A Narrative Review of Nicotine and Alcohol Addiction Recovery Content on TikTok

Abstract

Objectives

Adolescent substance use remains a public health concern, and social media platforms may serve as potential intervention targets. The objective of this review is to characterize studies on anti-substance use and/or pro-recovery content on the TikTok social media platform.

Methods

PubMed, Scopus, and Web of Science were searched for articles using search strings related to TikTok and substance use. Studies that characterized substance use content on TikTok and provided information on the associated hashtags were included. Studies that did not include hashtags reflecting anti-substance use or pro-recovery sentiments were excluded.

Results

Seven studies included hashtags that expressed being against, quitting, and/or recovering from substance use. Most previous studies focused on nicotine use. The content was largely created by adults. General content themes included motivations for reducing substance use, barriers to, and advice on how to reduce substance use, and personal recovery journey stories that celebrated success and normalized the recurrence of use. Some studies found that content created by individuals with lived experience and content focused on the benefits of quitting (rather than the costs of using) received higher engagement. Most studies noted that videos identified using anti-substance use hashtags often contain irrelevant or antithetical content.

Conclusion

This review highlights the value of social media sites such as TikTok as potential platforms for encouraging reductions in substance use. Future studies should quantify whether viewing and engaging with such content leads to changes in real-world measures such as reduced consumption.

INTRODUCTION

Adolescence is a developmental stage associated with profound neurobiological and psychosocial changes [1,2], which make adolescents particularly susceptible to the deleterious effects of substance misuse [3,4]. Substance use during adolescence is associated with increased risk-taking behaviors while intoxicated, such as driving and unsafe sexual activity, as well as with long-term negative consequences such as the development of mental health conditions, cognitive impairments, and impaired psychosocial functioning [4]. Although adolescent use of alcohol, tobacco, electronic cigarettes (e-cigarettes), and cannabis has declined in recent years, past-year prevalence estimates remain significant, with 46% of 12th-graders in the US reporting past-year alcohol use, 29% reporting cannabis use, and 23% reporting vaping nicotine [5]. Thus, adolescent substance use remains a public health concern [3,4,6], and identifying and addressing its risk factors can inform prevention and treatment efforts.

Social influence is a well-established factor linked to adolescent substance use, in which perceived use in adolescents’ social spheres is associated with future use [6-9]. This traditionally refers to social networks involving parents, older siblings, and peers, but increasingly extends to the digital realm of social media platforms. The use of social media is becoming increasingly common among adolescents: in 2024, approximately half of teenagers were using social media platforms, such as TikTok, Instagram, or Snapchat, to view, create, or engage with short videos at least daily [10]. Overall, more teenagers reported that social media has a positive effect on their lives than those who say the opposite, with platforms used to connect with friends, experience social support, express creativity, and find information [11]. However, some teenagers acknowledge negative experiences on social media platforms, such as social exclusion and feeling “overwhelmed by the drama” on social media [11]. Additionally, social media platforms can be a source of peer influence that encourages risky behaviors, such as substance use [12-16]. For example, high school students who witnessed their peers drinking alcohol on social media were more likely to start drinking and engage in binge drinking a year later [17].

Although sites such as TikTok have guidelines and policies that restrict the advertising of alcohol and other substances and the promotion of their use by minors, there are ways to circumvent age restrictions and gain access to content about substance use on social media platforms [18,19]. This is particularly worrisome because social media platforms contain a disproportionate amount of content that portrays substance use in a positive light; a recent review identified that more than 75% of substance use-related content on multiple social media platforms (mostly Twitter and YouTube) featured positive portrayals of substance use [20]. Similarly, studies of Tik-Tok videos tagged with substance-related hashtags (e.g., “#vaping,” “#alcohol”) found that 87% of vaping videos and 98% of alcohol videos on TikTok portrayed the substances in a positive light [21-25]. Thus, adolescents on social media platforms may be exposed to pro-substance content.

