The Relationship Between Nicotine and ADHD

teen boy smoking

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Teens and adults with attention-deficit hyperactivity disorder (ADHD) are more likely to smoke cigarettes and become nicotine-dependent than those who don't have ADHD. They're 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 connection between nicotine and ADHD is a public health concern because the regular use of cigarettes is associated with a host of negative health consequences. In addition, for many people, cigarettes can be a gateway to other drugs—potentially opening the door to the use of marijuana and cocaine.

Connection Between Nicotine and ADHD

There are a number of factors that seem to contribute to increased nicotine use by people with ADHD. Genes may play a large role as studies have identified a genetic correlation between nicotine dependence and ADHD, potentially due to genetic vulnerabilities.

These findings suggest that there may be common neurobiological factors that contribute to the development of ADHD and also increase a person's risk for tobacco use. In addition, a review of 12 studies found that in utero smoking exposure is related to an increased risk of ADHD development in the unborn child.

Problems with impulse control might also explain why more teens and adults with ADHD are more likely to engage in risky behaviors 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 fully understand all the mechanisms responsible, both neurobiological and behavioral factors seem to contribute to higher rates of nicotine use in people with ADHD. Social influences, such as being exposed to smoking by family members and peers, also raise this risk.

Nicotine and ADHD Symptoms

Nicotine is a central nervous system stimulant and appears to act on the brain in a way that is similar to the psychostimulant drugs commonly used to treat ADHD (such as methylphenidate and dextroamphetamine). A number of studies have found that nicotine can improve cognitive performance.

"Nicotine exerts beneficial effects on a range of processes known to be disrupted in individuals with ADHD," writes Dr. Scott Kollins, PhD, associate professor of psychiatry and medical psychology at the Duke University School of Medicine and director of the Duke ADHD Program. Dr. Kollins adds that the processes nicotine affects include "attention, inhibitory control, and working memory."

One study involving 52 adults with ADHD seems to confirm nicotine's ability to improve ADHD symptoms. In this case, subjects using a nicotine patch for two days had an 8% reduction in ADHD symptoms and a 9% reduction in negative mood, regardless of whether they smoked or not.

Based on findings such as these, it is possible that nicotine may help some people with ADHD compensate for the symptoms they experience. At the same time, some experts suggest that smoking may make hyperactivity worse.

For some people, nicotine may serve as a form of self-medication for ADHD symptoms.

Nicotine Interactions With ADHD Medications

Medications are often the first line of treatment with ADHD. If you have one of these prescriptions, you may be wondering whether nicotine interacts with your ADHD medication. At least one study suggests that the answer is yes.

This research involved 325 people with ADHD. Three months after starting treatment with methylphenidate, their tobacco consumption increased by 1.3 cigarettes per day, which equates to smoking 23 more packs per year. This suggests that starting an ADHD medication while smoking may increase smoking rates.

It's also important to know that cigarette smoking affects a number of psychiatric medications, such as those prescribed for anxiety, depression, and antipsychotics, potentially reducing their ability to work. Therefore, finding ways to quit nicotine may help increase the effectiveness of any other medications you are taking.

Benefits of Quitting Nicotine When You Have ADHD

If nicotine seems to ease your ADHD symptoms, you may worry that quitting smoking will make your symptoms worse. Some studies do indicate that adult smokers with ADHD felt that their symptoms worsened when they abstained from nicotine.

However, in addition to the important health benefits associated with quitting smoking—which include a decrease in breathing issues, reduced risk of heart attack, and lower cancer risk—stopping the use of nicotine offers even more benefits for people with ADHD.

For example, one study found that when adult smokers quit their habit, their feelings of anxiety and depression decreased. So, giving up nicotine may help relieve other mental health issues.

Nicotine Abstinence for People With ADHD

If you have ADHD and want to quit smoking, there are a few strategies that can help.

  • Ask your healthcare provider for help. Everyone is different, so your healthcare provider can help decide the best way for you to quit given your situation and health status.
  • Consider a smoking cessation aid. Some studies have found that using a smoking cessation aid, such as varenicline (Chantix), helps reduce smoking levels in people with ADHD.
  • Remember your why. It's also helpful to keep in mind the reasons you want to quit, whether it is to improve your health, because you no longer want to feel addicted, or something else. Remembering these when you feel like lighting up can help you avoid the urge.
  • Take a multi-treatment approach. In the study that found that quitting smoking can reduce anxiety and depression in people with ADHD, the subjects quit using a combination of counseling and a nicotine patch. Another study reported that medication combined with a nicotine patch appears to be helpful for people with ADHD.

Future Strategies to Break the Nicotine-ADHD Link

We know that people with ADHD smoke at rates that are significantly higher than their non-ADHD peers. And some use nicotine as a form of self-medication for ADHD symptoms. Therefore, it is possible that identifying and treating ADHD earlier may prevent the onset of smoking altogether.

Studies show 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 found that the smoking rate at the end of the study was significantly lower in ADHD subjects who were receiving stimulant treatment than in ADHD subjects who were not, and there was no significant difference between ADHD subjects receiving stimulant treatment and non-ADHD subjects.

A Word From Verywell

Future research is needed to help better explain the link between nicotine and ADHD so that more effective prevention and treatment strategies can be developed. In the meantime, finding a way to overcome your nicotine addiction if you have ADHD provides enough benefits to make it worth the effort.

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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.
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By Keath Low
 Keath Low, MA, is a therapist and clinical scientist with the Carolina Institute for Developmental Disabilities at the University of North Carolina. She specializes in treatment of ADD/ADHD.