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Smokers with Acute Hyperactive ADHD May Respond Better to Smoking Cessation Aids

Adults with ADHD are more likely to self-medicate with nicotine, particularly if their symptoms of hyperactivity/impulsivity are severe. A new study, however, finds that this group may be more responsive to anti-smoking treatments than others.

August 25, 2017

Decades of research indicate that adults with ADHD are more likely to smoke cigarettes and suffer from nicotine use disorder (NUD) than are other adults of the same age. This is especially true for those with hyperactive-type ADHD; the more severe a subject’s hyperactive/impulsive symptoms, the greater the likelihood that he or she will be dependent on nicotine. But a new study brings some hope; it finds that smokers with hyperactive ADHD may be more likely to respond positively to treatment to help them quit.

The study, published in the journal Drug and Alcohol Dependence last month, was a secondary analysis of a previously conducted study on the effectiveness of varenicline, a common anti-smoking treatment. The study, a randomized, double-blind trial of 205 adults with ADHD and NUD, found that varenicline was an effective treatment for ADHD-related nicotine dependence, when compared to a placebo.

The new study delved deeper into that data, analyzing the self-reported severity of each patient’s hyperactive-impulsive (HI) and inattentive (IN) symptoms, and comparing it to their eventual outcomes on varenicline. The researchers found that individuals with severe HI symptoms who were given placebos were much more likely to have increased their nicotine intake by the end of the study — further confirming the association between hyperactivity, impulsivity, and nicotine dependence.

On the other hand, patients with high HI levels who were given varenicline responded much better than did those with less severe HI symptoms or those with inattentive-type ADHD. The average cigarette use for the entire group was 14.7 cigarettes per day at the beginning of the study; by the end, the high-HI group treated with varenicline had decreased its cigarette consumption to 3.06 per day.

This opens up options for tailored treatments for nicotine dependence, the researchers said, and may help doctors identify which of their patients with ADHD will respond best to varenicline.

“Individuals with high HI seemed especially responsive to varenicline, for unknown reasons,” said Claire Wilcox, M.D., who was not involved in the study but wrote a brief commentary of it for NEJM Journal Watch. “In the clinic, a self-report scale for HI symptoms may help to identify individuals more likely to improve on varenicline.”

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