Smokers with ADHD at much greater risk of substance abuse

Smokers with ADHD at much greater risk of substance abuse

By Charlotte Fantelli

Research published today (26th July) in the British Journal of Psychiatry, shows that smokers with attention deficit hyperactivity disorder (ADHD) have a much-increased risk of developing substance misuse problems.

Ok, I was very skeptical when I read the headline! I honestly considered if this was just another 'state the obvious' piece of research. I say this, as it would make sense that those who smoke are often in the same demographic as those at risk of substance abuse, those who misuse substances are much more likely to be smokers than the general population, and of course having a condition such as ADHD will, in some cases, lead people to self medicate to deal with symptoms. I instantly came up with many 'common sense' theories to dismiss these findings.

But, and I reiterate, but, even with this skepticism, I was shocked as to the extent of the increase. Out of the 651 young people studied, 213 had ADHD, the remaining 438 did not - these were the control group. The youngsters were followed for a decade to monitor their relationship with smoking and substance use. Of those studied 28% were smokers (this equates to 34% of those with ADHD and 24% of those without).

At the age of 23, the results show the rates of alcohol dependence:

  • 7% for non-smokers without ADHD

  • 10% for non-smokers with ADHD

  • 18% for smokers without ADHD 

  • 35% for smokers with ADHD


The rates of drug addiction are equally as alarming, they show that:

  • 3% of non-smokers without ADHD had drug addiction problems
  • 6% of non-smokers with ADHD had drug addiction problems
  • 11% for smokers without ADHD had drug addiction problems
  • While smokers with ADHD had a staggering estimated drug dependence rate of 43%, 

Another interesting finding of this study, was that the group with ADHD who smoked, started smoking earlier, with the average age of onset being 13.9 years, compared to 15.4 years for those who smoked but did not have ADHD.

Dr Joseph Biederman, lead researcher, of Massachusetts General Hospital, says: “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.” She adds.

The reasons behind the fact that smoking often acts as a precursor to drug abuse isn't entirely clear, the study suggests it may be the way nicotine affects dopamine transition, which may reinforce addictive behaviours. I would personally argue that those who do not smoke are likely to view drug taking with similar eyes to smoking, and those who do smoke are more likely to be socially and emotionally more susceptible to the possibilities of taking drugs. 

Whatever the reason for the increase in this group, what it does tell us is that these people are highly susceptible to substance abuse problems and more needs to be done to help them early on, before it becomes an issue in their lives.

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Charlotte Fantelli talks personal and professional experience of mental health.

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