^[9]

The treatment comparisons below concern adults stopping cigarette smoking. They should not automatically be generalized to adolescents, pregnancy, exclusive vaping, smokeless tobacco, or every newer nicotine product.

Behavioral Counseling

Behavioral counseling provides support through conversation rather than medication. Reviews support its effectiveness for smoking cessation. U.S. Public Health Service guidance also supports telephone quitline counseling, which allows counseling by phone rather than requiring an in-person visit.^[4][10]

Call 1-800-QUIT-NOW (1-800-784-8669) for free, confidential quit coaching. Quitlines are available throughout the United States. A coach can help you plan for cravings, discuss previous attempts, and connect you with medication resources.^[16]

Ask how counseling will address the barriers that matter to you, such as withdrawal, daily routines, mood, cost, or a return to use. Naming a specific difficulty gives the counselor something concrete to help you plan for.^[2][5]

Possible questions include:

• Can we review the routines linked with my use?
• Can we plan for cravings and withdrawal concerns?
• Can we discuss mood concerns and cannabis co-use?
• Can we review a return to use without blame?
• Can we discuss goals other than stopping nicotine immediately?
• What support is affordable for me?

Repeated attempts are part of treatment for many people, not a reason to withhold help. The U.S. guideline describes tobacco dependence as a chronic condition that often requires repeated intervention and multiple quit attempts.^[10]

Nicotine Replacement Therapy

Nicotine replacement therapy, or NRT, supplies nicotine without cigarette smoke. Forms include a patch and faster-acting products such as gum. Research supports NRT for smoking cessation, especially combining a patch with a faster-acting form.^[4]

“Faster-acting” distinguishes products such as gum from the patch. Combining these forms is an evidence-supported option to discuss with a clinician or pharmacist. It is not a requirement for every quit attempt or a personalized medication schedule.^[4]

A 2024 Cochrane overview found high-certainty evidence that combining a nicotine patch with a faster-acting form produced higher quit rates than using one form of NRT alone.^[4]

Varenicline

Varenicline is a medicine used to help adults stop smoking. A 2024 Cochrane overview found high-certainty evidence of higher quit rates than with bupropion or one form of nicotine replacement therapy. Comparisons with combined NRT were less certain. Ask a clinician which choice fits your health, preferences, and previous quit attempts.^[4]

The same overview considered cytisine, also called cytisinicline. Cytisinicline is not FDA-approved as of October 9, 2026. Its developer reported in June that the FDA had issued a complete response letter concerning manufacturing and unfinished labeling. Evidence of benefit in trials is different from U.S. approval or availability.^[4][15]

Bupropion

Bupropion is another medicine with evidence for helping adults stop smoking. The 2024 overview found high-certainty evidence of benefit compared with placebo (an inactive comparison treatment) or no medication. It also found higher quit rates with varenicline than with bupropion.^[4]

That comparison should not be interpreted as proof that bupropion does not work. Evidence of benefit and evidence of a larger benefit with another treatment answer different questions. Average results do not determine an individual’s outcome.^[4]

Comparing Supported Adult Smoking Treatments

These options have evidence for smoking cessation. The comparisons help frame a discussion, but do not supply a personalized treatment choice.

Combining Medication and Behavioral Support

Combining counseling and medication has stronger support than simply noting that each works separately. The 2008 U.S. Public Health Service guideline found the combination more effective for tobacco dependence than either approach alone. For a reader planning to stop smoking, this supports asking about counseling even when considering medication, and vice versa.^[10]

This is a treatment recommendation, not a universal medication rule. The guideline identifies exceptions when a medicine is medically unsuitable and notes insufficient medication-effectiveness evidence for certain populations, including pregnant women and adolescents. The choice should account for the person’s needs and medical circumstances.^[10]

Help for Quitting Vaping

There is direct trial evidence for helping young people stop nicotine vaping. The results depend on the treatment and the population studied. Smoking-cessation evidence remains useful, but it should not be presented as if it automatically answers every vaping question.^[13][14]

Varenicline with Counseling

In a 2025 trial, 261 people ages 16 to 25 who vaped daily or nearly daily and did not regularly smoke tobacco were assigned by chance to varenicline with counseling, placebo (an inactive pill) with counseling, or text-support referral alone.^[13] The study took place in one U.S. state and enrolled people who wanted to reduce or quit vaping.^[13]

Verified continuous abstinence, meaning no vaping throughout the measured period, during weeks 9 through 12 was 51% with varenicline versus 14% with placebo.^[13] In the trial, continuous abstinence during weeks 9 through 24 was 28% with varenicline versus 7% with placebo.^[13] These results support a discussion with a clinician. They do not establish a medication plan for every young person or every vaping pattern.^[13]

