DO PATIENTS WITH ADHD HAVE A HARDER TIME QUITTING CIGARETTES?

Abstract

A significant number of adolescents in the United States continue to use tobacco (nicotine), mainly in the form of smoked cigarettes, and attention-deficit/hyperactivity disorder (ADHD) is linked to ever smoked and current smoking (Upadhyaya et al., 2005), as well as early initiation of smoking in adolescents. ADHD is a risk factor for smoking independent of other psychiatric comorbidity, including conduct disorder. In addition, nicotine has been shown to improve attention in smokers, nonsmokers, and adults with ADHD. There is preliminary evidence that adult smokers with ADHD may have greater difficulty quitting smoking (Pomerleau et al., 1995). Hence, some authors have even suggested a selfmedication hypothesis for nicotine use in patients with ADHD. Bupropion SR is efficacious in adult smokers (30%Y50% abstinence rates; Hurt et al., 1997) and has modest efficacy in improving symptoms of ADHD. Hence, we conducted and published a pilot open-label study of bupropion SR for smoking cessation in 16 adolescent smokers (Upadhyaya et al., 2004). In addition to nicotine dependence, 11 subjects in the study had comorbid ADHD. The point abstinence rate at week 4 was around 31%. Since that time, there has been at least one report of a dosedependent relationship between ADHD and smoking. Selfreported symptoms of ADHD were linked in a dosedependent manner with earlier onset and rate of smoking in a large national epidemiological study of adolescents (Kollins et al., 2005). Hence, we decided to reexamine the data from our 2004 pilot study to see whether the adolescent smokers in our study with comorbid ADHD had poorer outcomes compared to those without ADHD. Only 1 (9%) of 11 subjects with ADHD was able to abstain from smoking at week 4 compared to 4 (80%) of 5 subjects without ADHD. Although very preliminary, the results suggest that it may be more difficult for adolescents with ADHD to quit smoking cigarettes compared with adolescents without ADHD. This result is consistent with those from adult smokers with ADHD who are trying to quit smoking (Pomerleau et al., 1995). Given the high comorbidity of nicotine dependence in ADHD, further studies are needed to examine smoking cessation outcomes in adolescent and adult smokers with ADHD. If the preliminary observation that adolescent smokers with ADHD may have more difficulty quitting smoking is replicated, it would suggest that adolescent smokers with ADHD may need more tailored interventions for smoking cessation.