Assessing the Role of Attention-Deficit/Hyperactivity Disorder Symptoms in Smokers With and Without Posttraumatic Stress Disorder

Abstract

which may, in turn, confer increased risk for smoking relapse in those with higher levels of symptomatology of both disorders. IntroductionCigarette smoking co-occurs with a broad range psychiatric disorders ( Lasser et al., 2000 ). Individuals with posttraumatic stress disorder (PTSD) or attention-defi cit hyperactivity disorder (ADHD) endorse rates of smoking two to three times higher ( Beckham et al., 1995 ; Breslau, Davis, & Schultz, 2003 ;Lambert & Hartsough, 1998 ;Lasser et al., 2000 ;Milberger, Biederman, Faraone, Chen, & Jones, 1997 ;Molina & Pelham, 2003 ;Pomerleau, Downey, Stelson, & Pomerleau, 1995 ) and have more diffi cultly quitting than nondiagnosed samples ( Covey, Manubay, Jiang, Nortick, & Palumbo, 2008 ;Humfl eet et al., 2005 ;Lasser et al., 2000 ). Further more , subclinical ADHD symptoms are associated with increased risk for smoking ( Kollins, McClernon, & Fuemmeler, 2005 ).Dysregulated affective functioning has been proposed as a potential mechanism underlying the risk for smoking in both PTSD and ADHD, which are frequently comorbid themselves ( Adler, Kunz, Chua, Rotrosen, & Resnick, 2004 ; Cook, McFall, Calhoun, & Beckham, 2007 ;Gehricke et al., 2007 ;Hurtig et al., 2007 ;Kessler et al., 2006 ;McClernon & Kollins, 2008 ;Park et al., 2011 ;Smalley et al., 2007 ). However, no studies have assessed the association of ADHD symptoms with smoking that also consider PTSD symptoms or includes individuals with PTSD. It is possible that PTSD and ADHD are associated with nicotine dependence via shared affective mechanisms and that the risk for smoking to regulate affect is associated with higher levels of PTSD and ADHD symptoms. The overall aim of this Abstract Introduction: Smoking prevalence among individuals with posttraumatic stress disorder (PTSD) is elevated relative to non -PTSD smokers, and there is evidence to suggest that affect regulation may be a motivation for smoking among those with this disorder. Previous studies have also indicated that (a) PTSD is frequently comorbid with attention-defi cit/hyperactivity disorder (ADHD), (b) individuals with ADHD smoke at significantly higher rates than the general population, (c) subclinical ADHD symptoms are a risk factor for smoking, and (d) affect regulation is a motivation for smoking in ADHD. The goal of this study was to assess the degree to which ADHD symptoms were uniquely associated with smoking-related affective functioning (SRAF) variables above and beyond the variance already explained by PTSD symptoms. Methods:Smokers with ( n = 55) and without PTSD ( n = 68) completed measures assessing PTSD symptoms, ADHD symptoms, and SRAF. Results:The PTSD group endorsed signifi cantly more severe levels of DSM-IV inattentive and hyperactive -impulsive ADHD symptoms. A series of hierarchical regressions among the entire sample indicated that, after accounting for PTSD symptoms, ADHD symptoms were associated with lower positive affect, higher negative affect, higher emotion dysregulation, higher anxiety sensitivity, and higher urges to smoke to i...

Posttraumatic stress disorder and tobacco use: A systematic review and meta-analysis

“…Of these studies, nine studies found significant associations between PTSD diagnosis and nicotine dependence. In particular, six found higher levels of nicotine dependence among individuals with PTSD compared to those without PTSD (Mitchell, Van Voorhees, Dennis, et al, 2012;Vrana et al, 2013;Vrana, Calhoun, Dennis, Kirby, & Beckham, 2015) or any other psychiatric condition (Baggett et al, 2016;Beckham, Calhoun, Dennis, Wilson, & Dedert, 2013;Wilson, Dedert, Dennis, et al, 2014), and three found that diagnosis of PTSD was associated with increased risk for nicotine dependence (Cougle et al, 2010;Greenberg et al, 2012;Roberts, Chikovani, Makhashvili, Patel, & McKee, 2013). It should be noted that the proportion of individuals with other psychiatric conditions in these studies was extremely low (≤6%).…”

