- What Is Anxiety?
- Take our Generalized Anxiety Disorder Test
- Find a therapist to overcome anxiety
Key points
- Nicotine pouches are often seen as a “safe” way to consume nicotine, but they can worsen anxiety and panic.
- The central nervous system, which controls anxiety, is directly affected by nicotine use.
- Nicotine pouches can disproportionately affect the <a href="https://healthylife7.com/maternal-mental-health-is-making-headlines-experts-say-its-long-overdue/” title=”Maternal mental health is making headlines. Experts say it’s long overdue”>mental health of adolescent users.
The harms of cigarette use are by now widely documented and virtually undisputed. As a result, the prevalence rates of smoking in the United States continue to dwindle, with 2025 estimates from the CDC showing that around 9% of adults smoke cigarettes, the second consecutive year to see rates under 10%, and a dramatic decline from 1965’s high of nearly 43% (Richardson, 2026). It would be wonderful news if this meant that overall nicotine use was dropping significantly as well, but as cigarette use has declined, another form of nicotine delivery, non-tobacco nicotine pouches, has become popular. These pouches, available at gas stations, convenience stores, pharmacies, and other retailers, are often seen as a safe, tobaccoless option for those individuals who use nicotine. But the reality is different than the marketing might indicate.
A fatal flaw in the argument that these pouches are “safe” is the undeniable fact that nicotine itself is an addictive substance and that dependence can result in a higher risk for emotional, cognitive, and neurological impairments. Adolescent exposure is particularly troubling, with research indicating that “nicotine exposure and withdrawal can have long-term effects on emotional and cognitive functioning, particularly when nicotine exposure occurs during the critical period of adolescence” (Holliday, et al., 2016). More specifically, research mentions agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder and specific phobia as connected to nicotine use (Moylan, et al., 2012).
Nicotine products that eliminate tobacco, which is widely recognized as a carcinogen, carry mass appeal as “safer” options, and the marketing data bears this out: worldwide retail sales of nicotine pouches grew by over 50% last year, reaching nearly $7 billion. The United States accounts for about 80% of that market share, and monthly sales in the U.S. more than tripled between 2023 and 2025 (Hernandez Sherwood, 2026). Robert K. Jackler, a researcher at Stanford University, points out that this stark increase has been buoyed by social media, where influencers with vast reach tout the benefits of the pouches. Jackler adds that, despite cigarette television and radio ads having been banned for more than a half-century, “the tobacco industry is back on mass media big time,” and it is largely the younger population that is susceptible to these inaccurate and dangerous messages (Stanford, 2026).
The growing ubiquity and false narratives about the safety of nicotine pouches pose serious psychological risks. There is a longstanding misconception that nicotine can alleviate anxiety and stress (picture the stressed-out employee “relaxing” as he puffs away on his cigarette break.) Ironically, research shows the exact opposite: nicotine addiction has been found to worsen symptoms of anxiety and stress (Astarita, et al., 2026). As a powerful stimulant, nicotine releases adrenaline, raises heart rate and blood pressure, and unleashes a quick flood of dopamine, the body’s pleasure hormone. But what this results in is an overall speeding up of the body’s systems, which can result in feelings of jitteriness, hyper-alertness, and wakefulness. Because the physical boost provided fades quickly, the possibility of developing dependence is high for many users.
That “physical boost” that many users experience is actually nicotine’s effect on the central nervous system (CNS), which controls how threats are perceived, how emotions are processed, and how the body experiences the physical sensations of anxiety or panic. The CNS is essentially the anxiety portal of the brain and body—if, for instance, it is in an escalated state (as it can be by the effects of nicotine,) it may misperceive or overestimate a threat, feel emotions of anxiety and fear, and physically respond with anxiety or panic symptoms, such as elevated heart rate, lightheadedness, muscle spasms, and the slew of other uncomfortable anxiety-driven physical sensations. Neurobiologically, nicotine stimulates several neurotransmitters, including noradrenaline, acetylcholine, serotonin, and glutamate, all of which are connected to anxiety. Noradrenaline, for instance, is associated with the body’s “fight or flight” response; acetylcholine is connected to the body’s stress response; serotonin affects threat processing; and glutamate is involved with fear conditioning (Singh, et al., 2023). In essence, the brain’s receptors are made more active by nicotine, which increases hormone levels and worsens anxiety.
