Adults with attention deficit hyperactivity disorder (ADHD) are more likely to smoke cigarettes and become dependent on nicotine. They may also find it more difficult to give up smoking nicotine. Researchers are investigating why this is the case.

According to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), as many as 10 million adults in the United States (U.S.) have ADHD.

Nicotine is a natural component of tobacco. The Food and Drug Administration (FDA) explains that nicotine can change how the brain works, leading to cravings and addiction.

Tobacco products, such as cigarettes, deliver nicotine to the brain quickly. This satisfies a person’s cravings for nicotine. However, it also makes it easier for a person to become dependent on it and makes it harder to quit smoking.

Smoking nicotine can increase a person’s risk of developing heart disease, stroke, lung cancer, and other health conditions.

This article explores the connection between ADHD and smoking nicotine.

Help is available

Seeking help for addiction may feel daunting or even scary, but several organizations can provide support.

If you believe that you or someone close to you is showing signs of addiction, you can contact the following organizations for immediate help and advice:

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ADHD is a neurodevelopmental disorder that can affect children and adults. According to the Centers for Disease Control and Prevention (CDC), people with ADHD show a pattern of inattentive and hyperactive symptoms.

Some of the symptoms of ADHD, according to the CDC, include:

Inattentive symptomsHyperactive symptoms
being easily distracted often feeling the urge to fidget, such as tapping hands or feet
often misplacing important things, such as keys, phones, and walletsoften feeling extremely restless and wearing others out with their activity
often finding it difficult to organize tasks and activities always being “on the go,” starting lots of projects, and making lots of plans
often finding it difficult to pay attention to what someone is saying often feeling the urge to interrupt people before they have finished speaking

People with ADHD may display either inattentive or hyperactive symptoms, but usually, people with ADHD display both.

A healthcare professional can diagnose an adult with ADHD if they experience five or more of these symptoms, and the symptoms have been present for at least 6 months.

The symptoms also have to be present in two or more settings — such as at home and at work — and they must negatively impact a person’s functioning and performance.

People with ADHD are more likely to start smoking nicotine cigarettes than people without ADHD. They may also have more intense withdrawal symptoms when they stop smoking.

A 2016 study compared the smoking behaviors of young adults and found that those with ADHD were significantly more likely to become daily smokers than those without ADHD.

The researchers also note that after the participants stopped smoking, those with ADHD reported more intense withdrawal symptoms and stronger cravings than those without ADHD.

Trends in cigarette smoking among adults in the U.S. are dropping, according to the CDC. However, this trend is not reflected among people with ADHD, suggesting that ADHD is a risk factor for smoking.

Estimates from CHADD also suggest that, as well as having higher smoking rates, youth with ADHD are twice as likely to become addicted to nicotine than their peers without ADHD.

Why is nicotine use higher in those with ADHD?

One explanation could be that some people with ADHD find that nicotine helps them manage their symptoms.

Nicotine’s stimulating effects may help improve attention and concentration in people with ADHD. This theory is called the self-medication theory, according to 2015 research.

However, a 2017 review indicates that receiving early treatment with prescribed ADHD medication does not prevent nicotine use.

ADHD and smoking

People with ADHD tend to have more difficulty quitting smoking than people without ADHD. More research is needed to find out why, but a 2018 review shows that people with ADHD are more prone to making impulsive decisions and often favor a smaller immediate reward over a larger reward in the future.

People with ADHD may be more likely to seek the quick fix of nicotine that smoking provides because it is a behavior that gives an immediate reward.

However, more research is needed to fully understand why smoking rates are higher in people with ADHD and why they find it harder to quit smoking.

According to the CDC, doctors often prescribe stimulants to help people with ADHD manage their symptoms. Nicotine stimulates the brain in similar ways and can help a person focus on a task and boost concentration levels.

A 2016 study suggests that nicotine has beneficial effects on the concentration, attention, and emotional regulation of people with ADHD.

However, the effects are short-lived. Over time, many people need to smoke more nicotine more often to achieve the same effects.

Additionally, people with ADHD find it harder to quit smoking nicotine and may feel more intense withdrawal symptoms when they do.

According to the CDC, cigarette smoking is the leading cause of preventable deaths in the U.S.

People who smoke are more likely to develop health conditions such as heart disease, stroke, and lung cancer than people who do not smoke.

Aside from the usual risks of smoking nicotine, research suggests that young people with ADHD who smoke are more likely to misuse other substances, including alcohol and other drugs.

The reasons for this are not yet known, and further research is needed to explain the link.

This section answers some frequently asked questions about ADHD and nicotine.

Can nicotine affect ADHD medication?

Nicotine is a stimulant that acts on the brain in a similar way to some of the medications used to treat ADHD.

Although most of the research into ADHD has focused on children, there is no evidence to suggest that nicotine interferes with any ADHD medications.

Can quitting nicotine affect ADHD?

The health implications of smoking nicotine are the same for people with or without ADHD. However, a 2016 study suggests that people with ADHD may feel the withdrawal symptoms more strongly than those without ADHD.

Many of the symptoms of nicotine withdrawal are common traits among people with ADHD. These symptoms can include:

According to a 2017 review, some people with ADHD believe the severity of these symptoms increases during nicotine withdrawal.

A person with ADHD should continue to take any prescribed medications while quitting the use of nicotine. This may help reduce the severity of withdrawal symptoms.

Smoking nicotine increases the risk of:

  • cancer
  • heart disease
  • stroke
  • diabetes
  • and more

The CDC says quitting smoking is one of the most important steps a person can take to improve their health and quality of life.

A person with ADHD may find it harder to quit smoking nicotine, but there are ways to help. Some useful methods include:

  • Behavioral therapies and counseling: People with ADHD who are trying to quit smoking may find behavioral therapies, such as cognitive behavioral therapy (CBT), beneficial. Therapy may offer coping strategies to help people resist cravings.
  • Using incentives: A person with ADHD may find it helpful to use reward-based practices when attempting to quit smoking. An older 2010 literature review found that monetary incentives could help people with ADHD stop smoking. A person could replicate this by allowing themselves to have a treat every 10 days of not smoking, or by using an app that rewards a person for good habits.
  • Using nicotine replacements: Products such as nicotine patches or gum may also help reduce any cravings or withdrawal symptoms for those who are struggling to quit.
  • Using alternative medicine: Although there is limited evidence to support the effectiveness, some people use complementary medicines, such as hypnotherapy and acupuncture, to quit smoking.

Some people may find that it takes several attempts to quit smoking. This does not mean that a person has failed at quitting. Each attempt can show a person which methods are most helpful for them.

Anyone with ADHD who is trying to quit smoking nicotine should talk with a healthcare professional about getting support.

In 2019, the U.S. government raised the legal age at which someone can buy tobacco to 21. This includes the sale of e-cigarettes. The hope is that this will deter younger people from starting to smoke nicotine.

Ideally, a person with ADHD will have access to medication, counseling, behavioral therapies, and educational support to help them cope with the disorder and avoid behaviors such as smoking nicotine.

Proper medication will remove the need to self-medicate. However, traits of the disorder, such as impulsiveness, risk-taking, and seeking immediate rewards, may still lead a person to nicotine cigarettes.

The earlier a person stops smoking nicotine, the easier it is and the quicker they see the health benefits.

People with ADHD are more likely to smoke nicotine and have a harder time quitting than people without ADHD. They may also experience stronger withdrawal symptoms and cravings.

Adults with ADHD who use nicotine cigarettes to help manage their symptoms may find that with proper medication, they can quit.

Person-specific behavioral therapies and counseling can also help people cope with any cravings associated with nicotine withdrawal.