Conversely, a minority of videos contain anti-substance use (i.e., videos describing the negative consequences of using substances) and/or pro-recovery (i.e., videos positively depicting people recovering from addiction) content that adolescents may encounter on social media. This suggests that social media may be harnessed to promote positive health behaviors. However, this topic has been relatively understudied. This review aimed to conduct a comprehensive review of studies on anti-substance use and/or pro-recovery content in TikTok, with a focus on the three most commonly used substances by the youth: alcohol, cannabis, and nicotine [5].

METHODS

The literature review was conducted in February 2025. An overview of this process is shown in Fig. 1. To identify review studies, we searched PubMed [Title/Abstract], Scopus [Article title, Abstract, Keywords], and Web of Science (all databases) [Abstract] for articles published in English. The search strings used were “TikTok” and 17 different terms related to recovery (“recovery,” “sober,” “sobriety”); addiction (“addict,” “addiction”); alcohol (“alcohol,” “alcoholic”); cannabis (“weed,” “marijuana,” “cannabis,” “dabbing”); and nicotine (“nicotine,” “tobacco,” “cigarette,” “e-cigarette,” “vape,” “vaping”).

Fig. 1.

Flowchart of literature review process.

After removing duplicates, the remaining article abstracts were screened by one reviewer (LYM) using the following criteria: 1) mentioned that the content on the TikTok platform was being characterized, 2) mentioned that the content on one or more substances was being characterized, and 3) provided information on which hashtags were used to identify videos for analysis. The remaining articles were then shortlisted for full-text screening. Studies that only included substanceneutral (e.g., #alcohol, #vaping, #cigar) and/or pro-substance (e.g., #vapetricks, #juulgang, #borg or “blackout rage gallon,” a trend in the US that encourages binge drinking) hashtags were excluded from analyses, as previous studies have identified that these hashtags have minimal anti-substance use or pro-recovery content [20-25]. The excluded studies focused on e-cigarettes (n=17), other nicotine products (n=5), alcohol (n=5), and cannabis (n=1).

Information on the study authors, publication year, substance of interest, hashtags characterized, average engagement metrics (views, likes, comments, and shares) per video, and the coding methods used to analyze the videos were extracted. Where available, demographic information of the content creators was extracted. In one study [26], demographic information was not included in the publication; therefore, these data (sex and age) were manually derived from the videos. The percentage of videos containing each theme was either taken as reported in the study or manually calculated.

RESULTS

Study characteristics

Seven studies included hashtags that expressed being against or quitting substance use and/or promoting recovery (Table 1). Most studies included anti-substance use content, focusing on e-cigarette use/vaping [24,27-30], followed by tobacco/cigarette use [26,27,29], and broadly defined substance use [31]. All the studies were conducted in the US, with the exception of one in Indonesia [26]. The hashtags used in six studies generally referred to substance use, while one specifically referred to a smoking cessation campaign in Indonesia (#1Minute2Quit/#SuaraTanpaRokok) [26]. Collectively, the studies analyzed 20 anti-substance use hashtags; only one hashtag (#quitvaping) was analyzed in more than one study [28,30]. Some studies analyzed all videos associated with the hashtag(s) [26,29], some analyzed a random subset of videos [24,30], and others analyzed a subset of videos that had the highest number of views [27,28] or “likes” [31].

Table 1.

