ADHD Treatment May Lower Smoking Rates in Youth

smoking rates in youthResearchers have found that conventional stimulant medicines for attention-deficit hyperactivity disorder (ADHD) may have a second benefit: lowering smoking rates in youth.[1] Duke Medicine researchers say the association is especially apparent when the medicine is taken consistently.1

“Given that individuals with ADHD are more likely to smoke, our study supports the use of stimulant treatment to reduce the likelihood of smoking in youth with ADHD, ” said senior author Scott Kollins, PhD. “The risk is further lowered when adherence to medication treatment is consistent, presumably since this increases the chances that symptoms are managed effectively.”1

ADHD is a common childhood disorder that often continues into adolescence and beyond.1 It is characterized by hyperactivity, difficulty paying attention, and impulsivity.1 Commonly, this disorder is treated with stimulant medicine, as well as behavior therapy.1

It has been found that individuals with ADHD smoke at rates that are significantly higher than the general population—and they often begin smoking earlier.1 In fact, studies have shown that youth with ADHD are two to three times more likely to smoke cigarettes than their peers, and 40 percent of adults with ADHD smoke regularly—which is more than twice the rate among adults without ADHD.1

Research on how stimulant medicines influence smoking behaviors has historically led to mixed results.1 While some studies suggest that there is an increase in smoking among those treated with stimulants, others have shown that there is either no effect or a decrease.1

“Nicotine operates on the same pathways in the brain as stimulant medications, and the relationship between stimulants and smoking has been controversial,” said lead author Erin Schoenfelder, PhD, clinical associate and a psychologist in the Duke ADHD Program. “It has been suggested that some people with ADHD ‘self-medicate’ their attention deficits using nicotine. Our findings show that treating ADHD effectively with medication may prevent young people from picking up the habit.”1

For the study, the researchers analyzed 14 longitudinal studies of cigarette smoking and ADHD treatment, which included a total of 2,360 individuals with ADHD.1 Therefore, this has been the largest meta-analysis on the issue to date.1 Some of the studies used nicotine dependence to measure smoking behaviors, although nicotine dependence may not be found in adolescents who recently started smoking.1 Therefore, in order to get a more accurate picture of smoking behaviors, researchers expanded their criteria to include smoking frequency and whether participants currently smoked.1 The analysis then revealed a significant association between stimulant treatment and lower smoking rates.1 The effect was greater in those with more severe ADHD and when patients took stimulant medicines continuously.1

“This study may debunk the perception that stimulants will increase one’s risk for smoking,” said Kollins. “It gives us more confidence when we talk with parents to reassure them that consistent ADHD treatment won’t increase their children’s risk of smoking, and in fact, may actually do the opposite.”1

“My hope is that this research can help inform our efforts to prevent negative outcomes for kids with ADHD, including cigarette smoking,” said Schoenfelder. “This population hasn’t been targeted for smoking prevention efforts, despite the well-known connection between ADHD and smoking.”1

[1] Nauert, R. (2014). ADHD Treatment May Lower Smoking Risk. Psych Central. Retrieved on May 15, 2014, from http://psychcentral.com/news/2014/05/13/adhd-treatment-may-lower-smoking-risk/69777.html

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