In addition to the fact that the central nervous system is directly affected by nicotine, there is the reality that not all pouches are created equal: in the U.S., nicotine levels in pouches can range from 1.5 milligrams all the way up to 15 milligrams. Central nervous system toxicity, which can produce dizziness, tremors, confusion, or seizures (not to mention many of the symptoms related to a panic attack), occurs at around 30 to 60 milligrams of ingested or absorbed nicotine (Mayer, 2014). Those “safer” nicotine deliverers can directly cause nervous system dysregulation, uncomfortable physical sensations, and cognitive disruption.
As a relatively new phenomenon, the relationship between nicotine pouches and anxiety still requires further research and observation, but the early research as well as the undeniable rise in popularity and usage point to an emerging mental health concern. Like the evolving view of cigarettes that occurred following the U.S. Surgeon General’s 1964 report announcing that cigarette smoking can cause lung cancer, our understanding of nicotine pouches and their effect on psychological health must continue to evolve. For now, it is safe to say that nicotine pouches negatively affect the central nervous system, can potentially worsen mental health issues such as anxiety and panic, can disproportionately harm adolescents, and are not truly “safe” replacements for dangerous substances such as cigarettes.
- What Is Anxiety?
- Take our Generalized Anxiety Disorder Test
- Find a therapist to overcome anxiety
Richardson, Yolanda. “U.S. Adult Cigarette Smoking Continued to Fall in 2025 – but Big Tobacco Still Spends Billions to Keep People Addicted.” Campaign for Tobacco-Free Kids, 29 May 2026, https://www.tobaccofreekids.org/press-releases/2026_05_29_cdc-survey-sh…. Accessed 22 Aug. 2026
Holliday ED, Nucero P, Kutlu MG, Oliver C, Connelly KL, Gould TJ, Unterwald EM. Long-term effects of chronic nicotine on emotional and cognitive behaviors and hippocampus cell morphology in mice: comparisons of adult and adolescent nicotine exposure. Eur J Neurosci. 2016 Nov;44(10):2818-2828. doi: 10.1111/ejn.13398. Epub 2016 Oct 19. PMID: 27623427; PMCID: PMC5274542
Moylan S, Jacka FN, Pasco JA, Berk M. Cigarette smoking, nicotine dependence and anxiety disorders: a systematic review of population-based, epidemiological studies. BMC Med. 2012 Oct 19;10:123. doi: 10.1186/1741-7015-10-123. PMID: 23083451; PMCID: PMC3523047
Hernandez Sherwood, Christina. “Nicotine Pouches, Tobacco’s Latest Ploy: Five Things to Know.” News Center, 2026, https://med.stanford.edu/news/insights/2026/06/nicotine-pouches-addicti…. Accessed 22 Aug. 2026
“SRITA – Stanford Research into the Impact of Tobacco Advertising.” Tobacco.Stanford.Edu, Stanford University, 2026, https://tobacco.stanford.edu/. Accessed 22 Aug. 2026
Astarita, Cheyenne, et al. “Nicotine Addiction and Mental Health: Breaking the Cycle | SBM – Society of Behavioral Medicine.” Society of Behavioral Medicine, 2021, https://www.sbm.org/healthy-living/nicotine-addiction-and-mental-health-breaking-the-cycle. Accessed 22 Aug. 2026
Singh N, Wanjari A, Sinha AH. Effects of Nicotine on the Central Nervous System and Sleep Quality in Relation to Other Stimulants: A Narrative Review. Cureus. 2023 Nov 21;15(11):e49162. doi: 10.7759/cureus.49162. PMID: 38130519; PMCID: PMC10733894
Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. Arch Toxicol. 2014 Jan;88(1):5-7. doi: 10.1007/s00204-013-1127-0. Epub 2013 Oct 4. PMID: 24091634; PMCID: PMC3880486