“…Of those studies, ten found that individuals with PTSD do not smoke a higher number of cigarettes than those without this condition, and one study reported that a diagnosis of PTSD was not associated with cigarettes smoked per day. Again, when exploring the comparison groups we found that most were vulnerable populations including individuals who are homeless (Baggett et al, 2016), individuals exposed to a traumatic event (Baschnagel et al, 2008;Beaudoin, 2011;Farris, 2015;Ritter et al, 2011), and individuals with current or prior diagnosis of a psychiatric disorder (Cook et al, 2017;Marshall et al, 2008;Marshall et al, 2009;Mitchell et al, 2012;Wilson et al, 2014). Finally, one study found mixed results wherein individuals with PTSD smoked more heavily than those without this condition (Zvolensky et al, 2008), but not more than individuals with another anxiety disorder.…”

“…Eleven studies found PTSD was not associated with heavier use of tobacco products (Baggett et al, 2016;Baschnagel et al, 2008;Beaudoin, 2011;Beckham et al, 2007;Cook et al, 2017;Farris, 2015;Marshall et al, 2008;Marshall et al, 2009;Mitchell et al, 2012;Ritter, McCauley, Amstadter, et al, 2011;Wilson et al, 2014). Of those studies, ten found that individuals with PTSD do not smoke a higher number of cigarettes than those without this condition, and one study reported that a diagnosis of PTSD was not associated with cigarettes smoked per day.…”

Smoking Motivation in Adults With Attention-Deficit/Hyperactivity Disorder Using the Wisconsin Inventory of Smoking Dependence Motives

“…ADHD is also an independent risk factor for cigarette smoking (Lambert & Hartsough, 1998;Milberger, Biederman, Faraone, Chen, & Jones, 1997a, 1997bMolina & Pelham, 2003;Pomerleau, Downey, Stelson, & Pomerleau, 1995) and is associated with earlier age of smoking onset, higher nicotine dependence, and progression to regular use (Fuemmeler, Kollins, & McClernon, 2007;Kollins, McClernon, & Fuemmeler, 2005;Milberger et al, 1997a;Rohde, Kahler, Lewinsohn, & Brown, 2004;Wilens et al, 2008). Even among non-ADHD psychiatric samples who smoke, ADHD symptoms are associated with smoking-related variables (Mitchell et al, 2012).…”

The Difficulties in Emotion Regulation Scale–Parent Report: A Psychometric Investigation Examining Adolescents With and Without ADHD

“…ED is a transdiagnostic characteristic associated with externalizing (e.g., oppositional defiant disorder), internalizing (e.g., anxiety, depression), and, as defined here, neurodevelopmental disorders (Bunford, Evans, & Wymbs, 2015; Mazefsky et al, 2013) such as attention deficit/hyperactivity disorder (ADHD; Bunford, Evans, Becker, & Langberg, 2015; Bunford, Evans, et al, 2017; Bunford, Evans, & Langberg, 2014; Graziano & Garcia, 2016; Okado & Mueller, 2016; Sjöwall, Backman, & Thorell, 2015). Although whether ED is a core feature or merely an associated feature of ADHD remains debated (Barkley, 2010), there is a growing body of work indicating that ED is associated with negative outcomes such as alcohol problems (Bunford, Wymbs, Dawson, & Shorey, 2017) and smoking (Mitchell et al, 2012), and with functional impairment in the academic and social domains (Bunford, Evans, Becker, et al, 2015; Maedgen & Carlson, 2000; McQuade, Penzel, Silk, & Lee, 2016; Melnick & Hinshaw, 2000) among children, adolescents, and adults with ADHD. These findings underscore the importance of ED in association with ADHD across the life span; however, there is little guidance on best practices for measuring ED in this population, especially in adolescents (Bunford, Evans, et al, 2017; Bunford, Evans, & Wymbs, 2015).…”