Smoking cessation and inattention or hyperactivity/impulsivity: a post hoc analysis

Abstract

Tobacco use is more prevalent and smoking cessation less likely among persons with attention deficit hyperactivity disorder (ADHD) than the general population. Evidence that tobacco use and nicotine hold divergent relationships with inattention and hyperactivity/impulsivity, the core symptoms of ADHD, prompted this post hoc investigation of abstinence patterns by type of ADHD symptoms. Subjects were 583 adult smokers treated openly with bupropion and nicotine patch during the initial 8-week phase of a maintenance treatment study. Using the ADHD Current Symptom Scale, clinically significant ADHD symptom subtypes, i.e., predominantly inattention (ADHD-inattention) and predominantly hyperactivity/impulsivity with or without inattention (ADHD-hyperactivity/impulsivity with or without inattention), were identified. The study outcome was abstinence status, verified by expired carbon monoxide </=8 parts per million, at five clinic visits from Week 1 through the end of treatment at Week 8. The distribution by ADHD symptom status was: No ADHD = 540; ADHD-inattention = 20; ADHD-hyperactivity/impulsivity with/without inattention = 23. The study groups did not differ on demographic or smoking variables. The frequency of past major depression was highest with ADHD-inattention and the frequency of past alcohol dependence was highest with ADHD-hyperactivity/impulsivity with/without inattention. Compared to smokers with no ADHD, smokers of both ADHD subtypes combined showed lower abstinence rates throughout the study (OR = 0.54, 95% CI = 0.32-0.99). Disaggregation by symptom subtype and separate comparisons against smokers with no ADHD showed that lower odds of quitting occurred mainly with ADHD-hyperactivity/impulsivity with/without inattention (OR = 0.40, 95% CI = 0.19-0.82), not with ADHD-inattention (OR = 0.74, 95% CI = 0.36-1.51). Combined bupropion and nicotine patch treatment appears to be helpful for smokers with inattention but not smokers with hyperactivity/inattention symptoms. The reasons for this divergent treatment response warrant further investigation.

Figure 1. Abstinence rates (abstainers/all participants) during Weeks 1 to 8 by Attention Deficit Hyperactivity Disorder (ADHD) symptom status

A) Inattention and Hyperactivity/Impulsivity Combined (ADHD) versus No ADHD (p<0.01); B) ADHD-Inattention only (IN) versus No ADHD (p=0.41); ADHD-Hyperactivity (HI) with or without Inattention (HI+/-IN) versus No ADHD (p=0.01).