Breaking the Habit: Understanding the Link Between ADHD and Smoking in Women—and How to Quit 🧠🚭

ADHD and Smoking

If you're a woman with ADHD and find yourself smoking, you're not alone. Many women with ADHD turn to cigarettes to manage symptoms like restlessness, impulsivity, and lack of attention. Nicotine use probably helps you stay calm and concentrate. If you want to quit cigarette use but don't know how, this is the place to learn.

On this page, we will explore why women with ADHD are more likely to smoke, how nicotine impacts your brain, why nicotine withdrawal is so hard, and what steps you can take to quit smoking for good.

The Science Behind ADHD, Smoking, and Nicotine 🧠

Smoking and ADHD are closely linked. In the ADHD brain, there is less availability of the neurotransmitter dopamine. Dopamine helps with reward, motivation, and concentration. In ADHD, adults and children, dysregulation in dopamine is partly responsible for things like hyperactivity and impulsivity.

Tobacco use, specifically nicotine, acts like a stimulant. Nicotine triggers a quick increase in dopamine, giving you that temporary sense of calm and even improved concentration.

This is why many ADHD smokers use cigarettes to help them focus. Tobacco products may even improve performance on term papers or work activities. The problem is that over time, your brain adjusts to the extra dopamine, leading to increased use of nicotine and higher levels of addiction.

The Self-Medication Hypothesis

Women with ADHD often use nicotine as a way to self-medicate. It makes sense because you may not even know you have ADHD when you start smoking, and even if you do, you may have tried medication and not been offered many options, even though there are many to try and choose from.

Nicotine, a stimulant, helps with attention and focus. However, unlike prescribed treatment, nicotine carries severe long-term health risks.

Stimulant treatment, when prescribed and supervised by a doctor, is considered a much safer choice. Nicotine can make your adult ADHD symptoms worse because it leads to constant craving and dysregulation.

ADHD and Smoking: What the Numbers Show 📊

Research reveals the following:

• Smoking rates are higher among adolescents, especially among females.
• Women with ADHD are twice as likely to smoke as those without ADHD.
• Studies have shown nicotine smoking starts earlier for people with ADHD, leading to higher risk and rates of nicotine dependence and addiction and more difficulties with smoking cessation.
• Relapse is common due to the emotional challenges that come with withdrawal symptoms, especially for those with ADHD who already struggle with impulsivity and mood regulation.
• Up to 40% of adults with ADHD are smokers, compared to just 16% of the general population.
• Research suggests nicotine abstinence is really the best way for you to go as an ADHD woman.
• Impulsive behavior and emotional regulation can make quitting especially difficult. The more impulsive you are, the harder it is to break the habit. As your brain adjusts to nicotine, you need more to feel the same effects, leading to higher use of cigarettes and increased dependence.

Strategies for Women with ADHD to Quit Smoking 🚀

Now, let's look at what we know about effective quitting strategies. We will examine four areas: nicotine replacement therapy (NRT) plus extra support for emotional dysregulation, stress management, medication support, consideration for hormonal strategies, and relapse prevention.

What is Nicotine Replacement Therapy?

Nicotine Replacement Therapy (NRT) is a smoking cessation treatment that delivers nicotine to your body in controlled, lower doses than cigarettes, without the harmful chemicals found in tobacco smoke.

How NRT Works:

NRT helps reduce the discomfort of quitting by maintaining a low level of nicotine in the bloodstream, easing cravings and withdrawal symptoms like irritability, anxiety, and difficulty concentrating. Over time, the user can reduce the dose of nicotine provided by the NRT product, gradually weaning off nicotine dependence.

Common Methods of NRT:

• Nicotine patch
• Nicotine gum
• Nicotine lozenges
• Nicotine inhalers
• Nicotine nasal sprays

Effectiveness of NRT:

NRT has been shown to be effective in helping people quit smoking when combined with other interventions such as therapy or medication.