Text Support for Teenagers

A 2024 U.S. trial enrolled 1,503 adolescents ages 13 to 17 who wanted to quit vaping.^[14] At seven months, 37.8% of those offered a tailored text-message program reported no vaping in the previous 30 days, compared with 28.0% in the assessment-only group.^[14] The outcome was self-reported, rather than biochemically verified.^[14]

The messages taught coping skills and offered social support. This is a practical option to ask about when seeking help for a teenager, including when regular in-person appointments are difficult.^[14]

What the Wider Vaping Evidence Can Tell Us

A 2025 Cochrane review judged the evidence for varenicline and tailored text-message support to be low certainty. That means further research could change the estimated benefit. Text-message findings came from young people using the same program, so they do not establish that every texting service works equally well.^[18]

The review found no clear evidence of a benefit from combined nicotine replacement therapy for quitting vaping, but confidence in that comparison was very low. This differs from the stronger evidence for combined nicotine replacement when stopping smoking. Serious harms and later smoking outcomes remained uncertain.^[18]

Make the Plan Fit Your Vaping Pattern

Tell the clinician or counselor which products you use, whether you know their nicotine content, what happens when you stop, and whether cannabis is involved. In interviews with young adults, routines, flavors, device handling, and treatment cost were recurring barriers. A plan should address those obstacles as well as withdrawal.^[5]

Special Considerations

Treatment evidence must be matched to the population studied. Adult cigarette trials should not be treated as universal evidence for adolescents, pregnant people, or people using only newer products.

Adolescents

Young people who already smoke or vape need cessation support, not only advice about avoiding nicotine. Counseling is supported for adolescent smokers. For nicotine vaping, newer trials support tailored text help for teenagers and varenicline with counseling in a studied group ages 16 to 25. A clinician should assess which options fit the young person.^[10][13][14]

Pregnancy

Ask prenatal care about counseling to stop smoking. U.S. Public Health Service guidance supports intensive behavioral support during pregnancy and found insufficient evidence to make a general medication-effectiveness recommendation for pregnant smokers. Medication decisions need a pregnancy-specific discussion of risks and benefits with the treating clinician.^[10]

Depression and Other Mental Health Conditions

Mood concerns and nicotine use can be addressed together. A Cochrane overview found that quitting smoking was associated with improved anxiety and depression compared with continuing to smoke, although confidence varied by outcome. Temporary anxiety or low mood can also occur during nicotine withdrawal. Tell the care team what you are experiencing so support can be adjusted.^[4][1]

Cardiovascular Disease

A review found that stopping smoking was associated with fewer cardiovascular events (serious problems involving the heart or circulation) and fewer deaths among people living with cardiovascular disease. The overview reported low-certainty evidence for major adverse cardiovascular events and moderate-certainty evidence for cardiovascular death. These findings require careful interpretation, but they support the importance of cessation in this population.^[4]

For someone with heart or circulation disease, a useful question is: “Which cessation approach fits my situation?” The importance of quitting does not determine which medicine is appropriate for you.^[4]

Nicotine and Cannabis Co-Use

In an interview study of California young adults motivated to quit vaping nicotine and/or cannabis, participants described overlapping routines, withdrawal concerns, mental health coping, and perceived benefits, but also substance-specific reasons for use. The convenience sample (participants recruited through availability rather than representative sampling) limits generalization. These findings support asking about both substances rather than assuming one plan addresses them identically.^[5]

A plan should identify whether the goal concerns nicotine, cannabis, smoking, vaping, or all of them. Treating these as one indistinguishable behavior may overlook important triggers and withdrawal experiences.

Medication Interactions and Health Conditions

Medication interactions are ways one medicine can change another’s effects. A comparison of quit rates cannot tell you which combinations are suitable for your health conditions and current medicines.

A practical question for a treatment discussion is: “Do any of my medicines or health conditions change which options I can use?” U.S. guidance supports cessation medicines while recognizing exceptions when a medicine is medically unsuitable. Average quit-rate comparisons do not resolve that individual question.^[10]

Harm Reduction

Harm reduction aims to lower health risk when complete abstinence is not immediately achievable. For tobacco use, the central distinction is whether combustible smoking continues.

A review of tobacco use disorder identifies stopping combustible smoking as the main goal. For someone unable to stop nicotine completely, switching to a less risky delivery method may be a secondary goal, potentially followed by stopping the alternative product later.^[2]

This does not establish that every alternative product is safe or that switching will occur completely. A switch that leaves cigarette consumption largely unchanged may have a different health meaning from fully stopping combustible smoking.

When choosing a harm-reduction goal, consider:

• Whether combustible tobacco will stop completely
• Whether dual use is likely to continue
• Whether the alternative has evidence as a cessation aid
• Whether nicotine dependence may be maintained
• Whether the plan includes later review rather than an indefinite assumption of safety
• Whether the person understands the difference between reduced exposure and proven long-term risk reduction

Harm reduction should not be used to dismiss someone who is not ready for immediate abstinence. It should also not be presented as proof that all nicotine products are interchangeable.

