From lower graduation rates to higher rates of traffic accidents, researchers have found many ways that the lives of people with ADHD differ from those of people without ADHD on average. One of these is smoking.

People with ADHD smoke more. On top of that, they start smoking younger and have a harder time quitting. No wonder, then, that a 2013 study called ADHD a “serious risk factor” for both “early smoking” and “nicotine dependence in adulthood.”

SmokingAmong young people, the difference in smoking rates may be even more extreme. In a 2003 study, 30 percent of teens with ADHD smoked compared to 12 percent of teens without the disorder.

Recently, a group of researchers from University of Amsterdam asked the obvious followup question: if young people with ADHD smoke so much more often than their peers without ADHD, then WHY?

In a systematic review of previous studies on the topic, the researchers looked for evidence as to the possible causes of higher smoking rates among youth with ADHD. They analyzed several factors that could conceivable lead people with ADHD to smoke more.

For example, one possible explanation is that symptoms of ADHD like impulsivity make people more likely to take up smoking. Another is that young people with ADHD are more susceptible to peer pressure. Yet another is that people with ADHD are smoking to self-medicate. And it’s also possible that smoking and ADHD share similar underlying causes (for example, similar genetic causes).

When they looked at the weight of the evidence for these difference possible causes, the researchers concluded that among youth with ADHD, smoking behavior in general may be best explained by factors that include a combination of peer pressure and of ADHD symptoms predisposing people to engage in smoking.

However, when the researchers looked at nicotine dependence specifically, rather than smoking in general, they found a different story. Looking through the research on the topic, they concluded that nicotine dependence among young people with ADHD may be best explained by self-medication.

In other words, it appears that while young people with ADHD smoke more because of a range of different factors, young people with ADHD are at higher risk for nicotine dependence specifically because they’re self-medicating.

This could explain why a previous meta-analysis found that stimulant medication lowered smoking rates among people with ADHD. If you’re actually medicating your ADHD, of course you’re going to have less need to self-medicate!

There’s still more research to be done here – these reviews aren’t the final word on smoking and ADHD. But they do suggest that, based on the studies that have been done so far, the weight of the evidence indicates that self-medication plays an important role in putting people with ADHD at risk for nicotine dependence.

Do you have experiences smoking or giving up smoking with ADHD? Did meds make a difference? Please share below!

Image: Flickr/Jody Sticca