Steps for Quitting:

1. Planning with a Doctor: Talk to a doctor who knows about ADHD and quitting smoking. They can help you make an intervention plan that takes into account both your ADHD and your smoking habits. Ask about options like stimulants like methylphenidate and/or bupropion.
2. Adding Counseling: Start therapy like Cognitive Behavioral Therapy (CBT) or another therapy that’s adjusted for ADHD. This can help you manage your feelings better, control quick actions, and handle stress.
3. Check-ins and Adjustments: Meet with your doctor regularly to talk about how things are going and change your plan if needed, like adjusting your NRT dose.
4. Getting Support: Join a support group for people quitting smoking. Try to find one for people with ADHD if available.
5. Review and Tweak Your Approach: Regularly check how you’re doing with your doctor and talk about any problems with smoking abstinence, side effects, or slip-ups.

Other Important Tips:

• Therapy is key: Mental health support is really important. It can help you handle emotions without needing to smoke.
• Medication might help: Some ADHD medicines can improve focus and mood, which can make quitting smoking easier.
• Be ready for tough emotions: Quitting smoking might make you feel anxious, sad, or even depressed. Having friends, family, or a therapist to talk to can make a big difference.

Managing Stress While Quitting Smoking

• Communicate Openly: Let friends and family know that you might be moodier than usual while you're quitting. Explain that nicotine withdrawal can affect your emotions and that your reactions might not always be as controlled as usual.
• Decrease Stress: Actively work to reduce stress in your life. This could be through mindfulness and relaxation techniques like meditation, deep breathing exercises, or yoga; physical activity, as regular exercise can greatly reduce stress and improve your mood; and hobbies and interests to engage in activities that relax you and keep your mind off smoking.

Addressing Hormonal Fluctuations

Hormonal changes during the menstrual cycle can worsen ADHD symptoms and increase nicotine cravings. Research suggests that women with ADHD should track their cycles and be aware of when they are more vulnerable to relapse (e.g., during the luteal phase, before menstruation). Quit during the first half of your cycle.

What to Expect with Nicotine Withdrawal

When you stop smoking, your body begins to adjust to the absence of nicotine, leading to withdrawal symptoms. These can be tough, but knowing what to expect can help you manage them:

Physical Symptoms:

• Cravings for nicotine: One of the strongest withdrawal symptoms.
• Headaches and dizziness: These can occur as your body adjusts.
• Increased appetite and weight gain: Nicotine suppresses appetite, so you might feel hungrier.
• Insomnia: Difficulty sleeping is common but usually temporary.

Emotional Symptoms:

• Irritability, frustration, or anger: Small problems might feel magnified.
• Anxiety: You might feel more anxious than usual.
• Depression: Feeling low is not uncommon when quitting smoking.
• Difficulty concentrating: Your mind might feel a bit foggy.

Getting Through It

• Understand it's temporary: Most intense withdrawal symptoms subside after the first 4 to 6 weeks.
• Create a quit plan: Having a structured plan can help you manage cravings and withdrawal symptoms more effectively.
• Celebrate small victories: Each day without smoking is an achievement—celebrate these milestones to motivate yourself.
• Be ready - It's not Easy: Quitting smoking is a profound change that can shake up your usual way of handling stress and emotions. Remember, it’s okay to ask for help, and connecting with others who understand what you’re going through can make a big difference. With the right strategies and support, you can navigate through these challenges successfully.

Medication Support

Bupropion (Zyban), a non-stimulant medication used for both smoking cessation and depression, has also shown effectiveness in ADHD populations. Bupropion acts on the same dopamine pathways as nicotine and ADHD medications, reducing withdrawal symptoms and cravings. Women with ADHD who used bupropion had significantly higher quit rates compared to placebo groups, likely because it addressed both mood regulation and nicotine cravings.

Why Therapy?

Get into therapy with a good therapist if you can. Therapy has been shown to help women with ADHD quit smoking by addressing emotional regulation issues, impulsivity, and stress management. Research indicates that women with ADHD tend to smoke as a form of self-medication, using nicotine to regulate mood, reduce anxiety, and manage ADHD symptoms like restlessness or inattention. You need support and new coping mechanisms for managing emotional challenges that arise during withdrawal, such as frustration, sadness, or heightened ADHD symptoms.

