The Connection Between ADHD and Smoking

teen boy smoking
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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 person's 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 don't 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 psychostimulants—methylphenidate and dextroamphetamine—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 n icotine 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 — some of whom were receiving stimulants — 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.

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6 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Rhodes JD, Pelham WE, Gnagy EM, Shiffman S, Derefinko KJ, Molina BS. Cigarette smoking and ADHD: An examination of prognostically relevant smoking behaviors among adolescents and young adults. Psychol Addict Behav. 2016;30(5):588-600. doi:10.1037/adb0000188

  2. McClernon FJ, Kollins SH. ADHD and Smoking: From Genes to Brain to Behavior. Ann N Y Acad Sci. 2008;1141:131-147. doi:10.1196/annals.1441.016

  3. Flory K, Malone PS, Lamis DA. Childhood ADHD symptoms and risk for cigarette smoking during adolescence: School adjustment as a potential mediator. Psychol Addict Behav. 2011;25(2):320-329. doi:10.1037/a0022633

  4. Campos MW, Serebrisky D, Castaldelli-Maia JM. Smoking and Cognition. Curr Drug Abuse Rev. 2016;9(2):76-79. doi:10.2174/1874473709666160803101633

  5. Schoenfelder EN, Faraone SV, Kollins SH. Stimulant Treatment of ADHD and Cigarette Smoking: A Meta-Analysis. Pediatrics. 2014;133(6):1070-1080. doi:10.2174/1874473709666160803101633

  6. Hammerness P, Joshi G, Doyle R, et al. Do Stimulants Reduce the Risk for Cigarette Smoking in Youth with Attention-Deficit Hyperactivity Disorder? A Prospective, Long-Term, Open-Label Study of Extended-Release Methylphenidate. J Pediatr. 2013;162(1):22-7.e2. doi:10.1016/j.jpeds.2012.06.046

Additional Reading
  • Kenneth P. Tercyak; Caryn Lerman; Janet Audrain; 'Association of Attention-Deficit/Hyperactivity Disorder Symptoms With Levels of Cigarette Smoking in a Community Sample of Adolescents,' J. Am. Acad. Child Adolescent Psychiatry, 41:7, July 2002.

  • Francis Joseph McClernon and Scott Haden Kollins; 'ADHD and Smoking: From Genes to Behavior,' Annals of the New York Academy of Sciences, 2008 October; 1141: 131-147.