Four Things People with ADHD Should Know About Smoking
1. Smoking is twice as common among people with attention deficit hyperactivity disorder (ADHD) than in the general population, and fewer ADHD smokers succeed in quitting.
“An appealing short-term effect of nicotine is that it helps with the ability to focus. This is conceivably one reason why many people with ADHD smoke,” says Lirio Covey, PhD, professor of clinical psychology in Columbia’s Department of Psychiatry. Dr. Covey, former director of the Smoking Cessation Clinic at Columbia University Medical Center, currently investigates the effect of smoking on people with ADHD and the best techniques to help them quit.
“People with ADHD also think that smoking cigarettes calms them down,” she adds, “but lab studies have shown that smoking can aggravate hyperactivity.”
2. An ADHD drug, methylphenidate (Concerta), may help some ADHD smokers quit.
Whether methylphenidate can help depends on the type of ADHD symptoms patients experience, Dr. Covey says. Between 2005 and 2008, Dr. Covey and her research group tested the idea that treatment with methylphenidate, by reducing the symptoms of ADHD, would improve the success of a smoking cessation treatment (behavioral counseling paired with the nicotine patch).
“The study found that methylphenidate reduced ADHD symptoms, but it did not improve the overall quit rate,” she says.
But when Dr. Covey analyzed the results more closely, she found that certain groups seemed to benefit from methylphenidate. “Smokers with more severe ADHD symptoms did better with methylphenidate than smokers with less intense symptoms, and those who primarily had attention problems did better than those with hyperactivity problems. Another surprising finding that merits further study was that members of minority groups did better with methylphenidate compared to placebo.”
3. Quitting will not make you more anxious or depressed.
“A lot of people think smoking reduces anxiety. When smokers are under stress, the first thing they do is smoke a cigarette,” Dr. Covey says. “This is one reason people are afraid to even attempt quitting. And some older research did suggest depression could be a side effect of quitting.”
The newest research shows that, for most people, mood improves or remains unchanged. In Dr. Covey’s latest study, published this summer in the Journal of Substance Abuse Treatment, signs of anxiety and depression were tracked in 110 smokers with ADHD who succeeded in quitting and 145 who were unable to quit.
“We found that anxiety declined in all the participants, but the decline was greater in successful quitters. It happened right away, one week after quit day, and it lasted until the end of the trial,” she says.
Symptoms of depression initially declined more in the quitters, but by the end of the trial, both groups experienced fewer symptoms of depression. “To me, that says a lot about the benefits of participating in a clinical trial,” Dr. Covey says, “but the bottom line is that most smokers with ADHD can stop smoking and not experience any worsening of mood.”
Yet Dr. Covey warns that some people may indeed experience these negative effects, and clinicians need to watch out for them.
“I’ve had patients who became depressed after quitting,” Dr. Covey says. “They had depression earlier and that reemerged after quitting. So some smokers need additional treatment.”
4. People with ADHD can quit, but it may take several attempts.
In Dr. Covey’s study, 43 percent successfully quit using a combination of behavioral counseling and the nicotine patch (in most clinical trials of smoking cessation treatments, 20 percent to 30 percent of participants quit).
The newer nicotine nasal spray is also very helpful for smokers with ADHD in reducing craving and withdrawal symptoms. “The patch can take longer to have an effect because the nicotine has to go through the skin. The nasal spray is very fast, though not as fast as a cigarette,” Dr. Covey says. “But it’s still nicotine—an addictive drug—so I make sure they reduce the frequency of use over time.”
Dr. Covey encourages smokers to try again if the first (or second, or third) attempt fails. “The thinking is that for most people, it takes several attempts before you finally succeed. People learn at each attempt what doesn’t work,” Dr. Covey says.
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