Attention-deficit linked to smokers' self-medication needs

November 19, 2001

People who have trouble paying attention, especially those who also tend to be hyperactive, may smoke tobacco in order to help manage their symptoms, a new study indicates.

Apparently, tobacco's stimulating effects -- which help these people feel more focused -- and its ability to lift their spirits, go a long way toward explaining why these people smoke and may provide useful insights into the kinds of help they need to stop, according to the study in the November issue of Nicotine and Tobacco Research.

Individuals whose inattention and hyperactivity symptoms are so severe that they qualify for a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) have a well-documented propensity for cigarette smoking, explains lead author Caryn Lerman, Ph.D., of the University of Pennsylvania Cancer Center. They are not only more likely to start smoking, but also more likely to start at a younger age and less likely to quit.

Knowing this, Lerman and her colleagues wondered if attention deficits and hyperactivity symptoms, even at levels too low to qualify for a diagnosis of ADHD, might provide insight into a person's reasons for smoking. If so, Lerman notes, simple screening procedures could be used to identify smokers entering cessation programs who may have more difficulty quitting smoking and to tailor treatments to address their specific needs.

Lerman's group surveyed 226 smokers over the age of 18 who were about to enter a free smoking cessation program in either Washington, DC or Buffalo, NY. Each participant smoked at least 10 cigarettes a day, with an average of 20 a day. Testing revealed a normal range of inattention and hyperactivity symptoms within the group; only four participants had symptoms severe enough to indicate full-blown ADHD.

As anticipated, the researchers discovered that the more severe a smoker's attention problems are, the more likely he or she is to use tobacco as a form "self-medication." Lerman notes that the smokers with inattention symptoms were more likely to say they relied on tobacco to make them more alert and focused. They were also more likely to smoke in order to relieve symptoms of depression, such as cares and worries.

Although hyperactivity alone does not appear to have a major impact on a person's reasons for smoking, Lerman's team found, the combination of inattention and hyperactivity does. Study subjects with a higher number of combined inattention and hyperactivity symptoms were more likely to smoke to improve their attention and to relieve their withdrawal symptoms. According to Lerman, these observations suggest that "nicotine withdrawal produces more severe disturbances in concentration and attention among [these] smokers."

The study findings suggest that screening participants in smoking cessation programs for symptoms of inattention and hyperactivity could identify what Lerman calls "smokers who should be targeted for additional intervention" and help program coordinators tailor interventions to meet their needs. Although the current study does not indicate exactly which interventions would be most helpful in such cases, she notes, it does suggest that remedies proven to ease ADHD and nicotine withdrawal symptoms - such as nicotine patches and the anti-depressant bupropion - could be particularly useful.
The research was funded by the National Cancer Institute and was conducted in conjunction with the University of Pennsylvania/Georgetown Transdisciplinary Tobacco Use Research Center.

Nicotine & Tobacco Research is the official peer-reviewed quarterly journal of the Society for Research on Nicotine and Tobacco. For information about the journal, contact Gary E. Swan, Ph.D., at 650-859-5322.

Posted by the Center for the Advancement of Health For more research news and information, go to our special section devoted to health and behavior in the "Peer-Reviewed Journals" area of Eurekalert!, For information about the Center, call Ira Allen,, 202-387-2829.

Center for Advancing Health

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