ADHD medication reduces cotinine levels and withdrawal in smokers with ADHD

Abstract

Individuals with ADHD may self-medicate with nicotine, the main psychoactive ingredient in tobacco smoke, in order to reduce symptoms and negative moods associated with ADHD. ADHD medication (e.g., methylphenidate and atomoxetine) may mimic some of the effects of nicotine and may aid smoking cessation in smokers with ADHD. The present study examined if ADHD medication reduces smoking and withdrawal in non-treatment seeking smokers with ADHD. Fifteen adult smokers with ADHD participated in the study, which consisted of an experimental phase and field monitoring phase to examine the acute and extended effects, respectively, of ADHD medication. During the experimental phase, smokers were asked to complete a Continuous Performance Task (CPT) and the Shiffman–Jarvik smoking withdrawal questionnaire during the following four conditions: (1) ADHD medication + cigarette smoking, (2) ADHD medication + overnight abstinence, (3) placebo + cigarette smoking, and (4) placebo + overnight abstinence. During the field monitoring phase, participants were asked to provide salivary cotinine samples and complete electronic diaries about smoking, smoking urge, ADHD symptoms, and stress in everyday life for two days on ADHD medication and for two days on placebo. Results of the experimental phase showed that ADHD medication improved task performance on the CPT and reduced withdrawal during overnight abstinence. During the field monitoring phase, ADHD medication reduced salivary cotinine levels compared to placebo. In addition, the electronic diary revealed that ADHD medication improved difficulty concentrating during no smoking events and stress. The findings of the present study suggest that, along with other strategies, ADHD medication may be used to aid smoking withdrawal and cessation in smokers with ADHD.

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a frequent diagnosis for symptoms of inattention, impulsivity, and hyperactivity in children and the prevalence rates for adults range from 2 to 6% (Weiss and Murray, 2003). Individuals with ADHD are at an increased risk for early smoking initiation, have elevated smoking prevalence and reduced quit rates compared to the general population (Burke et al., 2001, Lambert and Hartsough, 1998, Milberger et al., 1997, Molina and Pelham, 2003, Pomerleau et al., 1995). Recent research has shown that nicotine, the main psychoactive ingredient of tobacco smoke, reduces clinical symptoms and negative moods in individuals with ADHD independent of smoking status (Gehricke et al., 2009). The effects of nicotine on ADHD symptoms may be similar to those found in response to ADHD medications such as methylphenidate (e.g., Ritalin and Concerta), atomoxetine (e.g., Strattera), and dextroamphetamine (e.g., Dexedrine, Adderall, and Vyvanse) (Conners et al., 1996, Gehricke et al., 2006, Levin et al., 1996, Potter and Newhouse, 2004). These medications for ADHD may be able to mimic some of the behavioral effects of nicotine and thus may aid smokers with ADHD during smoking cessation (Gehricke et al., 2009, Gehricke et al., 2007).

Covey et al. (2009) found that an 11-week administration of OROS-methylphenidate (OMPH) led to a four-week complete abstinence rate of 42.9% in non-Caucasians with ADHD compared to 23.1% in Caucasians with ADHD. However, no information was provided on the motivation to quit, medication-induced task improvement during abstinence, and interactions with perceived stress, which may have contributed in one form or another to the differences in abstinence rates. In addition, Ray et al. (2009) showed that the non-stimulant atomoxetine reduced smoking withdrawal symptoms during abstinence. Moreover, stress has been found to negatively affect abstinence rates in smokers (Businelle et al., 2010, Shaw and al'Absi, 2008) and ADHD medication may be useful to reduce withdrawal associated with abstinence, in particular during stress.

Overall, little is known about the effects of ADHD medication on smoking and withdrawal symptoms without the confounding effects of motivation to quit in smokers with ADHD. The goal of the present study was to provide more information on the interaction between ADHD medication administration, cigarette smoking, clinical symptoms and withdrawal in non-treatment seeking smokers with ADHD. The study consisted of an experimental phase and a subsequent field monitoring phase to examine the acute and extended effects, respectively, of ADHD medication. More specifically, the experimental phase examined the acute effects of ADHD medication compared to placebo and smoking compared to abstinence on task performance and withdrawal symptoms in a controlled setting. The field monitoring phase evaluated effects of two days of ADHD medication administration compared to two days of placebo on nicotine intake, smoking urge, and ADHD symptoms during everyday life. In addition, this phase examined the interactive effects of ADHD medication and smoking on smoking urge and symptoms of ADHD during stress compared to no stress. For the experimental phase, it was hypothesized that ADHD medication compared to placebo would improve task performance and reduce withdrawal symptoms during smoking abstinence. For the field monitoring phase, it was hypothesized that ADHD medication would reduce nicotine intake compared to placebo. In addition, it was expected that ADHD medication would reduce smoking urge and ADHD symptoms during no smoking events and stress.