Characteristics of included studies

Study	Year	Substance	Anti-substance hashtags	Number of videos	Video engagement metrics	Coding methods	Video creator information
Amin et al. [28]	2024	E-cigarettes (100%)	#quitnicotine, #quitvaping, #stoppingjuuling, #vapingcessation, #vapefree	87	1.2 billion views, 110344 likes, NR comments, 655 shares	Inductive thematic analysis, PEMAT-AV	Female: 58%; Healthcare provider: 14%
Marynak et al. [27]	2022	E-cigarettes (75%), cigarettes (9%), NRT (5%)	#nicotineaddiction	149	NR views, 62433 likes, 740 comments, NR shares	Inductive and deductive coding	≤21 years old: 26%; Female: 47%; LGBTQ+: 11%
Nugraha et al. [26]	2024	Cigarettes (100%)	#1Minute2Quit	21	N/A	Content analysis	≤21 years old: 4.8%; Female: 15%
Purushothaman et al. [29]	2022	E-cigarettes (≥37.7%)	#nicsick	69	4115 views, 648 likes, 16 comments, 4 shares	Content analysis (open inductive coding)	N/A
Russell et al. [31]	2021	Alcohol (22%), undisclosed (78%)	#addiction, #recovery, #sober	82	2101821 views, 325042 likes, 6555 comments, 6653 shares	Content analysis	≤21 years old: 3.7%; Female: 51.2%; White: 86.6%
Wu et al. [30]	2024	E-cigarettes (100%)	#quittingvaping, #quitvape, #quitvaping	412	203201 views, 21185 likes, 248 comments, 368 shares	Aspect-based sentiment analysis	Healthcare provider: 2.4%
Xie et al. [24]	2023	E-cigarettes (100%)	#antivaping, #notvape, #novape, #novaping, #stopvaping, #vapeisbad, #yousuckvapes	30	169350 views*, 21400 likes*, 190 comments*, 98 shares*	Hand-coding	N/A

Nugraha et al. [26] (2024) did not distinguish engagement metrics based on platform (e.g., TikTok versus Instagram), so data were not included here. Videos analyzed in Purushothaman et al. [29] did not always explicitly state what form of nicotine was being used, but 37.7% of videos involved vaping on camera. Xie et al. [24] examined pro-vaping and anti-vaping hashtags, but only information on anti-vaping hashtags is included here. *indicates that study reported these data as median, not mean. N/A, not applicable; NR, not reported in the study; NRT, nicotine replacement therapy; PEMAT-AV, Patient Education Materials Assessment Tool for Audio-visual Materials

Content creator demographic information

In three studies that included information about content creator age, videos were mostly created by adults [26,27,31]. The percentages of content creators perceived to be under the age of 21 were low: 3.7% [31], 4.8% [26], and 26% [27]. Two of these studies had similar proportions of male and female content creators [27,31], whereas one study had mostly male content creators (85%) [26].

In studies that characterized content creator identity, varying percentages of videos were created by content creators thought to have lived experience of successful quit attempts (13.1% [30], 47.6% [31], 100% [26]). Videos from healthcare professionals (e.g., doctors) comprised a small percentage of videos (14% [28], 2.4% [30]). In two studies, a considerable percentage of videos (37.7% in [29] and 58.5% in [30]) came from content creators who actively used substances, sometimes even in the videos [29].

Themes in video content

Motivations for reducing substance use

Most studies have identified motivation for reducing substance use as a theme in video content. In a study of quit-vaping hashtags, this theme was found in 9.2% of videos. These videos mentioned the negative consequences of use (e.g., health concerns and financial considerations) and benefits of quitting (e.g., the desire to regain control over one’s life) [28]. In another study investigating anti-vaping videos, one-third contained educational information regarding the potential health risks associated with vaping [24]. In a study on addiction, recovery, and sobriety [31], 40.2% of videos involved sharing one’s journey from active substance use to recovery, which often juxtaposed the negative consequences of active use with the positive effects of recovery, such as regaining child custody, rebuilding trust in loved ones, and improving physical health [31].

Three nicotine-related studies provided more detailed characterizations of the content on the motivation to quit. In one study, the authors found that 30.8% of videos mentioned physical consequences, followed by mental health (20.9%), financial (9.5%), and social (2.9%) consequences of vaping [30]. In another study, the physical (e.g., tremors, headaches) or psychological (e.g., irritability, anxiety) consequences of using were most commonly cited in 46% of #nicotineaddiction videos, followed by social consequences such as conflicts with peers or family as a result of vaping behaviors (18%), whereas spending excessive time or money was only found in 7% of videos [27]. A third study found that 52.3% of #nicsick videos contained content about nicotine poisoning or sickness, such as content creators talking about the adverse effects of using (e.g., headache, burning sensation in the throat) and/or experiencing such adverse effects on camera (e.g., vomiting, nasal discharge, vigorous coughing) [29]. Thus, negative consequences in the physical domain were most prominent in anti-substance use videos.

