A report, 'Tobacco smoking in individuals with attention-deficit hyperactivity disorder: epidemiology and pharmacological approaches to cessation,' is newly published data in CNS Drugs. "The co-occurrence of attention-deficit hyperactivity disorder (ADHD) and nicotine dependence is common. Individuals with ADHD are more likely to initiate smoking and become dependent on nicotine than their non-ADHD counterparts, and recent evidence suggests that they may have more difficulty quitting smoking," scientists in the United States report (see also Attention Deficit Hyperactivity Disorder Prevention).

"Little is known about how to best approach treating these co-morbidities to optimize clinical outcome. Clinicians treating individuals with either ADHD or nicotine dependence should be aware of their common co-occurrence and the need to address both in treatment. This review of ADHD and nicotine dependence provides an overview of relevant epidemiology, bidirectional interactions and implications for pharmacological and adjunctive psychosocial treatment. Incorporating the current evidence base and their clinical experience, the authors propose a stepwise approach to treating patients with co-morbid ADHD and nicotine dependence. Given the potential for ADHD symptoms to interfere with smoking cessation success, the first priority is to stabilize ADHD. The first-line pharmacological approach should be a long-acting psychostimulant. Upon ADHD stabilization, motivational techniques should be used to encourage readiness for a smoking cessation attempt. In the context of behavioural cessation interventions sensitive to the patient's needs and developmental stage, pharmacological intervention targeting smoking cessation may be initiated. The authors recommend varenicline as a first-line agent, given its superior effect size among available medication treatments. Symptoms of ADHD, as well as nicotine withdrawal and craving symptoms, should be monitored closely during the cessation attempt, and adjustments to therapy should be considered if warranted," wrote K.M. Gray and colleagues, Medical University of South Carolina.

The researchers concluded: "The authors conclude that, while current treatments may potentially be effective for co-morbid ADHD and nicotine dependence, further research is needed to parse the complex associations between these disorders and prospectively study combined treatments."

Gray and colleagues published their study in CNS Drugs (Tobacco smoking in individuals with attention-deficit hyperactivity disorder: epidemiology and pharmacological approaches to cessation. CNS Drugs, 2009;23(8):661-8).

For additional information, contact K.M. Gray, Medical University of South Carolina, Dept. of Psychiatry and Behavioral Sciences, Charleston, South Carolina USA..

The publisher's contact information for the journal CNS Drugs is: Adis International Ltd., 41 Centorian Dr., Private Bag 65901, Mairangi Bay, Auckland 10, New Zealand.