According to the American Lung Association, most adults started smoking before they were 18 years old. Peer pressure, advertisements and living with parents who smoke are some common reasons younger people take up the habit.
But add attention deficit hyperactivity disorder into the mix, and the reasons young people start smoking — and are more likely to continue — are more complex. “Does ADHD increase the risk for cigarette smoking? Unequivocally, yes,” says Scott H. Kollins, professor and vice chair for research in the department of psychiatry and behavior at the Duke University School of Medicine. “Many studies support the idea that ADHD is a risk factor for cigarette use and substance abuse.”
[See: 10 Concerns Parents Have About Their Kids’ Health.]
Beyond Genetics: Behavioral Disorders
That ADHD is thought to be caused by genetic factors may have to do with the association. “ADHD is highly heritable,” Kollins says. So what’s that have to do with lighting up? He explains that some of the genes that drive the risk for ADHD are also the same genes that are linked to a risk of smoking, so “there may be a shared genetic risk.”
Dr. L. Eugene Arnold, professor emeritus of psychiatry and behavioral health at the Nisonger Center at Ohio State University’s Wexner Medical Center and author of the book, “A Family’s Guide to Attention-Deficit/Hyperactivity Disorder,” also says that there’s a correlation between ADHD and smoking. However, he adds that having the disorder doesn’t mean it’s “100 percent fate” that a young person will take up smoking, despite the fact that people with ADHD have a risk that is “much higher than for the general population.”
While genetics certainly play a part, he explains that oppositional defiant disorder, in which children are irritable and aggressive to the point of creating severe issues at school, home and other environments, may prompt an ADHD youngster to start smoking. The Centers for Disease Control and Prevention notes that “children with ADHD are more likely to be diagnosed with a behavior disorder such as oppositional defiant disorder or conduct disorder” and that “about 1 in 4 children with ADHD have a diagnosed behavior disorder.”
Arnold explains that the higher rate of cigarette and marijuana smoking, alcohol use and other illicit drug use among people with ADHD may be explained by this comorbid oppositional defiant disorder, adding that about half of those who display the combined elements of ADHD (hyperactive-impulsive and inattentive) tend to also have conduct disorders. At the same time, he notes that ADHD alone — having nothing to do with a comorbid conduct disorder — has still been shown to up the odds that a person will start smoking.
[See: 8 Things You Didn’t Know About Counseling.]
Impulse Control Issues and Smoking
In fact, Kollins says that the “very nature of ADHD” may help explain why people gravitate towards cigarettes. He explains that some people with ADHD struggle with impulse control and exhibit thrill-seeking behaviors, making it more challenging to resist the urge. When kids start experimenting around 12 or 13 — the age when such opportunities typically arise — he says it’s even more of a struggle to manage inhibitory control.
As the teen years continue, Kollins says that it’s not unusual for youngsters with ADHD to maintain the cigarette smoking habit rather than dismiss it as a one-time experiment. “People with ADHD are more likely to transition to regular use and become dependent,” he says. “And once they are regular smokers, it’s been shown that they have a harder time quitting and that they also tend to smoke more cigarettes per day.” Once again, he points to the nature of ADHD in which lack of inhibitory control makes it more likely for a person to smoke — and to relapse when trying to quit.
ADHD, Gender and Smoking
Interestingly, it’s been shown that girls with ADHD are more likely to start smoking than boys. A study published in August in the American Journal of Psychiatry notes that “adolescents with more severe ADHD symptoms in childhood were more likely to begin smoking and start smoking earlier.” This was the case for females more than boys. Inattention may be to blame. “This study confirms that specific relationships between inattention and smoking observed in previous research may arise partially from causal effects, which has implications for intervention,” the researchers stated. “Diminishing inattention should reduce initiation and progression to heavy smoking, particularly for females. Preventing nicotine exposure among females with ADHD is critical, as adolescent females may be more susceptible to nicotine’s neurotoxic effects.”
Elaboration on this study, published at the website PsyPost, explains that inattentive females are more likely to face peer and academic pressures that lead to greater levels of depression and anxiety than inattentive males. As a result, these females are more inclined to gravitate towards the mood-boosting surges sometimes associated with nicotine. “The increased vulnerability of females to peer and academic consequences of inattention may contribute to greater depression and anxiety among inattentive females relative to inattentive males, increasing their receptivity to nicotine’s effects on attention and mood,” notes the study’s author Irene J. Elkins of the University of Minnesota–Twin Cities.
This finding intrigues Kollins. In terms of difficulties related to withdrawal, he says that the “severity of withdrawal is more pronounced” for females with ADHD compared to males and females without ADHD and also compared to males with ADHD.
How to Help Children
Although having ADHD can increase the odds a young person will smoke, Kollins explains that it’s important to know that someone who doesn’t meet all of the diagnostic criteria for the disorder can still be at risk for starting the habit. Kollins says that if someone has some ADHD symptoms but not enough for a full-blown clinical diagnosis, he or she can still be at risk for smoking. Just meeting two ADHD criteria still puts someone at significant risk for smoking, he says. Armed with this knowledge, he emphasizes the need for primary care specialists and pediatricians who may be on the fence about an ADHD diagnosis to take this into consideration. “Think of what else a young child may be at risk for” even if he or she is subthreshold for having the disorder, Kollins says. It’s important not to rule out other risks just because a person doesn’t entirely meet a full set of diagnostic criteria.
[See: 10 of the Biggest Health Threats Facing Your Kids This School Year.]
To help children stop smoking, whether they have ADHD or not, Kollins suggests that parents employ techniques known to be effective in general. “To mitigate risks,” he says, “know the risks.” He encourages parents to talk to children, interact with their peers and monitor activities, adding that “the single biggest predictor of substance use and delinquency is parental involvement.”
Arnold agrees that it’s essential to learn more about this topic and others. “The only way we can learn how to help kids with ADHD or any other problem is from studies,” he says. He explains that studies can provide new understandings, including possible treatments that can help improve people’s lives. As such, he emphasizes the need for people to participate in studies so they can contribute to related advancements.
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Can ADHD Increase the Odds a Young Person Will Smoke? originally appeared on usnews.com