Barriers to reducing substance use, normalizing return to use

Discussing barriers to successful reduction of substance use was found in 13.8% of quit-vaping videos, which included topics such as the difficulty in managing withdrawal symptoms [28]. Other barriers included not wanting to lose the social benefits of using, such as a sense of belonging among peers (28%), and the physical/psychological benefits of using, such as stress relief, pleasurable sensations, and a way to escape (28%) [27]. These videos focus on the short-term positive effects of substance use, albeit often at a much greater cost in the long term. Another concern related to quitting and maintaining a reduction in substance use is slips and relapses. These were mentioned in the context of quit attempts for vaping in 20.7% of videos in one study [28], unsuccessful quit attempts in 4% of #nicotineaddiction videos [27], and recurrence of use in 12.2% of recovery-oriented videos [31].

Tips/strategies for reducing substance use

Tips and strategies were common in videos for a quit-smoking campaign (33.3%) [26] and quit-vaping videos (23.0%) [28]; some examples include digital interventions, behavioral change, and pharmacotherapies [28]. Other suggestions from the recovery-oriented videos included participation in rewarding alternative activities (39.0%) and spirituality (8.5%) [31]. Many (45.1%) of the recovery-oriented videos mentioned the importance of social support in recovery [31], and 5.7% of the quit-vaping videos mentioned seeking social support, including using TikTok as a source of accountability [28]. Formal treatment or seeking help from healthcare providers for substance use was featured in only 19.5% of the recovery-oriented videos [31] and 4.6% of the quit-vaping videos [28].

Sharing personal journeys and celebrating successes

Sharing one’s journey from active substance use to recovery occurred in 40.2% of recovery-related videos [31]. Such sharing was often coupled with describing and celebrating recovery milestones (e.g., sober duration or date), which occurred in 37.8% of recovery-related videos [31]. Another study found that 22% of #nicotineaddiction videos mentioned the intention for, current, or past quit attempts, and this theme was more commonly mentioned in videos from older content creators (≥21 years old) than younger content creators [27]. A few (3%) of these videos also focused on successful quit attempts [27]. The theme of sharing one’s “emotional journey of quitting vaping” was found in 12.6% of quit-vaping videos, with the celebration of successful cessation occurring in 5.7% of videos [28].

Irrelevant or pro-substance use content

Nearly all studies reported excluding some videos from their analyses, as the videos contained content irrelevant to anti-use/pro-recovery hashtags [24,27-31]. For example, one study excluded 16.6% of the videos identified using vapingrelated hashtags because they did not contain content on ecigarettes or vaping [24]. Other studies excluded videos that did not contain anti-substance use content, with percentages of 6% [28] and 51.2% [30] when using explicitly quit-vapingrelated hashtags, 47.7% when using nicotine-poisoning-related hashtags [29], and higher percentages for hashtags related to sobriety (49%), addiction (80%), and recovery (87%) [31]. Sometimes, the content deemed irrelevant was innocuous, such as videos of people ostensibly vaping but actually playing instruments [24], but others contained pro-substance use content. For example, excluded #nicsick videos primarily showed content related to vaping [26], and 19.5% of the excluded videos from the recovery study showed active substance use and not recovery [31].

Features associated with video engagement

Three studies [24,26,30] identified associations between specific video features and video engagement. One study found that vaping cessation content created by people who had successfully quit vaping was associated with higher engagement than content created by people who do not vape or by healthcare professionals [30]. Another study found that quit-smoking videos by content creators who have particular occupations (e.g., entrepreneurs, athletes, celebrities) received more likes than other occupations [26].

Specific video content is also associated with engagement. One study characterized and compared loss-framing content (i.e., the negative consequences of substance use, such as migraines from vaping) and gain-framing content (i.e., the positive consequences of abstinence/recovery, such as experiencing better lung capacity after quitting vaping) [30]. Although loss-framed content was nearly always more common than gain-framed content, the authors found that quit-vaping videos with the former were associated with less engagement than the latter [30]. Similarly, a third of anti-vaping videos provided some kind of education on potential health risks associated with vaping (i.e., loss-framing), and those videos had fewer average “likes” than other anti-vaping videos [24]. Finally, videos from the smoking cessation campaign that included practical tips received more engagement than videos that did not [26].

