Nicotine, ADHD, And The Evidence: Treatments For People With ADHD
Attention-deficit hyperactivity disorder (ADHD) can be linked to numerous causes. Researchers continue to work to discover what exactly can cause ADHD to uncover aspects of the condition that can be predicted to understand, prevent, and treat symptoms. The running research on causation shows some links between addictive substances like nicotine and an ADHD diagnosis or the increase in the severity of its symptoms. Below, learn more about the link.
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What is attention-deficit hyperactivity disorder?
Attention-deficit hyperactivity disorder (ADHD) is a common mental health disorder, with symptoms that can range in severity. ADHD is considered a chronic and debilitating disorder, as symptoms can impact daily life, relationships, and academic or professional achievement.
Core features of ADHD
ADHD symptoms can be classified under two headings: inattentive symptoms, and hyperactivity and impulsivity symptoms.
Inattentive symptoms may include:
- Frequent daydreaming
- Forgetting to do daily tasks
- Finds it difficult to follow through on projects
- Avoiding tasks that require sustained mental effort
- Difficulty listening when others are speaking
- Unique reaction time profiles, with periods of hyper-focus in brain response, interspersed with lapses in attention
Hyperactive/impulsive symptoms may include:
- Frequent fidgeting
- Blurting statements or answers before the other person is finished speaking
- Goes through their day as if “driven by a motor”, always on the go
- Difficulty waiting for their turn
- Interrupts or intrudes on others
Depending on what symptoms they experience, a person with ADHD may have either predominantly inattentive presentation, predominantly hyperactive/impulsive presentation, or combined presentation.
ADHD in children, adolescents, and adults
ADHD is often diagnosed in children. Adults can also have ADHD, but many go undiagnosed due to a lack of common public knowledge about the disorder in previous years. ADHD is most frequently first noticed in the classroom, when a child has difficulty completing schoolwork, paying attention in class, or becomes disruptive.
Why nicotine use is more common in people with ADHD
Shared genetic and neurological risk factors
According to research, people with ADHD may share this predilection for smoking due to shared genetic and neurological risk factors. This psychiatric comorbidity may be linked to the dysregulation of dopamine and serotonin neurotransmitter systems. Both of these systems regulate motivation and reward-seeking, so smoking can be an attempt at self-medicating the symptoms of ADHD.
Prevalence of tobacco smoking and vaping in adolescents and adults with ADHD
Tobacco use is more common in individuals with any type of psychiatric disorder, and those with ADHD are no exception. Studies show a comparable rate of comorbidity with cigarette smoking and ADHD, around 40%. In addition, a longitudinal study of 140 children with ADHD and 120 non-psychiatric control subjects suggests that people with ADHD begin smoking at an earlier age. This study found that children with ADHD smoked at almost double the rate of the control group, and 75% of the ADHD group started smoking before the age of 16, compared to only 27% of the non-ADHD smokers.
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The dopamine connection between ADHD and nicotine
Let’s take a closer look at how dopamine regulation and ADHD can make nicotine use a challenge for some individuals.
Dopamine regulation and reward pathways
While research is ongoing, some studies have found genetic variations that can cause dysregulation of certain dopaminagenic and nicotinic-acetylcholinergic circuits. Dopamine pathways regulate reward, attention, and impulse control. These reward centers are less active in individuals with ADHD. When people with ADHD smoke nicotine, it stimulates nicotine receptors, creating an artificial dopamine surge that can relieve symptoms like brain fog and restlessness.
Immediate rewards, delay aversion, and impulsivity
Smoking cessation can also be more difficult for people with ADHD. The dopamine release caused by smoking can work instantly to clear the mind, and when they stop smoking, there can be a “crash” during which symptoms become more intense. The brain then immediately craves another cigarette to stave off the worsening symptoms. In addition, one of the symptoms of ADHD can be poor impulse control, which adds another layer of difficulty to quitting.
Does nicotine actually improve ADHD symptoms?
Like some stimulant medications, nicotine can have a calming effect on some of the symptoms of ADHD. For this reason, some people have turned to smoking as a form of self-prescription for ADHD. One study determined that 40% of people with ADHD were smokers, compared to approximately 20% of the general population, suggesting that ADHD self-prescription and predisposition to addiction could be at play.
Acute nicotine administration and attention
Another study found that nicotine was not only an effective form of ADHD treatment but provided the same relief without the side effects of standard ADHD treatment options. In this study, a man was given a transdermal nicotine patch to treat nicotine withdrawal symptoms and ADHD symptoms simultaneously, and the man in question (using the moniker "Mr. A") reported a decrease in both his symptoms of ADHD and his desire to smoke while wearing the patch.
Acute nicotine administration for symptom control has been used in clinical trials. And while it’s been shown to improve symptoms when compared to control groups of non-smokers and ones that used placebo patches, professionals have not adopted it as a first line treatment due to risk factors and inconsistency of results.
