Early in my advocacy, I noticed a connection between ADHD and nicotine: The adults in my discussion group who had smoked cigarettes as teens and young adults seem to carry the least “baggage” from undiagnosed ADHD.
I also heard from more than a few men who claimed they couldn’t function without “snuff” (chewing tobacco). Yes, and some developed cancers of the mouth and throat.
Everybody Used To Smoke
I thought back to my childhood. Everybody smoked. At least it seemed that way. We moved through clouds of smoke everywhere—in homes, on airplanes, in automobiles, and in all public places.
Check out this “newsreel” from 1954: “Odd Holders for Odd Needs.” Indeed. What fun the sophisticated smokers were having!
The historical magazine advertisements I share later in this post hint at the ubiquity of cigarettes—and their many “health benefits.”
Then it dawned on me: Since that time (1950s-70s), Americans have stopped smoking by the millions. That means that a big chunk of the population who used to be “medicated” for ADHD were no longer. Note to self: Add “nicotine and the brain” to your long list of topics to research.
Then one day, exhausted in my hotel room at the end of an ADHD conference, I was half-watching commercial TV. The advertisement featured a woman
- Leaving her front door half-dressed,
- Realizing she’d forgotten her keys,
- Going back to get them,
- Coming back out,
- Putting her papers and handbag on the car’s roof,
- And driving off!
Wait. Was this an ad for ADHD? No, it was an ad for a smoking-cessation program.
Which brings us to another type of ad: this post’s gallery of “mid-Century” advertisements that surely seemed targeted to folks with ADHD. (Anxiety, too, but ADHD is our topic now, and ADHD is often mistaken for anxiety). A little more preamble and we’ll get to it.
Research: ADHD and Nicotine
Back to my early curiosity about ADHD and nicotine. I started digging. But back then, I didn’t find much.
Yes, I learned general information about nicotine and its effect on the brain. Here’s a lingo-free sample from the National Institute on Drug Abuse:
Nicotine also activates areas of the brain that are involved in producing feelings of pleasure and reward. Recently, scientists discovered that nicotine raises the levels of a neurotransmitter called dopamine in the parts of the brain that produce feelings of pleasure and reward. Dopamine, which is sometimes called the pleasure molecule, is the same neurotransmitter that is involved in addictions to other drugs such as cocaine and heroin.
Researchers now believe that this change in dopamine may play a key role in all addictions. This may help explain why it is so hard for people to stop smoking.
I found a bit of specific research on ADHD and nicotine. For example, there was this from 1996: Nicotine effects on adults with attention-deficit/hyperactivity disorder.
“Several lines of evidence,” it began, “suggest that nicotine may be useful in treating the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD).”
By the mid-2000s, though, interest was picking up. Excerpted here is a 2008 Reuters article (“ADHD tied to more severe nicotine dependence”) reporting on a study from prominent ADHD researcher Tim Wilens, MD:
Young people with attention-deficit hyperactivity disorder (ADHD) may be particularly vulnerable to serious nicotine addiction if they start smoking, a new study suggests.
Past research has shown that kids with ADHD are more likely than their peers without the disorder to start smoking. These latest findings suggest that once they do take up the habit, they also tend to become more severely nicotine-dependent, researchers report in the Journal of Pediatrics.
“The nicotine dependence appears to be about twice as bad,” said lead researcher Dr. Timothy E. Wilens of Massachusetts General Hospital in Boston.
The study, which included 166 15- to 25-year-olds with and without ADHD, found that those with the disorder scored significantly higher on a questionnaire that gauges physical dependence on nicotine.
Their average score was double that of smokers without.
By 2017, research was informing clinical treatments: Attention-Deficit/Hyperactivity Disorder and Nicotine Dependence in Adults
Considering the argument of ADHD being an independent risk factor for nicotine dependence, we think the co-occurrence of the smoking addiction and ADHD symptoms in the context of dopamine dysregulation is important in the clinical setting. Treatment modalities and of preventive strategies should be considered while keeping this in mind.
Today, a PubMed search on ADHD + nicotine will yield many results.
Tobacco: Leading Cause of Preventable Death
Don’t get me wrong. It’s great that we’ve come to view tobacco as unhealthy. According to this CDC Fact Sheet:
- Tobacco use is the leading cause of preventable disease, disability, and death in the United States.
- Nearly 40 million US adults still smoke cigarettes
- About 4.7 million middle and high school students use at least one tobacco product, including e-cigarettes.
- Every day, more than 3,800 youth younger than 18 years smoke their first cigarette.
- Each year, nearly half a million Americans die prematurely of smoking or exposure to secondhand smoke.
- Another 16 million live with a serious illness caused by smoking.
- Each year, the United States spends nearly $170 billion on medical care to treat smoking-related disease in adults.
Moreover, certain populations are more vulnerable to tobacco use, including people of color, people with no college education, and people suffering from “psychological distress.”
The Washington Post neatly packages CDC data in this piece: “Who still smokes in the United States“?
Stimulants Could Save Millions From Tobacco’s Risks
My point is: It’s ironic, isn’t it? I have seen stimulant medications help people with ADHD to live healthier lives. Many are able to get their weight, diet, and sleep under control—to the point that they can stop taking other prescription medicines. Typically, these are medications for the American epidemics of obesity, hypertension, and diabetes.
Yet, stimulants are too often demonized.
Here’s a tip for the next time someone asks you, “Why this ADHD all of a sudden?” Tell them about nicotine and the brain. Show them this chart—and maybe some of the ads that follow:
A Rogue’s Ad Gallery: Tobacco and “Nerves”
Finally, vintage magazine advertisements for cigarettes. Camel had quite the series touting its cigarettes’ benefits for your “nerves. Other brands prominently featured physician and “science” endorsements.
At the end, check out the ads for vaping.
For more tobacco advertising resources, visit Stanford Research into the Impact of Tobacco Advertising
As always, I welcome your comments.