Treating people who have attention deficit hyperactivity disorder with stimulant medication could reduce their likelihood of taking up smoking, according to research from Duke Medicine in Durham, NC.
Characterized by hyperactivity and impulsivity, attention deficit hyperactivity disorder (ADHD) is usually treated with stimulant medication (Vyvanse and Concerta are two examples of brands), behavior therapy, or a combination of the two.
Research has shown that adults with ADHD smoke at twice the rate of adults without ADHD. As well as smoking more than the general population, people with ADHD often start earlier. Youth with ADHD are two to three times more likely to smoke than youth without ADHD.
"Given that individuals with ADHD are more likely to smoke, our study supports the use of stimulant treatment to reduce the likelihood of smoking in youth with ADHD," says senior author behind the new study and director of the Duke ADHD Program, Prof. Scott Kollins.
Previous research on ADHD-smoking association has been mixed
Studies have previously looked at how stimulant medications might influence smoking behaviors in people with ADHD. The results of these studies have been mixed, however, with some suggesting an increase in smoking among people treated with stimulant medications, some showing a decrease and others showing no effect.
Lead author Erin Schoenfelder, PhD, clinical associate and a psychologist in the Duke ADHD Program, explains:
"Nicotine operates on the same pathways in the brain as stimulant medications, and the relationship between stimulants and smoking has been controversial. It has been suggested that some people with ADHD 'self-medicate' their attention deficits using nicotine."
The Duke Medicine researchers - who published their results in the journal Pediatrics - reviewed 14 studies that looked at cigarette smoking and ADHD treatment, which involved a total of 2,360 participants.
Our findings show that treating ADHD effectively with medication may prevent young people from picking up the habit," Dr. Schoenfelder says.
"This study may debunk the perception that stimulants will increase one's risk for smoking," Prof. Kollins says.
The Duke researchers found "a significant association" between stimulant treatment for ADHD and lower smoking rates. They also found the effect to be larger in people with more severe ADHD or in people who continuously took stimulant medications.
"The risk is further lowered when adherence to medication treatment is consistent, presumably since this increases the chances that symptoms are managed effectively," Prof. Kollins says.
"This study may debunk the perception that stimulants will increase one's risk for smoking," he adds. "It gives us more confidence when we talk with parents to reassure them that consistent ADHD treatment won't increase their children's risk of smoking, and in fact, may actually do the opposite."
Because of the design of the study, however, the researchers were unable to identify a causal relationship between stimulant treatment and lower smoking risk. They can only report a link between the two.
Additional studies are needed, they say, to provide more information on the timing and duration of treatment for best lowering smoking risk among people with ADHD.
Dr. Schoenfelder concludes:
"My hope is that this research can help inform our efforts to prevent negative outcomes for kids with ADHD, including cigarette smoking. This population hasn't been targeted for smoking prevention efforts, despite the well-known connection between ADHD and smoking."
In 2012, Medical News Today reported on a study that suggested a genetic link behind the association between smoking and ADHD. That study identified a gene variant, the C allele of rs1329650, as increasing risk for both ADHD and smoking.