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Analysis of an Association between Nicotine Dependence and Attention-Deficit/Hyperactivity Disorder

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  1. Introduction
  2. Background
  3. ADHD and the smoking epidemic
  4. Prenatal exposure
  5. Neurobiological support
  6. Pliszka etal (1996) Multistage Hypothesis of ADHD
  7. Self medication hypothesis
  8. Conclusion
  9. References

The goal of this paper is to evaluate the significance of the co-morbidity of nicotine abuse in adolescents afflicted with ADHD (Attention-Deficit Hyperactivity Disorder). Due to the nature of the disorder and its possible underlying pathophysiology of dopaminergic dysfunction, the use of nicotine can be implicated as a form of self-medication. I will provide evidence of the co-morbidity and early onset of nicotine dependence and prevalence of smoking habit in adolescents with ADHD. Furthermore, I will discuss prenatal exposure to nicotine and its behavioral consequences, followed by an analysis of the pharmacology of nicotine and proposed circuitry of ADHD. Nicotine use in ADHD adolescents can no longer be attributed to mainstream ?peer pressure". There are reinforcing effects provided by nicotine that parallel stimulant medication used to treat the disorder.

[...] Moreover, Milberger etal (1997) concluded that ADHD, particularly the co morbid subtype, is a significant risk factor for early initiation of cigarette smoking in children and adolescents. In addition, a significant association was found between cigarette smoking and drug abuse. There were some limitations to the Milberger study. In children younger than 12, mothers were responsible for the report of cigarette use. This could lead to an underreporting of smoking; however, if the latter is true, the association between ADHD and smoking would be even greater. [...]

[...] Longitudinal studies have been used to find some correlation between maternal exposure of nicotine in utero and hyperactive behavior in children in adolescents. The results show a clear connection between nicotine and decreased intellectual integrity in both animal models and human subjects. Whether it is the smoking during pregnancy, or the genes from a mother that would smoke during pregnancy that is the vehicle for dysfunction remains unclear; however, further insight into the pathophysiology of ADHD will provide clarification. The pathophysiology of ADHD is quite complex and is based upon both peripheral and central attentional systems. [...]

[...] Nicotine improves attention and arousal in ADHD subjects (Farone, 1998). The noradrenergic pathways of the locus ceruleus, which are involved in regulating attention, may also be affected. In ADHD, dysregulation of norepinephrine release in the locus ceruleus is suspected to decrease attention and interfere with subsequent signaling of dopamine-mediated systems in other areas of the brain. The nicotinic stimulation of norepinephrine may also mediate nicotine withdrawal induced inattention. Notably, after abrupt withdrawal of nicotine, decreased levels of dopamine and norepinephrine are believed to exacerbate the mood and behavioral dysregulation of ADHD patients. [...]

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