Nicotine & ADHD: Understanding the Connection

What Is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that includes persistent struggles with poor impulse control, distractibility, forgetfulness, and inattention. The type and severity of ADHD symptoms exist on a large spectrum, but the first signs of this condition emerge in childhood. People with ADHD generally face difficulties in work, school, and relationships.

Common symptoms of ADHD include:

• Forgetfulness
• ADHD impulsivity 
• Distractibility
• Restlessness
• Disorganization
• Difficulty with staying on task
• Lack of concentration
• Issues with time management
• Hyperactivity (difficulty sitting still)

Nicotine & ADHD: How They’re Connected

ADHD and nicotine use may relate for various reasons, partly due to specific symptoms of ADHD. Genetics may also increase the likelihood of smoking for those with ADHD, but many may turn to nicotine as a self-soothing or dopamine-boosting activity.

Below are possible connections between smoking nicotine and ADHD:

Restlessness

Nicotine is a stimulant that speeds up the central nervous system, inducing an increased sense of energy and wakefulness. Thus, nicotine can cause sleep problems, especially when consumed before bedtime. Similarly, ADHD also coincides with restlessness, and many people with this condition report sleep disturbances, daytime fatigue, and poor overall sleep quality.

Emotional Dysregulation

Research shows those with ADHD may exhibit lower levels of emotional regulation than their neurotypical peers. Some of this may speak to why they are prone to using nicotine in the first place. Alternatively, consistently consuming nicotine to cope with stressful emotions can impede their ability to adopt healthy coping mechanisms, sometimes exacerbating the intensity of ADHD symptoms.¹

Impulsivity

Nicotine may enhance impulsivity and diminish the desire to exert cognitive effort.  For example, a person may continue smoking even though they know the risks of nicotine. The impulse to feel good simply feels too alluring. Someone with ADHD may also be more susceptible to impulsive behaviors, making them more vulnerable to nicotine use.

Reward-Seeking Behavior

Nicotine causes the brain to release dopamine, often known as the pleasure hormone.² Because people with ADHD often have dopamine deficiencies, they are more likely to seek experiences or sensations that trigger release, such as smoking. Over time, repeated use can lead to nicotine addiction.

Self-Medicating

Self-medicating refers to taking certain mood-altering substances to manage stress or other difficult mental health symptoms. Someone with ADHD may self-medicate dysregulation, anxiety, social discomfort, or procrastination difficulties with nicotine. However, prolonged use may leave their brains relying on nicotine to feel “normal.”

How Does Nicotine Affect ADHD?

Nicotine affects ADHD symptoms in many ways. Because nicotine is a central nervous system stimulant, some of those with ADHD may experience temporarily improved focus or concentration. However, continued use can worsen symptoms like hyperactivity.  Additionally, individuals with ADHD who smoke may experience an increased risk of nicotine withdrawal symptoms when ceasing nicotine use.

How Does Nicotine Affect the ADHD Brain?

Research shows people with ADHD are more likely to start smoking and experience nicotine dependence than those without the condition. Nicotine provides immediate dopamine, which can be incentivizing for people with ADHD. With that, some people also seek the stimulant effects to boost focus or concentration.

How Does Nicotine Affect ADHD Medications?

While research is limited, some findings indicate that certain ADHD medications can increase the likelihood of continued nicotine use, leading to higher smoking rates.³ Additionally, many individuals with ADHD experience co-occurring mental health conditions and take other antidepressants or anti-anxiety prescriptions. In these cases, nicotine can reduce the efficacy of these medications.

How Does ADHD Affect Nicotine Withdrawal?

Although research is limited, some studies show individuals with ADHD are more likely to indicate more intense and long-lasting nicotine withdrawal symptoms.⁴ Because of this, they may struggle with more relapses, even though they want to quit nicotine.

ADHD symptoms that overlap and can worsen nicotine withdrawal include:⁵

• ADHD anxiety
• ADHD insomnia
• Restlessness
• Concentration issues
• Poor cognition
• Inability to sleep
• ADHD mood swings

Does Smoking Make ADHD Worse?

Smoking with ADHD can aggravate unwanted symptoms, including hyperactivity, restlessness, poor appetite, sleep problems, and agitation. These impacts do not account for the inherent risks associated with nicotine, which include potential financial consequences, health issues, and relationship problems. While nicotine may provide some temporary relief, these effects tend to be short-lived.

Does Nicotine Help With ADHD?

Like all stimulants, nicotine may have some mild effects on focus, concentration, and emotional regulation for people with ADHD. However, dependence is a real concern. Developing a nicotine tolerance means needing to smoke more to achieve the desired effects. Moreover, the health consequences associated with smoking tend to outweigh any short-term benefits.

ADHD & Nicotine Addiction

People with ADHD may be more vulnerable to developing addictions. For example, research shows over 15% of adults with ADHD meet the criteria for any substance use disorder (compared to 5.6% of the general population). Likewise, they are also more likely to have other co-occurring mental health issues, which may coincide with nicotine use.⁶

Risks of Nicotine Use With ADHD

Cigarette smoke is responsible for millions of deaths each year. Smoking increases the risk of developing cancers, experiencing heart disease, and having a stroke. In addition, people who smoke may experiment with other mood-altering substances like alcohol and drugs. While nicotine may provide some immediate symptom relief, these effects are temporary and do not resolve any issues associated with ADHD.

How to Quit Smoking With ADHD

Quitting nicotine with ADHD use is difficult, but taking healthy steps to reduce the risk of withdrawal and discomfort can help in the long term. Work closely with your doctor when reducing your consumption, as they can provide valuable information about quitting safely. Leaning on your support system is also beneficial as you navigate new challenges and resist cravings.

Below are eight tips to cut back on nicotine use with ADHD:

1. Consult your healthcare provider: Working with your medical providers is important as they can provide psychoeducation about what may work best based on your health history.
2. Try cognitive behavioral therapy (CBT): CBT for ADHD can help you identify specific goals related to your nicotine use. A therapist can assist you in implementing steps to reach desired outcomes and long-term success.
3. Explore alternative treatment approaches: Using interventions such as hypnosis, meditation for ADHD, yoga, or breathwork can help ground you as you work on reducing nicotine consumption.⁷
4. Consider smoking cessation programs: Rather than trying to stop on your own, smoking cessation programs provide individualized support to help you quit smoking for good.
5. Ask loved ones for support: Loved ones can help you stay accountable to your goals and provide support when struggling.
6. Try a replacement: Replace the urge to smoke with other coping skills, such as taking a walk, chewing gum, sipping on water, or anything else that temporarily satisfies your urge.
7. Join a support group: Support groups (even if they aren’t directly related to quitting nicotine) can provide a sense of goal-directed accountability and camaraderie.
8. Be patient when you slip up: Mistakes often happen in any recovery process and do not equate to failure. Aim to practice self-compassion with yourself and stay on your course.

When to Seek Professional Support

You can never ask for help too early when struggling with negative ADHD symptoms associated with nicotine use. Start by finding a neurodiversity-affirming therapist specializing in nicotine dependence and ADHD via an online therapist directory or online therapy platform.

Consider seeing a psychiatrist if you want to explore medications for ADHD. Online psychiatrist options are available and can be valuable for those who have limited access to mental health resources or prefer at-home care. Think about what would help you stay most accountable when quitting nicotine with ADHD.