Methylphenidate increases cigarette smoking in participants with ADHD
Methylphenidate (Ritalin®) is commonly prescribed for behavioral problems associated with attention deficit/hyperactivity disorder (ADHD). The results of previous studies suggest that methylphenidate increases cigarette smoking in participants without psychiatric diagnoses. Whether methylphenidate increases cigarette smoking in participants diagnosed with ADHD is unknown.
In this within-subjects, repeated measures experiment, the acute effects of a range of doses of methylphenidate (10, 20, and 40 mg) and placebo were assessed in nine cigarette smokers who were not attempting to quit and met diagnostic criteria for ADHD but no other Axis I psychiatric disorders other than nicotine dependence.
Each dose of methylphenidate was tested once while placebo was tested twice. One hour after ingesting drug, participants were allowed to smoke ad libitum for 4 h. Measures of smoking included total cigarettes smoked, total puffs, and carbon monoxide levels. Snacks and decaffeinated drinks were available ad libitum; caloric intake during the 4-h smoking session was calculated.
Methylphenidate increased the total number of cigarettes smoked, total number of puffs, and carbon monoxide levels. Methylphenidate decreased the number of food items consumed and caloric intake.
The results of this experiment suggest that acutely administered methylphenidate increases cigarette smoking in participants with ADHD, which is concordant with findings from previous studies that tested healthy young adults. These data indicate that clinicians may need to consider non-stimulant options or counsel their patients before starting methylphenidate when managing ADHD-diagnosed individuals who smoke.
KeywordsMethylphenidate Smoking ADHD Subjective effects Humans
The authors wish to thank Frances P. Wagner, R.N. for her expert nursing assistance and Amanda Bucher, Kathryn Hays, Shawn England, Michelle Gray, Erika Pike, and Sarah Veenema for their expert technical assistance. The National Institute on Drug Abuse Grants R01 DA 012665 (CRR) and T32 DA 007027-34 as well as the National Cancer institute grant R21 CA 124881 (WWS) supported this project. Research professorship funds from the University of Kentucky to CRR, startup funds from the University of Kentucky Department of Behavioral Science to WWS, and pilot grant funds from the University of Kentucky Department of Behavioral Science to ARV also supported this project.
- Brown RT, Amler RW, Freeman WS, Perrin JM, Stein MT, Feldman HM, Pierce K, Wolraich ML, American Academy of Pediatrics Committee on Quality Improvement, American Academy of Pediatrics Subcommittee on Attention-Deficit/Hyperactivity Disorder (2005) Treatment of attention-deficit/hyperactivity disorder: overview of the evidence. Pediatrics 115(6):749–757CrossRefGoogle Scholar
- Faraone SV, Biederman J, Spencer TJ, Aleardi M (2006) Comparing the efficacy of medications for ADHD using meta-analysis. Med Gen Med 8(4):4Google Scholar
- Interobserver Reliability. http://www.ccny.cuny.edu/bbpsy/modules/interob_reliability.htm. Accessed 15 Jul 2004
- Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM (2006) The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 163(4):716–723PubMedCrossRefGoogle Scholar
- Krause KH, Dressel SH, Krause J, Kung HF, Tatsch K (2000) Increased striatal dopamine transporter in adult patients with attention deficit hyperactivity disorder: effects of methylphenidate as measured by single photon emission computed tomography. Neurosci Lett 285:107–110PubMedCrossRefGoogle Scholar
- Lambert N (2002) Stimulant treatment as a risk factor for nicotine use and substance abuse. In: Jensen, Cooper (eds) Attention deficit hyperactivity disorder: state of the science-best practices. Civic Research Institute, Kingston, Chapter 18Google Scholar
- Spencer T, Biederman J, Wilens T, Doyle R, Surman C, Prince J, Mick E, Aleardi M, Herzig K, Faraone S (2005) A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder. Biol Psychiatry 57(5):456–463PubMedCrossRefGoogle Scholar
- Wilens TE, Biederman J, Spencer TJ, Bostic J, Prince J, Monuteaux MC, Soriano J, Fine C, Abrams A, Rater M, Polisner D (1999) A pilot controlled trial of ABT-418, a cholinergic agonist, in the treatment of adults with attention deficit hyperactivity disorder. Am J Psychiatry 156:1931–1937PubMedGoogle Scholar
- Winhusen TM, Somoza EC, Brigham GS, Liu DS, Green CA, Covey LS, Croghan IT, Adler LA, Weiss RD, Leimberger JD, Lewis DF, Dorer EM (2010) Impact of attention-deficit/hyperactivity disorder (ADHD) treatment on smoking cessation intervention in ADHD smokers: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 71(12):1680–1688PubMedCrossRefGoogle Scholar