DISCUSSION

This narrative review summarizes seven studies that characterize the anti-substance use and/or pro-recovery video content on TikTok. General themes included motivations and barriers to reducing use, advice on how to reduce use, and personal recovery journey stories that celebrate successes and normalize the recurrence of use. Studies have also noted that videos identified using anti-substance use hashtags often contain irrelevant or antithetical content. Finally, we summarized the video features associated with higher engagement, such as content created by individuals with lived experiences, and content that focused on the benefits of quitting (rather than the costs of using). This review thus provides an update on the current anti-substance use landscape of TikTok and provides insights into generating pro-recovery-related content.

Substance use on TikTok

The amount of substance use-related content in TikTok has increased in the past few years; correspondingly, studies investigating TikTok content have also increased. A review of substance use-related content on multiple social media platforms (mostly Twitter and YouTube) conducted a few years ago found only two studies on TikTok content. We identified an additional 33 studies that have been published. Of the studies identified, the number of studies on pro-substance use or substance use-neutral hashtags was four-fold higher (n=28) than that on anti-substance use or recovery-oriented hashtags (n=7), consistent with previous reviews indicating a disproportionate amount of pro-substance use content on social media platforms [21-25]. While understanding pro-substance use content can provide insight into current trends and guide prevention and treatment efforts, understanding anti-substance use/pro-recovery content is also valuable, particularly information on the metrics of video engagement is available, which may provide insight into what content is popular and potentially effective in discouraging people from using substances and/or encouraging them to seek help with addictive behaviors.

Anti-substance use content generated by individuals with lived experience

This review identified that a large proportion of anti-substance use content was created by people with lived experiences of having used substances (as opposed to people without that experience, such as healthcare professionals), and that such content may receive more engagement. Similarly, a recent study on addiction treatment and recovery content on YouTube found that people with lived experiences, particularly in recovery, contributed a number of videos and that their videos received the highest levels of positive engagement [32]. Similarly, a study of addiction-recovery-related content on Twitter found that approximately half of the recovery posts were from individuals with lived experiences of addiction and/or recovery and that their posts received more likes and replies than posts from general/non-health-related individuals [33].

These findings are consistent with the shift in the field to increasingly value the opinions and insight of people with lived experience of addiction and recovery [34,35]. For example, the increasing incorporation of peer recovery support specialists in clinical settings, with individuals experientially qualified to support people with addictions [35]. This review found that content posted by individuals with lived experiences provided insights into the negative consequences of substance use, personal motivations for quitting, and practical advice on how to reduce substance use. Such content may also serve several functions in normalizing the process of recovery, with individuals in recovery potentially serving as role models and providing hope and optimism [31,33,36], all of which may promote others’ recovery from addictions [37,38].

Notably, this review found that most anti-substance use content was generated by adults, which may not be as relatable to youths as content from peers. This is consistent with literature indicating that peers may exert a stronger influence on substance use than siblings or parents [39,40]. Engaging youths in generating anti-substance use/pro-recovery content may be an avenue worth exploring, as it may be more relatable and compelling for youths who engage in substance use. For example, the non-profit the Truth Initiative recently launched a social media campaign and challenge on TikTok called #ThisisQuitting for youth to create TikTok videos of them getting rid of their vapes “in creative ways.” Future studies could focus on videos created with such hashtags to identify how youth create messages to motivate others to quit vaping and other substances.