Findings from clinical trials and placebo studies
As a form of ADHD treatment, nicotine should only be prescribed and administered by a mental health professional, as high doses can lead to harmful health effects and are unlikely to produce safe, consistent, and useful results. In addition, no medication or substance is a “cure-all” for ADHD, and treatment should not be started, changed, or stopped without consulting a doctor.
Risks of using nicotine to manage ADHD
Despite the fact that nicotine can help to reduce or ameliorate ADHD symptoms, it is not recommended as an ADHD treatment. This is due to risk/benefit analyses that determine use of nicotine can cause more harm than good.
Addiction potential and substance use disorders
The potential risks of using nicotine prevents it from becoming a candidate for treatment. Nicotine is addictive, especially for individuals with ADHD. Nicotine products like cigarettes and e-cigarettes can lead to substance use disorder. E-cigarette use has been on the rise with adolescents, and adolescents with ADHD are at an even greater risk of becoming dependent.
Physical health risks
In addition to the risk of addiction are the physical health risks that smoking involves. Tobacco use can significantly increase your risk for developing:
- High blood pressure
- Cardiovascular disease
- COPD
- Lung and throat cancer
- Type II diabetes
The future of nicotine and ADHD
Because many studies have shown adverse effects when using nicotine, the substance should be used with particular caution and should not be applied as a one-size-fits-all treatment source for ADHD. For people within a specific niche, however, in those with smoking addiction and ADHD, or those who are having adverse side effects from standard ADHD medication, nicotine may have value and could replace other pharmaceutical ADHD treatment options in some populations.
The reality of nicotine dangers during pregnancy should not be ignored. People who are pregnant, nursing, or trying to conceive may find value in quitting nicotine use. While dosages might not be extensive enough to replicate the effect of smoking, the possibility for birth defects should not be ignored or compounded in someone whose medical history provides a predisposition for behavioral, developmental, or intellectual disorders.
Nicotine, ADHD, and teenagers
Teenagers may be particularly susceptible to the soothing effects of nicotine, and their lack of inhibitory control may put them at greater risk for developing a smoking habit than people who have already reached adulthood without having tobacco dependence. Aside from regular monitoring, teenagers can be made aware of the possible risks and side effects of smoking. The quick effectiveness of a cigarette could prove too difficult to resist for a teenager struggling with this disorder, which is why finding the best, personalized treatment option through a doctor becomes paramount.
ADHD, nicotine withdrawal, and symptom severity
Once people with ADHD experience smoking initiation, quitting smoking can become more difficult than it is for those in the general population; as many as 48% of the typical population give up smoking in their lifetime, while only 29% of people with ADHD successfully let go of the habit. Avoidance of trouble down the road may be one of the best reasons for avoiding nicotine altogether, unless it is administered in the form of medication designed to aid ADHD symptoms.
Clinical implications and treatment considerations
There are a number of evidence-based first line treatments for ADHD, including prescription medication, talk therapy, and lifestyle modifications.
Why nicotine is not a treatment for ADHD
The clinical implications of nicotine as treatment have shown some promise, but due to physical risks, as well as the addiction risk of ADHD symptomatology, nicotine is not used as a treatment for ADHD. Cessation of nicotine products can also increase symptom severity, making it more difficult to quit.
Evidence-based ADHD care and smoking cessation
The most effective way to manage ADHD symptoms can be to work with medical and mental health professionals to develop and implement a personalized treatment plan. Depending on symptom type and severity, providers may recommend any combination of medication, psychiatry for medication management, talk therapy, and educational tools to help create structure and organization.
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How therapy can help address ADHD and nicotine use
For those who already use tobacco and are having a difficult time quitting, therapy can be a helpful tool for smoking cessation as well as management of ADHD symptoms.
Behavioral strategies for ADHD symptoms
Cognitive behavioral therapy (CBT) is a common treatment for individuals with ADHD. Therapists can teach essential practical skills for time management, organization, and concentration. They can help clients to create routines in their daily life, as well as offering cognitive restructuring skills that can help avoid negative self-talk and patterns of anxiety or depression.
Support for quitting nicotine and managing cravings
Therapy can be a strong support for nicotine cessation as well. Behavioral counseling for smoking cessation and using medication or Nicotine Replacement Therapy (NRT) in the form of patches, lozenges, or gum can more than double a person’s chances of quitting.
Online therapy for ADHD
Online therapy can be a helpful option for various circumstances, like ADHD. For example, some study findings suggest that online text chats can be extremely useful to facilitate smoking cessation. Other studies have shown that online therapy can be incredibly helpful for people with ADHD status and their families, especially people who are having trouble getting off the waiting list for therapists in their area.
If you or a loved one are interested in nicotine as a potential ADHD treatment or if you are looking for assistance with a nicotine addiction complicated by ADHD, consider turning to the licensed professionals of BetterHelp.
