The Connection Between ADHD and Smoking

The Connection Between ADHD and Smoking ADHD Living With ADD/ADHD Print The Connection Between ADHD and Smoking By Keath Low Keath Low, MA, is a therapist and clinical scientist with the Carolina Institute for Developmental Disabilities at the University of North Carolina. She specializes in treatment of ADD/ADHD. Learn about our editorial policy Keath Low Medically reviewed by Medically reviewed by Steven Gans, MD on August 05, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on January 31, 2020 ADHD Overview Symptoms Causes Diagnosis Treatment Living With In Children Diverse Images/Universal Images Group/Getty Images Teenagers and adults with attention-deficit/hyperactivity disorder (ADHD) are more likely to smoke cigarettes and become nicotine-dependent than their peers who do not have ADHD.?? They are also more likely to start smoking at an earlier age and have a more difficult time successfully quitting as compared to the general population. This is obviously a public health concern because the regular use of cigarettes is associated with a host of negative health consequences. In addition, for many people, cigarette use can be a gateway to drug use. Use of Smoking With ADHD There are a number of factors that seem to contribute to this risk for smoking/tobacco use by those with ADHD. Genetics may play a large role. Both ADHD and smoking are highly heritable. Studies have identified a number of similar genetic markers associated with both ADHD and smoking.?? These findings suggest that there are common neurobiological factors that may contribute to the development of ADHD and a persons risk for tobacco use. Studies that have examined the relationship between genes, smoking  and ADHD have shown that ADHD symptoms interact with genes to increase smoking risk. In addition, in utero smoking exposure may interact with genes to increase the odds of ADHD.?? Problems with impulse control might also explain why more teens and adults with ADHD are more likely to engage in risky habits such as smoking. ADHD can make it more difficult to look clearly to the future and take into account the negative health consequences of current actions. Though we dont understand fully all the mechanisms responsible, both neurobiological and behavioral factors seem to contribute to these higher rates of smoking in teens and adults with ADHD. ?? Social influences such as being exposed to smoking by family members and peers also raise this risk for cigarette use. Nicotine and Self-Medication Nicotine is a known central nervous system stimulant and appears to act on the brain in a similar way as the psychostimulantsâ€"methylphenidate and dextroamphetamineâ€"that are most commonly used to treat ADHD. For some people, nicotine (the primary addictive substance in tobacco) in cigarettes may serve as a form of self-medication for ADHD symptoms. A number of studies have found that nicotine can improve attention.?? Nicotine exerts beneficial effects on a range of processes know to be disrupted in individuals with ADHD, including attention, inhibitory control, and working memory, writes Dr. Scott Kollins, associate professor of psychiatry and medical psychology at the Duke University School of Medicine and director of the Duke ADHD Program.?? As such, it has often been proposed that those with ADHD are at heightened risk for smoking because of the beneficial effects of nicotine across a range of cognitive processes. It is possible that nicotine may help some smokers with ADHD compensate for their low levels of attention, arousal, and concentration. Additional research is needed in this area to more fully understand the effect of nicotine on symptoms of ADHD and how this might increase the  risk of smoking in teens and adults with ADHD. Reducing Risk for Smoking We know that people with ADHD smoke at rates that are significantly higher than their non-ADHD peer group. It is also suspected that smoking for those with ADHD may be linked to self-medication for ADHD symptoms.?? Therefore, it is possible that identifying and treating ADHD earlier may prevent the onset of smoking altogether. Studies show promise that treatment for ADHD may indeed contribute to a reduced risk of smoking in teens with ADHD.?? In one report, researchers at Massachusetts General Hospital and Harvard Medical School conducted a two-year, prospective clinical trial of extended-release methylphenidate for smoking prevention in adolescents. They compared clinical trial subjects with ADHD receiving extended-release methylphenidate (Ritalin) with a sample of “naturalistic” adolescent ADHD subjects  â€" some of whom were receiving stimulants â€" as well as with adolescents who did not have ADHD. The smoking rate at the end of the study was significantly lower in ADHD subjects who were receiving stimulant treatment than it was in ADHD subjects who were not, and there was no significant difference between ADHD subjects receiving stimulant treatment and non-ADHD subjects.?? Although considered preliminary until replicated in future randomized clinical trials, the findings from this single-site, open-label study suggest that stimulant treatment may contribute to a decreased risk for smoking in adolescents with ADHD, said the researchers. If confirmed, this finding would have significant clinical and public health impacts. Future research is needed to help us better understand the link between ADHD and smoking so that more effective prevention and treatment strategies can be developed, particularly targeted prevention programs for youth with ADHD.