KIDS
June 5, 2014

Smoking and ADHD

People with ADHD are often smokers and may face serious health problems. Do stimulant drugs for the disorder reduce or increase this risk?

Cigarette smoking is a much bigger problem for people with ADHD than for those without it. The impulsivity characteristic of ADHD makes people more likely to try cigarettes; then, like so many others, they become physically addicted to nicotine.

A recent report reviewed the factors that may contribute to the risk that children and teens on stimulant medications would start smoking, as well as how treatment might be linked to prevention.

About 41 percent of adults with ADHD smoke, compared to 19 percent of the general adult population; and smokers with ADHD tend to begin smoking at a younger age.

It is better to seek appropriate drug therapies to treat ADHD symptoms than to embrace a life-threatening habit as a way to focus attention.

Children and adolescents with ADHD are two to three times more likely to smoke than their peers. Smokers with ADHD often have more severe nicotine dependence and withdrawal when they try to quit. Additionally, some studies suggest that those with ADHD and those who tend to smoke share a genetic link.

This all adds up to an additional burden of chronic disease, premature disability, and death from the effects of cigarette smoking for a population already burdened by a complex neurodevelopmental condition.

In searching for explanations for the linked behaviors, researchers have suggested that nicotine targets the balance of the same chemicals, dopamine and norepinephrine, that are important in regulating attention.

Nicotine has been shown to enhance attention in both ADHD and non-ADHD diagnosed individuals and improves clinical functioning in patients with ADHD. Therefore some researchers have theorized that smoking cigarettes may be a way of self-medicating the chemical imbalance experienced by ADHD sufferers.

Stimulant medications such as methylphenidate and dextroamphetamine, the most common treatments for ADHD, also target these chemical pathways to control ADHD symptoms.

Many studies have assessed the impact of stimulant medication treatment on smoking behavior in ADHD patients and the results are very different. Some research indicated that the medications increase smoking, other reported no effect at all, while some have shown that they help patients achieve abstinence from smoking.

The current report reviewed 17 studies, involving 2360 participants, which evaluated smoking behaviors of 1424 treated and 936 untreated ADHD patients.

Of the 17 studies, only one showed an increased rate of smoking with stimulant treatment. Nine showed that stimulant treatment was associated with lower rates or later onset of smoking; five showed no association between stimulant treatment and smoking; and two identified one positive and one negative impact of stimulant treatment on patients who also had diagnoses of conduct disorder. The best outcomes were seen when ADHD treatment was consistent and sustained.

The researchers concluded that stimulant treatment of ADHD does not increase the risk for smoking and may, when used consistently, lower the risk of smoking. They noted that stimulant medication is often an underutilized treatment for ADHD patients and that those who do use medication find it difficult to stick to their treatment regimens long-term.

Improved strategies for pharmacologic treatment of ADHD and improved compliance could have the dual benefit of better controlling ADHD symptoms and also decreasing smoking risk for an already high-risk population, they believe.

People with ADHD and families of teens with ADHD need to be especially vigilant in their efforts toward the prevention of smoking. It may be helpful to consult with health care providers regarding smoking abstinence, signs and symptoms of nicotine dependence, and methods to quit.

It can also be helpful to understand and be alert to the the possibility of using nicotine to self-medicate ADHD symptoms. It is a far better idea to seek appropriate drug therapies to treat ADHD symptoms — as well as comply with ADHD treatment regimens — than to embrace a life-threatening habit as a way to focus attention.

The study is published in Pediatrics.

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