Building a Practical Change Plan

A useful plan starts with the person’s current goal. Someone may be ready to quit on a chosen date, interested in reducing, considering a switch away from smoking, or simply trying to understand their use. Each position can lead to a concrete next step.

Map the Current Pattern

When preparing a plan, note the product, situation, approximate frequency, and what happened immediately before use. The purpose is not to produce a perfect count. It is to identify repeated connections such as driving, meals, stress, social settings, alcohol, boredom, or easy device access.

Also note which uses feel automatic and which relieve withdrawal. That distinction can help determine whether a plan needs stronger support for physical dependence, behavioral routines, or both.

Choose a Clear Initial Goal

A goal should name the product and desired change. “Use less nicotine” may be too vague if someone smokes, vapes, and uses pouches.

Possible goal structures include:

• Stop combustible smoking
• Stop all tobacco and nicotine use
• Stop vaping nicotine
• Reduce use while preparing for a quit attempt
• Replace cigarettes with an evidence-supported cessation approach
• Discuss treatment options before deciding

These are planning formats, not claims that each has equal health benefit.

Prepare for Predictable Situations

Choose a response for the times most strongly linked with use. That might involve changing a routine, removing easy access, delaying a purchase, using a non-nicotine activity during a break, or contacting a supportive person.

If withdrawal disrupted an earlier attempt, consider discussing evidence-based treatment rather than repeating the same unsupported approach. If cost or access is the barrier, say that directly when seeking care. Affordability affected treatment use in the young-adult vaping study.^[5]

Plan for a Return to Use

Decide in advance what to do if smoking or vaping occurs. A useful response is to stop, identify what led to it, and choose the next action rather than waiting for another ideal date.

Ask:

• Was withdrawal stronger than expected?
• Was the product readily available?
• Was alcohol, cannabis, stress, or a social setting involved?
• Did the plan address the routine linked with use?
• Was treatment difficult to afford or obtain?
• Does the goal need to be revised or supported differently?

A lapse is an event. It does not by itself establish that the entire attempt has failed.

Finding Appropriate Support

Ask whether a service offers tobacco or nicotine treatment and which products it treats.

If you want structured help, ask an accessible clinician or cessation service about support for the product you use. International guidance addresses adult tobacco cessation in clinical and community settings, and U.S. guidance supports telephone quitline counseling. Ask what is available to you rather than assuming a particular setting offers every treatment.^[9][10]

You can also call 1-800-QUIT-NOW (1-800-784-8669) to speak with a quit coach. Ask what support and medication assistance are available where you live.^[16]

Depression, anxiety, and difficulty sleeping are recognized nicotine withdrawal symptoms. Their usual course does not tell you how to respond to every individual symptom. A practical question for a care discussion is: “Which symptoms should prompt me to contact you, and where can I get help outside appointment hours?”^[1]

More Nicotine and Tobacco Guides

For product-specific context, explore cigarettes, chewing tobacco, snuff and snus. The smoking causes guide looks at factors that can maintain use.

Related health questions include secondhand smoke and vaping-associated lung injury (EVALI). These guides address different exposures and conditions, rather than treating every nicotine product as the same risk.

Find Support for Your Next Quit Attempt

If you are only gathering information, list every nicotine or tobacco product you use and identify whether any contains burned tobacco. That one distinction clarifies much of the health and treatment discussion.

If you want to reduce, choose one measurable change and review whether combustible smoking stops or dual use continues. Do not treat reduction alone as proof of long-term risk reduction. The harm-reduction framework prioritizes stopping combustible smoking, while the reviewed biomarker findings concern measures of potential harm rather than long-term health outcomes.^[2][4]

If you want to quit smoking, ask about counseling, nicotine replacement therapy, varenicline, and bupropion. Combined patch and faster-acting NRT and varenicline have particularly strong evidence, but suitability depends on your circumstances.^[4]

If you want to stop vaping, seek support that considers nicotine content, withdrawal concerns, device availability, routines, and any cannabis co-use. Ask whether recommendations are based directly on vaping-cessation research or adapted from adult smoking evidence.^[6][5]

If pregnancy, adolescence, cardiovascular disease, depression, or cannabis co-use is relevant, ask how the evidence applies to that situation. Bring a list of the products you use and one question you most want answered. A manageable first goal is to identify support matched to your product, circumstances, and readiness to change.^[10][4][5]

If you need support now for emotional distress or a suicidal crisis in the United States, call 988 or text 988. The 988 Suicide & Crisis Lifeline provides free, confidential support around the clock. For a life-threatening emergency, call 911.^[11][21]