Adult attention-deficit/hyperactivity disorder and nicotine withdrawal: a qualitative study of patient perceptions

Liebrenz, Michael; Fisher, Carl Erik; Nellen, Romilda; Frei, Anja; Biechl, Anne-Catherine; Hiestand, Nina; Huber, Alice; Buadze, Anna; Eich, Dominique (2016). Adult attention-deficit/hyperactivity disorder and nicotine withdrawal: a qualitative study of patient perceptions. BMC psychiatry, 16(1), p. 208. BioMed Central 10.1186/s12888-016-0911-9

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Background: Nicotine use has been reported to ameliorate symptoms of Attention-Deficit/Hyperactivity Disorder
(ADHD). Furthermore, adults with ADHD have a relatively high prevalence of cigarette smoking and greater difficulty
abstaining from smoking. Overall, though, there is scant literature investigating the beliefs, perceptions and
experiences of smokers with ADHD regarding smoking cessation and withdrawal.
Methods: Our participants (n = 20) fulfilling criteria for ADHD and a past or current dependence from nicotine were
recruited from the in- and outpatient clinic of the Zurich University Psychiatric Hospital and the Psychiatric Services
Aargau (Switzerland). We conducted in-depth interviews to explore their motivations to quit, past experiences with
and expectations about quitting using a purposeful sampling plan. The sample was selected to provide diversity in
relation to level of nicotine dependence, participation in a smoking-cessation program, gender, age, martial status
and social class. Mayring’s qualitative content analysis approach was used to evaluate findings.
Results: Adult smokers with ADHD had made several attempts to quit, experienced intense withdrawal symptoms,
and relapsed early and often. They also often perceived a worsening of ADHD symptoms with nicotine abstinence.
We identified three motives to quit smoking: 1) health concerns, 2) the feeling of being addicted, and 3) social
factors. Most participants favored a smoking cessation program specifically designed for individuals with ADHD
because they thought ADHD complicated their nicotine withdrawal and that an ADHD-specific smoking cessation
program should address specific symptoms of this disorder.
Conclusions: Since treatment initiation and adherence associate closely with perception, we hope these findings
will result in better cessation interventions for the vulnerable subgroup of smokers with ADHD.
Keywords: ADHD, Nicotine, Withdrawal, Subjective, Qualitative, Narrative

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