Effects of smoking abstinence on smoking-reinforced responding, withdrawal, and cognition in adults with and without attention deficit hyperactivity disorder

Abstract

Rationale Individuals with attention deficit hyperactivity disorder (ADHD) have a more difficult time quitting smoking compared to their non-ADHD peers. Little is known about the underlying behavioral mechanisms associated with this increased risk. Objectives This study aims to assess the effects of 24-h smoking abstinence in adult smokers with and without ADHD on the following outcomes: smoking-reinforced responding, withdrawal, and cognitive function. Methods Thirty-three (n=16 with ADHD, 17 without ADHD) adult smokers (more than or equal to ten cigarettes/day) were enrolled. Each participant completed two experimental sessions: one following smoking as usual and one following biochemically verified 24-h smoking abstinence. Smoking-reinforced responding measured via a progressive ratio task, smoking withdrawal measured via questionnaire, and cognition measured via a continuous performance test (CPT) were assessed at each session. Results Smoking abstinence robustly increased responding for cigarette puffs in both groups, and ADHD smokers responded more for puffs regardless of condition. Males in both groups worked more for cigarette puffs and made more commission errors on the CPT than females, regardless of condition. Smoking abstinence also increased ratings of withdrawal symptoms in both groups and smokers with ADHD, regardless of condition, reported greater symptoms of arousal, habit withdrawal, and somatic complaints. Across groups, smoking abstinence decreased inhibitory control and increased reaction time variability on the CPT. Abstinence-induced changes in inhibitory control and negative affect significantly predicted smoking-reinforced responding across groups. Conclusions Smokers with ADHD reported higher levels of withdrawal symptoms and worked more for cigarette puffs, regardless of condition, which could help explain higher levels of nicotine dependence and poorer cessation outcomes in this population. Abstinence-induced changes in smoking-reinforced responding are associated with changes in inhibitory control and negative affect regardless of ADHD status, a finding that may lead to novel prevention and treatment programs.

Nicotine Addiction and Psychiatric Disorders

“…This relationship between ADHD and greater nicotine withdrawal symptoms is supported by other studies. Female, but not male, smokers with ADHD had greater withdrawal symptoms (McClernon et al, 2011), and in other studies, smokers with ADHD showed great withdrawal symptoms and willingness to work harder for cigarette puffs (Kollins et al, 2013; Pomerleau et al, 2003). Furthermore, another study found that both male and female smokers with ADHD had a greater level of nicotine dependence than smokers without ADHD (Wilens et al, 2008).…”

Working Memory-Related Neural Activity Predicts Future Smoking Relapse

“…Prior work suggests that regions within the brain's executive control network (eg, DLPFC, MF/CG) are vital for cognitive control (Fassbender et al, 2004;Krain et al, 2006), whereas regions within the default mode network (eg, PCC, vmPFC) are involved in self-referential and stimulus-independent thought processes that can compete with executive control functions Smith et al, 2009). Given the importance of outwardly focused attention and cognitive control in smoking behavior change (Ashare et al, 2013b;Kollins et al, 2013;Sutherland et al, 2012), we expected that short-term relapse would be predicted by reduced activation in DLPFC and MF/CG, and less suppression of activation in PCC and vmPFC, as assessed during a pre-quit abstinence challenge (vs smoking satiety).…”

Associations of attention-deficit hyperactivity disorder symptom dimensions with smoking deprivation effects in adult smokers.

“…In this study, particularly during the first five days of abstinence, smokers with ADHD experienced greater craving, negative affect, physical symptoms, and habit withdrawal compared to smokers without ADHD and these abstinence effects were independent of changes in ADHD symptoms (McClernon et al, 2011). Finally, recent reports have demonstrated that higher levels of withdrawal and craving were associated with ADHD symptom level in laboratory (Ashare & Hawk, 2012; Kollins et al, 2013) and population-based (Ameringer & Leventhal, 2012) studies of smokers and in a clinical trial of those making a cessation attempt particularly after (vs. before) quit day (Berlin, Hu, Covey, & Winhusen, 2012). While extant findings provide support the ADHD-tobacco withdrawal relation, several features of this association require further attention.…”

“…Hence, ADHD symptoms may be associated with certain smoking withdrawal symptoms (e.g., concentration problems) during regular smoking, which reflect baseline disturbances associated with the ADHD syndrome rather than withdrawal effects per se. Indeed, preliminary laboratory work using small samples has suggested certain aspects of withdrawal may be elevated in ADHD smokers regardless of abstinence status, but suggest that there may not be further increases during abstinence states (Kollins et al, 2013). Further, studies that do not contrast abstinent and non-abstinent states (Pomerleau et al, 2003) leave unclear whether withdrawal symptoms reported in smokers with elevated ADHD symptoms are true abstinence effects or simply reflect baseline levels of psychological disturbance.…”