Quitting smoking or other nicotine habits like chewing tobacco or vaping can be challenging at best, especially if past attempts have failed, and unbeknownst to the user, the nicotine is serving to
manage or mask ADHD symptoms.
I hope this article finds its way to those who will benefit from it. Please feel free to forward it to someone you know who is struggling with nicotine addiction along with managing their ADHD. It explains how nicotine affects dopamine in individuals with ADHD, the reasons behind the high use rates of nicotine substances within this population, and the impact on ADHD symptoms when trying to stop smoking or other nicotinic substances. This article does not intend to substitute for medical advice, and I encourage anyone who wishes to explore this further to reach out to their doctor. I do include practical strategies for overcoming a smoking or other nicotine habit, especially if you have ADHD, and what steps you can take to breathe freely.
My interest in smoking and its influence on people with ADHD began while I was growing up. My father smoked cigarettes well into his 70s. He was a medical doctor, yet even after two heart attacks, a high blood pressure diagnosis, and twelve-year-old me pleading with him to stop after learning about the dangers in 7th-grade health class, he continued, albeit discreetly. The smell of a lit cigarette and the lingering scent of nicotine on his clothes and breath were all too familiar indicators that he still struggled.
Although never diagnosed, I suspect my father also had undiagnosed ADHD…let’s just say the apple didn’t fall far from the tree. I received a diagnosis in mid-adulthood, as did my brother and sister, along with six of his grandchildren. I loved my dad, yet his continued smoking habit was something I couldn’t understand for decades…until I learned more about the relationship between nicotine and dopamine training as a psychiatric mental health nurse practitioner.
A fuller understanding and increased compassion about my dad’s struggle with smoking cessation and its effect on ADHD symptoms only came when I worked as a professional ADHD Life coach and heard similar experiences about smoking from clients. Many described beginning to smoke at an early age and having incredible challenges when trying to stop. And, if they could stop smoking, many noticed an increase in their ADHD symptoms or received an initial diagnosis of ADHD following quitting cigarettes.
The Nicotine and Dopamine Connection
Dopamine is a neurotransmitter that plays a crucial role in the brain’s reward pathways and is essential for regulating attention, motivation, and pleasure. Researchers believe that an imbalance or deficiency of dopamine in crucial areas of the brain like the prefrontal cortex, striatum, nucleus accumbens, and the ventral tegmental area may be the cause of ADHD symptoms. Without enough dopamine to stimulate these regions, persons with ADHD experience executive dysfunction, attentional challenges, decision-making difficulties, lack of motivation, learning and memory challenges, and an increase in impulsivity and hyperactivity.
Nicotine, found in various amounts in cigarettes, tobacco chew, and vaping, activates nicotinic acetylcholine receptors (nAChRs) in regions of the brain, abundant in dopamine receptors—areas like the prefrontal cortex, nucleus accumbens, and the ventral tegmental area. When nicotine binds to receptors, it triggers the release of various neurotransmitters, including dopamine. This dopamine release can briefly enhance cognitive function, attention, focus, and working memory, providing short-term relief from ADHD symptoms.
Higher Smoking and Nicotine Use in Persons with ADHD
Higher smoking and nicotine use rates among individuals with ADHD compared to the general population have been attributed to several factors, including:
Self-Medication: Nicotine’s ability to stimulate dopamine release can temporarily relieve some symptoms of ADHD. Whether consciously or unconsciously, this can explain why individuals with ADHD might be more prone to starting to use nicotine and unknowingly continue to self-medicate with nicotine to increase their dopamine levels and decrease their ADHD symptoms.
Impulsivity and Risk-Taking Behavior: ADHD is characterized by increased impulsivity and risk-taking, thought to lead to a higher likelihood of experimenting with and continuing to use substances like nicotine.
Dopamine Deficiency: The deficiency of the neurotransmitter dopamine in the brains of persons with ADHD can make them more susceptible to seeking quick dopamine boosts from substances like nicotine.
Social Factors: Peer pressure and the human desire for social acceptance may also play a role in why individuals with ADHD might start smoking. Adolescents and adults with ADHD often face social challenges, including difficulties in forming and maintaining relationships. The desire to fit in and be socially accepted can lead to someone starting to smoke, vape, or chew tobacco and become a social activity that provides a sense of belonging and a way to connect with others, making it more challenging to quit.
