Study: Nicotine, Tobacco Use Linked to Teens’ ADHD Symptom Levels, Treatment
Teens with severe and/or untreated ADHD are more likely to use e-cigarettes, cigarettes, and tobacco products, according to a new longitudinal study that underscores the importance of managing symptoms for highly symptomatic adolescents.
March 10, 2025
Teens with highly symptomatic ADHD face an elevated risk for using e-cigarettes, cigarettes, and tobacco products, and that risk is likely diminished through the use of prescribed ADHD medication, according to a new study published in JAMA Network Open.1
Prior research has established that teens with ADHD are more likely than their neurotypical peers to use nicotine.2,3,4 However, this study is one of the first to longitudinally examine whether effective ADHD symptom management, like pharmacotherapy, may mitigate this risk. It suggests that teens with ADHD symptoms that are managed well are less likely to use tobacco products than their peers with untreated or otherwise severe ADHD symptoms.
This finding is consistent with previous research suggesting that untreated ADHD may double the risk5 of developing a substance use disorder (SUD), and that early and continual treatment for ADHD can reduce this risk.6
“The present findings support the assertion from prior clinical studies that alleviating core ADHD symptoms may lead to a reduction in risky behaviors among U.S. youths with ADHD,” the researchers wrote.
The study followed more than 13,500 U.S. youths ages 12 to 17 over nine years, from 2013 to 2023. The sample was divided into three categories: those with an ADHD diagnosis who received pharmacotherapy, those with an ADHD diagnosis who did not receive pharmacotherapy, and those without an ADHD diagnosis or pharmacotherapy.
Across all three groups, those with higher levels of ADHD symptoms were more likely to use nicotine or tobacco products during the nine-year period than were those with few or no symptoms, regardless of diagnosis (52% – 58% prevalence rate compared with 31% – 36%).
Youth in the study with asymptomatic ADHD, with or without ADHD medication, were no more at risk for vaping or other nicotine and tobacco consumption than was the control group without ADHD.
“The null findings between youth with asymptomatic ADHD…could be interpreted as ADHD treatment being protective against subsequent nicotine and tobacco use,” the researchers wrote.
The children and their parents, found from the Population Assessment of Tobacco and Health study, completed questionnaires at six different periods, reporting any usage of nine different nicotine or tobacco products in the past year, including e-cigarettes and cigarettes. In addition, they reported whether the adolescent has received an ADHD diagnosis or regularly taken medication for ADHD.
The participants also filled out a four-item assessment of ADHD symptoms at each survey period, a unique methodology considering that most ADHD studies only examine diagnosis.
“The group of adolescents with inattentive and hyperactive and/or impulsive symptoms and no ADHD diagnosis represents a high-risk subpopulation often missed in clinical research,” the researchers wrote.
Including this group allowed the researchers to parse out risk differences between having a diagnosis, receiving treatment, and having symptoms both with and without a diagnosis.
However, a limitation of this study resides in the four-item screener the researchers chose to use to measure ADHD symptoms, which has been abandoned by many clinicians due to its short nature and low specificity.
Why Are ADHD Teens More at Risk for Nicotine Use?
Prior research confirms the connection between nicotine consumption and having ADHD. Teens with ADHD report experiencing more pleasure from a single nicotine hit than those without ADHD.7
The researchers suggest that the increased risk for highly symptomatic ADHD teens results from youth using nicotine as self-medication for their ADHD symptoms.
This makes sense considering nicotine is a stimulant that targets the same receptors as ADHD stimulants like Ritalin or Adderall. Nicotine reduces anxiety, improves motivation, and sharpens memory, but only in the short term.
“Over time, some studies are showing three to six months, it ends up making them so addicted that they’re craving that nicotine, and it worsens their natural production of dopamine,” said Kristin Seymour, MSN, RN, AHCNS-BC, in an ADDitude webinar “Vaping: A Parent’s Guide to Prevention, Cessation, and Treatment.”
Self-medicating with nicotine not only worsens ADHD symptoms in the long run but also leads to life-threatening side effects like DNA damage, heart disease, and cancer.
Seymour suggests that another reason behind this risk is that teens with ADHD struggle with social anxiety and impulsivity.
“Most teens are ready, aim, fire, but people with ADHD are ready, fire, and then they think about aiming,” Seymour said. “This is a problem because they just do it and think about the repercussions later. By that time, they are already addicted because this is such a highly addictive agent.”
View Article Sources
1 McCabe SE, Pasman E, Wilens T, et al. (2025). Attention-deficit/hyperactivity disorder symptoms and later e-cigarette and tobacco use in US youths. JAMA Netw Open. 8(2) doi:10.1001/jamanetworkopen.2024.58834
2 Wilens, T. E., Martelon, M., Joshi, G., Bateman, C., Fried, R., Petty, C., & Biederman, J. (2011). Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 50(6), 543–553. https://doi.org/10.1016/j.jaac.2011.01.021
3 Goldenson, N. I., Stone, M. D., Leventhal, A. M. (2018). Associations of ADHD symptoms with smoking and alternative tobacco product use initiation during adolescence. Journal of Pediatric Psychology, 43(6), 613–624. https://doi.org/10.1093/jpepsy/jsx153
4 Dvorsky, M. R., & Langberg, J. M. (2019). Cigarette and e-cigarette use and social perceptions over the transition to college: The role of ADHD symptoms. Psychology of Addictive Behaviors, 33(3), 318–330.https://psycnet.apa.org/doi/10.1037/adb0000450
5 Van Emmerik-van Oortmerssen, K., Van de Glind, G., Van den Brink, W., Smit, F., Crunelle, C. L., Swets, M., & Schoevers, R. A. (2012). Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis. Drug and Alcohol Dependence, 122(1–2), 11–19. https://doi.org/10.1016/j.drugalcdep.2011.12.007
6 Boland, H., DiSalvo, M., Fried, R., Woodworth, K. Y., Wilens, T., Faraone, S. V., & Biederman, J. (2020). A literature review and meta-analysis on the effects of ADHD medications on functional outcomes. Journal of Psychiatric Research, 123, 21–30. https://doi.org/10.1016/j.jpsychires.2020.01.006
7Kollins, S.H., Sweitzer, M.M., McClernon, F.J. et al. (2020). 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. Neuropsychopharmacology. 45, 851–856 https://doi.org/10.1038/s41386-019-0581-7
