Abstinence-induced withdrawal severity among adolescent smokers with and without ADHD: disentangling effects of nicotine and smoking reinstatement
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.
KeywordsAdolescents ADHD NRT Sensorimotor replacement Attention Denicotinized cigarette
This research is supported by the National Institute on Drug Abuse: K23DA033302 to LCB.
- Berlin I, MC H, Covey LS, Winhusen T (2012) Attention-deficit/hyperactivity disorder (ADHD) symptoms, craving to smoke, and tobacco withdrawal symptoms in adult smokers with ADHD. Drug Alcohol Depend 124:268–273. https://doi.org/10.1016/j.drugalcdep.2012.01.019 CrossRefPubMedPubMedCentralGoogle Scholar
- De Biasi M, Dani JA (2011) Reward, addiction, withdrawal to nicotine. Annu Rev Neurosci 34:105–130. https://doi.org/10.1146/annurev-neuro-061010-113734 CrossRefPubMedPubMedCentralGoogle Scholar
- DHHS (2014) The health consequences of smoking—50 years of progress: a report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 17, AtlantaGoogle Scholar
- Kollins SH, English JS, Roley ME, O'Brien B, Blair J, Lane SD, McClernon FJ (2013) Effects of smoking abstinence on smoking-reinforced responding, withdrawal, and cognition in adults with and without attention deficit hyperactivity disorder. Psychopharmacology 227:19–30. https://doi.org/10.1007/s00213-012-2937-0 CrossRefPubMedGoogle Scholar
- McClernon FJ, Kollins SH, Lutz AM, Fitzgerald DP, Murray DW, Redman C, Rose JE (2008) Effects of smoking abstinence on adult smokers with and without attention deficit hyperactivity disorder: results of a preliminary study. Psychopharmacology 197:95–105. https://doi.org/10.1007/s00213-007-1009-3 CrossRefPubMedGoogle Scholar
- McClernon FJ, Van Voorhees EE, English J, Hallyburton M, Holdaway A, Kollins SH (2011) Smoking withdrawal symptoms are more severe among smokers with ADHD and independent of ADHD symptom change: results from a 12-day contingency-managed abstinence trial. Nicotine Tob Res 13:784–792. https://doi.org/10.1093/ntr/ntr073 CrossRefPubMedPubMedCentralGoogle Scholar
- NCCDP (2012) Reports of the Surgeon General. Centers for Disease Control and Prevention (US), AtlantaGoogle Scholar
- Reich W, Leacock N, Shanfeld K (1997) DICA-IV Diagnostic Interview for children and Adolescents-IV. Multi-Health Systems, Inc., TorontoGoogle Scholar
- Singh T, Arrazola RA, Corey CG, Husten CG, Neff LJ, Homa DM, King BA (2016) Tobacco use among middle and high school students—United States, 2011–2015 vol 65Google Scholar
- Westman E, Levin E, Rose J (1992) Smoking while wearing the nicotine patch-is smoking satisfying or harmful. In: Clinical Research, vol 4. SLACK INC 6900 GROVE RD, THOROFARE, NJ 08086, pp A871-A871Google Scholar
- Zucker M, Morris MK, Ingram SM, Morris RD, Bakeman R (2002) Concordance of self- and informant ratings of adults' current and childhood attention-deficit/hyperactivity disorder symptoms. Psychol Assess 14(4):379–389Google Scholar