Stress and Coping Strategies: Individuals with ADHD often face higher levels of stress due to the challenges associated with the disorder. The physical act of smoking can be a way to manage stress and anxiety, serve as something to do with one’s hands during stressful times, and provide a momentary escape. Once this coping mechanism is ingrained, it’s challenging to break the habit.
Family Influence and Early Exposure: Family dynamics and early exposure to smoking can also influence smoking in individuals with ADHD. Growing up in a household where smoking is prevalent can normalize the behavior and increase the likelihood of others in that family smoking. This transgenerational inheritability of ADHD may also increase the number of people in families susceptible to using nicotine to manage underlying undiagnosed ADHD, further reinforcing the habit.
The Challenge of Nicotine Cessation and ADHD
There are numerous reasons that quitting smoking or any nicotine cessation is one of the hardest and more complicated addictions for people with ADHD to overcome. One of the reasons may be the release of dopamine created by the activation of the nicotine receptors, creating feelings of reward and pleasure, increasing the susceptibility to becoming addicted, and the difficulty of stopping the habit.
Also, chronic nicotine use can lead to tolerance, requiring someone to increase their nicotine intake to prevent withdrawal and not experience a worsening of ADHD symptoms like inattention and impulsivity. This physiological need to increase the amount of nicotine so as not to experience withdrawal or an increase of their ADHD symptoms, make it especially difficult for individuals with ADHD to maintain abstinence from smoking, chewing tobacco, or vaping for any length of time.
If You Want to Stop Smoking With ADHD
Given the unique challenges faced by individuals with ADHD, cessation approaches need to consider the neurobiological and social factors involved. Strategies may include pharmacological, social, and behavioral approaches that would uniquely address the challenges faced by this population. By doing so, individuals with ADHD have a better chance of achieving their health goals and improving the management of their ADHD symptoms without relying on nicotine.
Pharmacotherapy Approach
Medications such as nicotine replacement therapy (NRT), bupropion, and varenicline are often used to help reduce withdrawal symptoms and cravings. Bupropion is an atypical antidepressant that also aids in smoking cessation. It works by affecting neurotransmitters in the brain, primarily norepinephrine and dopamine, which are involved in addiction and mood regulation. By altering the balance of these chemicals, bupropion reduces the withdrawal symptoms and cravings associated with quitting smoking.
Varenicline acts as a partial agonist at the nicotinic acetylcholine receptors in the brain. This means it binds to these receptors and partially stimulates them, which helps reduce cravings and withdrawal symptoms. Additionally, varenicline blocks nicotine from binding to these receptors, which diminishes the pleasurable effects of smoking, thereby reducing the urge to smoke.
Combining classic stimulant pharmacological management of ADHD (methylphenidate and amphetamines) with medications to reduce withdrawal symptoms and cravings can be beneficial. This combined treatment approach helps manage both nicotine dependence and ADHD symptoms, making it easier for individuals to quit smoking.
Behavioral Interventions
Cognitive-behavioral therapy (CBT) or ADHD Life Coaching can help individuals develop coping strategies for managing ADHD symptoms without nicotine. Techniques such as mindfulness, stress management, and problem-solving skills can be incredibly useful.
Social Support Systems
Peer support groups, group counseling, and smoking cessation programs designed specifically for individuals with ADHD can provide social support and motivation. These programs can offer a sense of community and understanding, helping individuals feel less isolated in their journey to quit smoking and resulting in better health outcomes without relying on nicotine.
Understanding the neurobiological interplay between nicotine and ADHD provides insight into why smoking rates are higher in this population and why quitting can be so challenging. I loved my dad and regret any time lost not understanding the correlation between ADHD and nicotine when I was unaware of his lifelong challenge and inability to quit smoking. Characteristically, he accomplished most of what he set out to do. I now know he would have stopped smoking if he could.
As always, I am forever grateful for the lessons I continue to learn about ADHD from my client’s experiences and the insight they provide. Thank you.
What experience have you had with smoking and ADHD? I’d love to know. Let me know below.