Support Around Relapse and Maintenance

Researchers find that it may take you several attempts to quit, but that's okay. This is normal; don't give up because you fear failing. But also, it's essential to put support in place for half a year after you quit. Continued support for at least six months post-quitting to help prevent relapse in people with ADHD. You are vulnerable to emotional regulation issues during the second half of your period and to stress. Have a support system in place, stay in therapy, and be kind to yourself.

References and resources  on ADHD and Cigarette Smoking:

1. 1. Nicotine & Dopamine Regulation in ADHD
      • McClernon, F. J., Kollins, S. H., Lutz, A. M., Fitzgerald, D. P., Murray, D. W., Redman, C., & Rose, J. E. (2013). Effects of smoking abstinence on adult smokers with and without attention-deficit/hyperactivity disorder: Results of a pilot study. Biological Psychiatry, 73(10), 882-889. https://doi.org/10.1016/j.biopsych.2012.09.027
   2. Impulsivity and Smoking in ADHD
      • Kollins, S. H., English, J. S., Robinson, R., Hallyburton, M., Chrisman, A. K., & Babalola, O. (2016). Smoking topography in adult smokers with and without attention deficit hyperactivity disorder: Preliminary results. Journal of Attention Disorders, 20(1), 39-48. https://doi.org/10.1177/1087054713493312
   3. Emotional Dysregulation and ADHD Smoking
      • Mitchell, J. T., & Potts, J. M. (2020). Smoking and emotional regulation in adults with attention-deficit/hyperactivity disorder: Examining associations and implications. Nicotine & Tobacco Research, 22(3), 377-383. https://doi.org/10.1093/ntr/ntz037
   4. ADHD and Smoking Relapse
      • Tindle, H. A., Freiberg, M. S., & McGough, J. J. (2022). Relapse prevention in smoking cessation among individuals with ADHD: Strategies and challenges. Journal of Attention Disorders, 26(5), 728-735. https://doi.org/10.1177/1087054719869970
   5. Bupropion and ADHD in Smoking Cessation
      • Wilens, T. E., Adamson, J. J., Monuteaux, M. C., Faraone, S. V., Schillinger, M., Westerberg, D., & Biederman, J. (2002). Effect of bupropion on smoking cessation in adults with attention-deficit/hyperactivity disorder. Biological Psychiatry, 51(4), 302-308. https://doi.org/10.1016/S0006-3223(01)01203-9
   6. ADHD, Nicotine Addiction, and Early Smoking
      • Tercyak, K. P., Lerman, C., & Audrain, J. (2014). The role of ADHD symptoms in the initiation and persistence of adolescent tobacco use. Addiction, 109(1), 115-123. https://doi.org/10.1111/add.12415
   7. Polysubstance Use and ADHD Smoking
      • Molina, B. S. G., & Pelham, W. E. (2018). Attention-deficit/hyperactivity disorder and risk for substance use disorders: Mediators, moderators, and nonspecific risk. Current Psychiatry Reports, 20(10), 1-8. https://doi.org/10.1007/s11920-018-0922-7
   8. NRT & Behavioral Interventions for ADHD Smokers
      • Hitsman, B., Moss, T. G., Montoya, I. D., George, T. P., & McKee, S. A. (2015). The role of behavioral support in combination with nicotine replacement therapy for smoking cessation in individuals with ADHD. Nicotine & Tobacco Research, 17(12), 1552-1558. https://doi.org/10.1093/ntr/ntv043
   9. Mindfulness-Based Interventions for ADHD and Smoking
      • Mitchell, J. T., Zylowska, L., & Kollins, S. H. (2017). Mindfulness meditation and smoking cessation among adults with attention-deficit/hyperactivity disorder. Journal of Clinical Psychology, 73(9), 1204-1216. https://doi.org/10.1002/jclp.22419
   10. Hormonal Fluctuations and Smoking in ADHD
       • Quinn, P. D., & Chang, Z. (2018). Impact of hormonal fluctuations on smoking cessation in women with ADHD. Current Psychiatry Reports, 20(5), 44-52. https://doi.org/10.1007/s11920-018-0903-x
2. These references provide the foundational studies related to ADHD, smoking addiction, and the factors influencing smoking cessation in individuals with ADHD, particularly women.

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