Impact of Attention-Deficit/Hyperactivity Disorder (ADHD) Treatment on Smoking Cessation Intervention in ADHD Smokers

Abstract

Objective High smoking rates in adults with attention deficit hyperactivity disorder (ADHD) and nicotine’s amelioration of ADHD suggest that effective ADHD treatment might facilitate abstinence in smokers with ADHD. The present study evaluated if using osmotic release methylphenidate (OROS-MPH) to treat ADHD enhances response to smoking cessation treatment in smokers with ADHD. Method A randomized, double-blind, placebo-controlled, 11-week trial with a one month follow-up conducted at six clinical sites between December 2005 and January 2008. Adults (18–55), meeting DSM-IV criteria for ADHD and interested in quitting smoking were randomized to OROS-MPH titrated to 72 mg/day (n=127) or placebo (n=128). All participants received brief weekly individual smoking cessation counseling for 11 weeks and 21 mg/day nicotine patch starting on the smoking quit day (day 27) through study week 11. Outcome measures included prolonged smoking abstinence and DSM-IV ADHD Rating Scale (ADHD-RS) score. Results Of 255 randomized, 204 (80%) completed the trial. Prolonged abstinence rates, 43.3% and 42.2%, for the OROS-MPH and placebo groups, respectively, did not differ significantly (odds ratio, 1.1; 95% confidence interval, 0.63 – 1.79; p=0.81). OROS-MPH, relative to placebo, evidenced a greater reduction in DSM-IV ADHD-RS score (p<0.0001) and in cigarettes per day during the post-quit phase (p=.016). OROS-MPH, relative to placebo, increased blood pressure and heart rate to a statistically, but not clinically, significant degree; medication discontinuation did not differ significantly between treatments. Conclusions ADHD treatment did not improve smoking cessation success; OROS-MPH, relative to placebo, effectively treated ADHD and was safe and generally well tolerated in this healthy sample of adult ADHD smokers.

Preliminary Evidence That Adherence to Counseling Mediates the Effects of Pretreatment Self-efficacy and Motivation on Outcome of a Cessation Attempt in Smokers with ADHD

“…Prolonged abstinence was used as the primary outcome (Y) in these analyses, with complete abstinence and Week 10 PPA serving as confirmatory outcome measures. All analyses pooled data across the two treatment groups from the original study (OROS-MPH and placebo), as we previously established that there was no effect of OROS-MPH on smoking cessation outcomes in the study sample (Winhusen et al, 2010). Table 2 shows the results of bootstrapped regressions examining the three predictor variables-desire to quit, perceived difficulty quitting, and expected success in quitting-in relation to the primary outcome of prolonged abstinence and the secondary outcomes of complete abstinence and Week 10 PPA.…”

“…The main findings of this study were that osmotic-release oral system methylphenidate (OROS-MPH), when provided in combination with nicotine patch and brief counseling, did improve ADHD symptoms but did not enhance smoking cessation outcomes relative to placebo (plus nicotine patch and counseling; Winhusen et al, 2010). For these secondary analyses, we hypothesized that pretreatment desire to quit (i.e., motivation), expected success in quitting (i.e., self-efficacy), and perceived difficulty quitting would predict smoking cessation treatment outcomes and that treatment adherence (i.e., adherence to nicotine patch, session attendance, and adherence to counseling) would mediate this effect.…”

“…For a complete description of procedures for the trial, see Winhusen et al (2010). Briefly, the study was an 11-week, double-blind, placebo-controlled, parallel-group trial of OROS-MPH versus placebo in combination with nicotine patch and counseling as a treatment for smoking cessation in adults with ADHD.…”

Stimulant Treatment of ADHD and Cigarette Smoking: A Meta-Analysis

“…40 Randomized clinical trials of stimulants to aid cessation among ADHD smokers have revealed no evidence that either methylphenidate or amphetamine products are more effective than placebo for facilitating smoking abstinence. 41,42 However, in contrast to some laboratory studies, both stimulant and placebotreated individuals in these studies reduced the number of cigarettes smoked daily, 42,43 and 1 open label study revealed that methylphenidate treatment decreased smoking to below the population rate. 44 Longitudinal studies that have examined smoking outcomes in stimulanttreated ADHD youth provide a more robust approach to evaluate the relationship between stimulant treatment and smoking outcomes.…”

“…[34][35][36][37][38][39][40] Although clinical trials of treatmentseeking smokers with ADHD have shown that neither methylphenidate nor amphetamine increase smoking, 41,42 studies have not examined how stimulant treatment might influence naturalistic smoking among individuals with ADHD who are not trying to quit. Such studies are necessary to resolve this discrepancy between laboratory studies and clinical trials of smoking cessation.…”