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The Royal College of Psychiatrists Improving the lives of people with mental illness

Smokers with ADHD ‘at greater risk of substance misuse’

Embargoed until 26 July 2012

New research suggests young people with attention deficit hyperactivity disorder (ADHD) who smoke are at significantly greater risk of developing drug and alcohol misuse problems than those who do not.


Previous research has shown that cigarette smoking is a gateway for the subsequent alcohol and drug misuse and dependence. This study, published online today by the British Journal of Psychiatry, shows that smokers with ADHD are at especially high risk.


The researchers studied 651 young people in America – 213 with ADHD and 438 without (the control group). They interviewed the youths to assess their smoking and substance use habits, and followed them up over a period of 10 years. Among these youths, the overall rate of smoking was 28% (34% in the ADHD group and 25% in the control group). The group with ADHD started smoking earlier – the average age of onset for them was 13.9 years, compared to 15.4 years for the control group.


At the age of 23, rates of alcohol dependence were 7% for non-smokers without ADHD, 10% for non-smokers with ADHD, 18% for smokers without ADHD and 35% for smokers with ADHD. Similar results were observed for drug addiction. Smokers with ADHD had an estimated drug dependence rate of 43%, compared with 3% for non-smokers without ADHD, 6% for non-smokers with ADHD and 11% for smokers without ADHD.


The team then carried out a second analysis by restricting the sample to those young people who did not show signs of alcohol or drug misuse or dependence at the four-year follow-up.

In this smaller group, they found that smokers with ADHD had a significantly higher risk for drug dependence compared to the other three groups. Smokers with ADHD had an estimated drug dependence rate of 34%, compared to 8% for non-smokers with ADHD, 10% for smokers without ADHD and 5% for non-smokers without ADHD.


The reasons why cigarette smoking acts as a gateway for drug and alcohol misuse is not entirely clear, but it may be because nicotine affects the way dopamine (a mood-enhancing chemical) is transmitted in the brain, which may in turn reinforce other addictive behaviours.


Lead researcher Dr Joseph Biederman, of Massachusetts General Hospital in Boston, said: "We found that smoking greatly and significantly increased the risk of young people with ADHD developing alcohol and drug misuse and dependence. This has important public health implications, and suggests that if smoking could be prevented in young people with ADHD then a large amount of problems associated with alcohol and drugs could also be prevented."

For further information, please contact:
Sarah Nevins
Press & Social Media Officer
Telephone: 020 3701 2543
Claire McLoughlin
Media & Communications Manager 
Telephone: 020 3701 2544
Out of hours contact number: 07860 755896



Biederman J, Petty CR, Hammerness P, Batchelder H and Faraone SV. Cigarette smoking as a risk factor for other substance misuse: 10-year study of individuals with and without attention-deficit hyperactivity disorder. British Journal of Psychiatry, 2012, epub ahead of print publication bjp.bp.111.100339


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