, Volume 235, Issue 1, pp 169–178 | Cite as

Abstinence-induced withdrawal severity among adolescent smokers with and without ADHD: disentangling effects of nicotine and smoking reinstatement

  • L. Cinnamon BidwellEmail author
  • Sara G. Balestrieri
  • Suzanne M. Colby
  • Valerie S. Knopik
  • Jennifer W. Tidey
Original Investigation



Individuals with attention deficit hyperactivity disorder (ADHD) start smoking earlier, are more likely to progress to nicotine dependence, and have a more difficult time quitting smoking compared to their non-ADHD peers. Little is known about the underlying behavioral mechanisms associated with this increased risk, particularly at the adolescent stage.


This study aimed to assess the effects of overnight nicotine abstinence and smoking reinstatement on subjective withdrawal states in adolescent smokers with and without ADHD.


Adolescent daily smokers (27 with ADHD and 17 without ADHD) completed three experimental sessions: (1) a placebo patch followed by smoking a nicotine cigarette, (2) placebo patch followed by smoking a nicotine-free cigarette, and (3) nicotine patch followed by smoking a nicotine-free cigarette. Subjects abstained overnight before each session, and patches were administered 45 min before smoking. The primary outcome measure was a smoking withdrawal symptom questionnaire.


ADHD smokers experienced greater difficulty concentrating and impatience/restlessness during abstinence than non-ADHD smokers. Smoking a cigarette improved abstinence-induced difficulty concentrating and restlessness, regardless of its nicotine content, and regardless of whether transdermal nicotine was received or not.


Thus, sensorimotor aspects of smoking, rather than nicotine itself, appeared to relieve withdrawal. Although ADHD smokers report greater withdrawal symptoms than non-ADHD smokers, they responded strongly to the sensorimotor aspects of smoking during withdrawal. These findings suggest that even lighter, adolescent smokers with ADHD are vulnerable to smoking progression through altered smoking abstinence and withdrawal relief processes.


Adolescents ADHD NRT Sensorimotor replacement Attention Denicotinized cigarette 



This research is supported by the National Institute on Drug Abuse: K23DA033302 to LCB.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • L. Cinnamon Bidwell
    • 1
    • 2
    Email author
  • Sara G. Balestrieri
    • 2
  • Suzanne M. Colby
    • 2
    • 3
    • 4
  • Valerie S. Knopik
    • 3
    • 5
    • 6
  • Jennifer W. Tidey
    • 3
    • 4
  1. 1.Institute of Cognitive ScienceUniversity of ColoradoBoulderUSA
  2. 2.Center for Alcohol and Addiction StudiesBrown UniversityProvidenceUSA
  3. 3.Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceUSA
  4. 4.Department of Behavioral and Social Health Sciences, School of Public HealthBrown UniversityProvidenceUSA
  5. 5.Division of Behavioral Genetics, Rhode Island Hospital, Department of Psychiatry and Human BehaviorThe Warren Alpert Medical School of Brown UniversityProvidenceUSA
  6. 6.Department of Human Development and Family StudiesPurdue UniversityWest LafayetteUSA

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