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Smoking and ADHD: What's the connection?

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Smoking cigarettes and other tobacco products has been linked to numerous health problems for those who smoke and the people around them. Emerging research shows a higher incidence of smoking in individuals with ADHD compared with the general population. The statistics are striking; here are some facts: 

  • Approximately 41% of adults with ADHD smoke compared with only 19% of adults in the general population (which includes those with ADHD).
  • Smokers with ADHD tend to  begin smoking  at a younger age than those without the disorder.1
  • Prenatal exposure to smoke increases the risk of ADHD.2
  • Smokers with ADHD are likely to have more severe nicotine dependence and more severe withdrawal symptoms when trying to quit; and both of these facts are especially true for women.3

Why do people ADHD smoke more?

The answer may boil down to chemical messengers in the brain known as neurotransmitters. Two neurotransmitters -- dopamine and norepinephrine -- play a significant role in regulating the attentional and behavioral symptoms associated with ADHD.  If the levels of these chemicals are, this may play a role in the degree to which ADHD symptoms that people experience.

The nicotine contained in cigarettes and tobacco stimulates dopamine production. When a person smokes, nicotine travels to the brain and attaches to special receptors that bind the neurotransmitter acetylcholine. The burst of receptor activity leads to an increase of activity by special pathways throughout your brain.  The stimulation of the the brain cells in these pathways is what promotes and activates the release of dopamine in the rewards pathways of your brain. This results in an increase in the neurotransmitter dopamine, that a person with ADHD may otherwise be lacking.4 Another possible reason  is that individuals use smoking as a means to self-treat their attention issues being that individuals with ADHD do not have enough dopamine and norepinephrine.  Smoking will increase these chemicals in the brain to beneficial levels which may result in ADHD symptoms becoming more manageable.5

Why are children with ADHD more at risk for smoking than their non-ADHD counterparts?

Children with ADHD often experience social difficulties and peer rejection as a result of behaviors or poor social skills.Several studies have demonstrated that  peer rejection among children with ADHD was a significant predictor  of cigarette smoking.6,7 Additionally, if these children are not receiving proper treatment for their ADHD by a health care professional, they may more likely to smoke as a means to self-medicate.8

If you are a smoker and want to quit, please see the resources below:

If you are a parent or an individual looking for information on youth tobacco prevention and/or cessation programs, please see the resources below:

Additional Reading:
Kollins, Scott (October 2012), Where There's Smoke, There's...ADHD: What the Science Says, Attention, v19 n5, pp. 14-17.

References:

  1. Lambert, N. L., & Hartsough, C. S. (1998). Prospective study of tobacco smoking and substance dependencies among samples of ADHD and non-ADHD participants. Journal of Learning Disabilities, 31(6), 533-544.
  2. Ernst, M (2001) Behavioral and Neural Consequences of Prenatal Exposure to Nicotine. Journal of the American Academy of Child & Adolescent Psychiatry, 40(6)630-641.
  3. Matthies, S (2012) ADHD as a Serious Risk Factor for Early Smoking and Nicotine Dependence in Adulthood. Journal of Attention Disorders, [Epub ahead of print].
  4. Blum, K (2008) Attention-deficit-hyperactivity disorder and reward deficiency syndrome. Neuropsychiatr Dis Treat. 4(5): 893?918.
  5. Brautbar N. (1995) Direct effects of nicotine on the brain: evidence for chemical
    addiction. Arch Environ Health. Jul-Aug;50(4):263-6.
  6. Sylvie Mrug, Brooke S. (2012) Peer Rejection and Friendships in Children with Attention-Deficit/Hyperactivity Disorder: Contributions to Long-Term Outcomes. Journal of Abnormal Child Psychology, 40(6), 1013-1026.
  7. Milberger, S (1997) ADHD Is Associated With Early Initiation of Cigarette Smoking in Children and Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 36 (1) , 37-44.
  8. Todd RD, Lobos EA, Sun LW, Neuman RJ. (2003) Mutational analysis of the nicotinic acetylcholine receptor alpha 4 subunit gene in attention deficit/hyperactivity disorder: evidence for association of an intronic polymorphism with attention problems. Molecular Psychiatry. (1):103-8

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