Shifting from anti-substance use to pro-recovery content

Although the reviewed content leaned more towards antisubstance use than pro-recovery content, the precise percentages depended on the hashtags used. For example, #nicsick and #nicotineaddiction tended to focus on the negative consequences of using (i.e., loss-framed), whereas #recovery and #sober were more focused on the benefits of recovery (i.e., gain-framed). Such a variety of content allows for analyses to determine which frames may be more effective in receiving views and engagement. Studies on the effectiveness of lossframed messaging in promoting behavioral change have yielded mixed results, depending partially on message sources, whether the goal is prevention or cessation, and which domains are being framed (e.g., financial versus physical health) [41,42]. Our review indicates that, although loss-framing content may be more common in TikTok, gain-framing may be more effective in evoking change. Future studies should test these hypotheses directly. For example, a recent study identified an interaction effect where loss-framed messages were effective at increasing the intention to quit vaping when coming from healthcare professionals, whereas gain-framed messages were more effective when coming from individuals with lived experiences [43]. This may also reflect the movement in the recovery community away from focusing on addiction pathology and problem-focused perspectives, towards solution-focused recovery-oriented systems of care [44-48]. Given the importance of framing health messages, future studies should explore how such messages should be framed to most effectively lead to behavioral changes.

Unexpected pro-substance content

There have been concerns that recommendation algorithms on TikTok that determine the videos featured by TikTok users may steer them toward problematic content [49]. This review identified that most studies found irrelevant or pro-substance use content when using anti-substance use hashtags (these videos were identified and excluded before analysis). This highlights how social media platforms could potentially be a minefield for people trying to find addiction-recoveryrelated content, who may end up finding pro-substance use content. This is similar to studies that found that searching app stores for mHealth apps to help with addiction may identify apps that encourage engagement in the addictive behavior (e.g., gambling apps) [50]; this may make seeking help triggering. This suggests that there may be value in specialized platforms with curated pro-recovery video messages to support people in recovery and minimize exposure to pro-substance use content [51].

Limitations

This review has several limitations. For example, the studies included were not summarized or compared using formal quantitative approaches, as there were only seven studies with limited overlap in how the videos were quantified. Because research on social media content remains a burgeoning field, future reviews should include a larger number of summarized studies, which may be more amenable to quantitative approaches.

Other limitations pertain to the generalizability of our conclusions. First, most reviewed papers focused on nicotine use; therefore, it is unclear whether the findings can be generalized to other substances. Since cessation of nicotine use is sometimes conceptualized and perceived differently from the cessation of other substances, such as alcohol and cannabis [52], future studies of other substance-specific content may be warranted. Second, most of the reviewed studies were conducted in the US, highlighting the need for further research to explore whether cultural differences in social media content are observed, for example, between Western, educated, industrialized, rich, and democratic (WEIRD) and non-WEIRD countries [53]. Third, the limitation of generalizability applies to our focus on a single social media platform. Although the findings in this study may likely be similar across social media platforms (e.g., YouTube Shorts, Instagram Reels, and Snapchat), empirical support is needed. Fourth, the studies included in this review presumably searched for content using TikTok accounts for adults (i.e., no age restrictions). Future studies should investigate the proportion of anti-substance use/pro-recovery content classified as age-restricted to gain a better sense for what content is most readily accessible to adolescents, namely those who do versus those who do not circumvent the age restrictions of the platform.

The final set of limitations pertains to the interpretation of the results. Studies that quantified engagement did not distinguish the demographics of people engaging with videos, and there may be differences in content preferred by adults and youth; even among youth, there may be sex-, age-, and culture-related differences [54]. Additionally, although we have summarized the video characteristics associated with engagement, it is important to note that video engagement is not necessarily a proxy for effectiveness in inducing behavioral changes. Thus, future studies on TikTok content should not only quantify video engagement but also other real-world measures, such as intention to quit and actual substance use [43]. This provides insights into the behavioral impact of social media content on substance use and recovery.

CONCLUSIONS

Social media may serve as a powerful platform for inspiring and supporting the youth in reducing substance use, especially if safeguards can be put in place to prevent people searching for anti-substance use/pro-recovery content from seeing pro-substance use content. Current content on social media platforms may provide role models who put positive faces on and lend voices to recovery, and disseminate information to reduce use and facilitate recovery. Existing studies suggest the importance of content created by individuals with lived experiences, with an emphasis on the benefits of addiction recovery.