Inattentive ADHD and Self Medicating with Nicotine and Smoking

People with Inattentive ADHD Self Medicate by Smoking

People with Inattentive ADHD often self medicate by smoking. They do this less often than their Hyperactive/Impulsive cousins but there is reason to believe that people with all the sub-types of ADHD smoke more than people without this diagnosis.

Nicotine is known to improve attention, processing speed and focus and test performed on people with ADHD after smoking show improvements in these Inattentive ADHD symptoms scores when they are compared to the scores taken from non-smokers with ADHD.

The problem, of course is that smoking is addictive, harmful to our health and harmful to the environment and self medicating Inattentive ADHD symptoms with nicotine and smoking is just a bad idea. Some might argue that treating a nicotine addiction with amphetamines is not much of a move in the 'better health' direction but most researchers believe that drugs such as Ritalin and Adderall are, in fact, much safer.

A study just published aimed to determine if you could decrease the rate of smoking, in heavy and not so heavy smokers, by treating people with ADHD with Ritalin. What they found was that heavy smokers with Combined type ADHD did decrease their smoking when treated with Ritalin but that heavy smokers with ADHD Inattentive quit more when they were treated with a placebo.  This is not the first study to show that placebos help people with Inattentive ADHD and these placebo effects never fail to astonish me.

The authors conclude that, "Contrasting treatment response... support the hypothesis of ADHD subtypes as distinct clinical entities and may indicate the need and directions for personalized targeted treatments
of smokers with ADHD.  I think the studies confirm what we know about Ritalin and ADD Inattentive and that is that for some reason this particular amphetamine targets brain areas that are not as responsible for the symptoms of ADD Inattentive.  It would be interesting to know if this would have been true of the Adderall family of amphetamines as well.

I have included the study below.  I hope you are having a great summer!!

Divergence by ADHD Subtype in Smoking Cessation Response to
OROS-Methylphenidate.
Covey LS, Hu MC, Weissman J, Croghan I, Adler L, Winhusen T.
SourceNew York State Psychiatric Institute, Columbia University
Medical Center, Psychiatry, Clinical Therapeutics, 1051 Riverside
Drive, New York, NY. lsc3@columbia.edu.

Abstract
INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is a
neuropsychiatric condition subclassified in DSM-IV according to its
core symptoms domains as (a) predominantly inattentive (ADHD-IN), (b)
predominantly hyperactive/impulsive (ADHD-H), and (c) combined
inattentive and hyperactive/impulsive (ADHD-C). Whether these subtypes
represent distinct clinical entities or points on a severity continuum
is controversial. Divergence in treatment response is a potential
indicator of qualitative heterogeneity. This study examined smoking
cessation response by ADHD subtype to osmotic-release oral system
methylphenidate (OROS-MPH).

METHODS: Male and female adult smokers (ADHD-C = 167 and ADHD-IN = 87)
were randomized to receive OROS-MPH or placebo as augmentation
treatment to nicotine patch and counseling. Logistic regression was
conducted to test the effect of OROS-MPH versus placebo on prolonged
smoking abstinence by ADHD subtype.

RESULTS: The subtypes were similar in baseline demographic, smoking,
and psychiatric history but differed in smoking cessation response to
OROS-MPH or placebo as a function of nicotine dependence level. The
3-way interaction was significant; χ(2)(1) = 8.22, p < .01. Among
highly dependent smokers, the prolonged abstinence rates were greater
with OROS-MPH than with placebo in the ADHD-C group (60% vs. 31.3%,
respectively, p < .05) but higher with placebo than with OROS-MPH in
the ADHD-IN group (60% vs. 11.8%, respectively, p < .01). Abstinence
rates did not differ by subtype or treatment among smokers who were
less nicotine dependent. Conclusion: Contrasting treatment response
and divergence in the impact of nicotine dependence level support the
hypothesis of ADHD subtypes as distinct clinical entities and may
indicate the need and directions for personalized targeted treatments
of smokers with ADHD.