ADHD News & Research

Study: Teens with ADHD Face Increased Risk for Nicotine Addiction

Young people with ADHD find nicotine use more pleasurable and reinforcing after just their first smoking or vaping experience, and this may lead to higher rates of dependence, according to findings from a new study.

January 27, 2020

Teens with ADHD are more likely to engage in habitual nicotine use after just a single, first-time exposure, and they report more pleasurable responses to nicotine, according to a study from Duke Health researchers. These findings suggest that an elevated risk for nicotine addiction among young adults with ADHD begins after just a single exposure to this addictive substance.1

This study, published in The Journal of Neuropsychopharmacology, examined the effects of nicotine on non-smoking young adults with ADHD. Specifically, researchers sought to determine whether the first exposure to nicotine has a significant impact on potential reoccurring nicotine use. They found that teens with ADHD were more likely to rate their first experience with nicotine as pleasurable and more likely to then self-administer nicotine in future settings.

It is not surprising that people with ADHD would be particularly susceptible to nicotine addiction: nicotine use is known to impact the brain physiology involved in ADHD.2 However, experts know little about the factors underlying this risk.1 Lead author Scott Kollins, Professor in the Department of Psychiatry and Behavioral Sciences in the Duke University School of Medicine, thinks that this study may be a step in the right direction. He says his findings suggest “that the very first exposure to nicotine might be more pleasurable or reinforcing for individuals with ADHD, which in turn may lead to higher rates of dependence.”2

Kollins and fellow researchers tracked the physiological, subjective, and reinforcing effects of nicotine for 136 non-smoking young adults between the ages of 18 and 25. To assess each participant’s eligibility, a clinician performed standard diagnostic procedures to each individual to confirm each diagnosis. Researchers used the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID) to confirm that those in the non-ADHD group did not meet ADHD criteria, and the Structured Clinical Interview for DSM (SCID) and clinical interviews out ruled other psychiatric diagnoses.1

61 participants had a clinical ADHD diagnosis, while the other 75 did not have any psychiatric condition. All participants reported no tobacco use in the past 3 years, no exposure to other nicotine-containing products, and none had smoked a full cigarette. Participants taking stimulant medication for ADHD agreed to stop using their medication 72 hours prior to each experimental session, and each participant’s urine sample confirmed that no participant had taken illegal drugs or lied about nicotine consumption.1

In three preliminary sessions, the researchers exposed participants to three blinded doses (0.0, 0.5, 1.0 mg) of nicotine nasal spray. Next, researchers presented participants with the opportunity to self-administer nicotine under two environmental conditions: while relaxing in the lab (low cognitive demand) or while solving math problems (high cognitive demand). Researchers expected participants with ADHD to choose to self-administer nicotine more when they needed to focus while solving math problems.1

Regardless of environmental condition, participants with ADHD chose to self-administer nicotine nasal spray more frequently than did the members of the non-ADHD group. Participants without ADHD chose to self-administer nicotine more often while being asked to solve math problems.1

Furthermore, participants with ADHD reported greater pleasant subjective effects following nicotine intake as compared to members of the non-ADHD control group; participants with ADHD also reported significantly greater dizziness following nicotine intake.1

Though researchers found no physiological discrepancies between participant groups (in regard to nicotine plasma levels, heart rate, and blood pressure), subjectivity reports and the reinforcing effects of nicotine ingestion differed starkly between the two groups, suggesting greater potential health risks for teens with ADHD who find nicotine subjectively more pleasurable.1

In an interview with NPR about his research, Kollins advised, “the conversation and the education about risk for nicotine needs to start early – really early.”3 Considering the impact of E-cigarettes on enticing young people to start using nicotine, vaping risks are immediate and urgent, particularly for people with ADHD.


1Kollins, S.H., Sweitzer, M.M., McClernon, F.J. et al. Increased subjective and reinforcing effects of initial nicotine exposure in young adults with attention deficit hyperactivity disorder (ADHD) compared to matched peers: results from an experimental model of first-time tobacco use. Neuropsychopharmacol. (2019).

2Avery, S. (2019, December 9). Young Adults with ADHD are At Higher Risk for Developing Nicotine Addiction. Retrieved January 27, 2020, from

3Kollins, S. (2019, December 16). Teens With ADHD More Likely To Get Hooked On Nicotine, Research Shows [Interview by A. Aubrey]. Retrieved January 27, 2020, from