Takeaway
ADHD and smoking behavior have several links, each of them distinct from the other. The substance can have a positive effect on ADHD patients and can be a useful method to treat the disorder. However, in other circumstances, nicotine can aggravate ADHD symptoms like behavioral inhibition, which could be part of what causes those symptoms in the first place and could perpetuate a cycle of familial health issues. For this reason, nicotine should be treated as a volatile substance, requiring a therapist's guidance, a doctor's care, and supervision before use.
Does nicotine worsen attention-deficit hyperactivity disorder?
Those with attention-deficit hyperactivity disorder are significantly more likely to use tobacco products than those without the condition. However, the evidence does not support the conclusion that nicotine worsens ADHD symptoms. Evidence does suggest that those with this disorder will find it harder to quit smoking.
In the past, researchers theorized that the increased difficulty was because this substance reduced ADHD symptoms, called the self-medication hypothesis. However, recent research indicated that those with ADHD struggled to quit just as much when their symptoms were managed than when they were not. Those who took stimulant medication as prescribed and learned behavioral strategies to manage their symptoms were still challenged by nicotine dependence, regardless of how well their symptoms were controlled.
Why do people with attention-deficit hyperactivity disorder crave nicotine?
Evidence suggests that some of the genetic variations that can lead to attention-deficit hyperactivity disorder also make a person more susceptible to cigarette smoking and nicotine dependence. Researchers point to dysregulation of the brain’s dopaminergic and nicotinic-acetyl cholinergic circuits as a likely cause. This substance stimulates those areas of the brain, which may temporarily reduce anxiety and slightly increase cognitive function. The inability of the brain to regulate dopamine properly may also be part of the reason why smokers with an attention disorder find it more challenging to quit smoking than those without the condition.
Does smoking help you focus if you have ADHD?
There is some evidence to suggest that nicotine improves attention and memory. However, the effects may not be substantial enough to alleviate symptoms in young adults diagnosed with an attention disorder. Smoking cessation is often more challenging for smokers with ADHD, and researchers once theorized that cigarette use was a form of self-medication. However, that theory has not been supported by research, leading scientists to examine further the link between nicotine, focus, and ADHD.
Is vaping bad for ADHD?
Vaping is not known to exacerbate attention-deficit hyperactivity disorder symptoms, but while vaping is thought to be less harmful than smoking, the associated risks are still poorly understood. Vaping may be useful as a smoking cessation intervention or harm-reduction technique, but evidence is still unclear regarding its utility. The use of a well-established smoking cessation treatment, like counseling or medication, is likely to be more effective than trying to switch to a vape. In addition, vaping can be dangerous and lead to health risks.
Young adults with attention-deficit hyperactivity disorder who smoke may find that their path to smoking abstinence becomes more straightforward with vaping. This option is sometimes considered a pseudo-nicotine replacement therapy, but there are better replacement therapy options that are better understood and likely offer a lower risk of relapse.
Can quitting nicotine make ADHD worse?
Nicotine is not likely to worsen symptoms. However, there is some overlap between smoking withdrawal symptoms and ADHD symptoms. Everyone who uses this substance may experience at least a slight increase in difficulty concentrating, restlessness, and anxiety, regardless of whether they have an attention disorder. For those who do have the diagnosis, the combination of smoking withdrawal and ADHD may appear as though their symptoms are worse. If a person commits to quitting smoking and can abstain from smoking or vaping for a sustained period, their ADHD symptoms may be more manageable. However, more studies on this topic are needed.
Why are people with ADHD more likely to develop substance use disorders?
ADHD symptoms have been linked to low-level dopamine response. Certain substances can create a short-term dopamine hit, followed by a crash in which the individual craves the response again. In addition, people with ADHD also struggle with impulse control, making it difficult to quit the self-medication effect.
How does nicotine affect dopamine in the ADHD brain?
When someone with ADHD uses nicotine, the dopamine response can improve symptoms for a short period, followed by a crash that can make symptoms feel worse than ever. This response to nicotine can make smoking cessation very difficult for the individual with ADHD.
Are e-cigarettes safer than smoking for people with ADHD?
No. E-cigarettes and traditional cigarettes share the same risks for addiction, as well as significant increases in risk for many chronic illnesses.
Does nicotine affect ADHD symptoms differently in adolescents?
Yes. Adolescents may take up smoking as a way to self-medicate their symptoms. This is often not intentional, but when they smoke they may find it easier to focus or control their impulses due to the dopamine rush that smoking provides.
What is the best way to quit smoking if you have ADHD?
If you have ADHD, working with a professional can be effective. Your doctor or therapist may recommend a combination of counseling, behavioral management, and medication. In addition, you may also want to work with a talk therapist on managing ADHD symptoms or adjusting medications to avoid using smoking as self-medication.
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