The Reinforcing Mechanisms of Smoking in Adult ADHD

Condition(s) targeted: ADHD

Intervention: Smoking (Drug); Abstinence (Behavioral); Placebo (Drug); Ritalin, Adderall, or Concerta (Drug)

Phase: N/A

Status: Recruiting

Sponsored by: University of California, Irvine

Official(s) and/or principal investigator(s):
Jean G Gehricke, Ph.D., Principal Investigator, Affiliation: University of California, Irvine

Overall contact:
Jean G Gehricke, Ph.D., Phone: 949-824-1834, Email: jgehrick@uci.edu

Whereas the smoking prevalence rates in the general population are declining, rates among people diagnosed with attention-deficit hyperactivity disorder (ADHD) continue to be elevated. Smoking may be a form of self-medication in people with ADHD, which has specific reinforcing mechanisms such as improvement of ADHD core symptoms, enhancement of moods and arousal, or a combination of both. In addition, the reinforcing effects of smoking may be potentiated by stimulant medication.

The proposed study examines the reinforcing effects of ad libitum smoking with and without stimulant medication in adult smokers with clinically diagnosed ADHD. Participants will include 40 adults (20 men, 20 women) diagnosed with ADHD and treated with stimulant medication. Participants will be recruited mainly from local treatment centers and clinical practices. The effects of smoking and stimulant medication will be studied both in the laboratory and in everyday life. In the laboratory, participants will undergo the Continuous Performance Task in order to assess attention and inhibition in response to smoking a cigarette versus abstinence with and without stimulant medication. In everyday life, participants will be asked to undergo 2 conditions: ad libitum smoking with stimulant medication and ad libitum smoking with placebo pill. During each condition, ADHD symptoms, moods, and arousal will be assessed with an electronic handheld diary for 2 days during waking hours in natural settings. Specifically, the electronic diary will monitor ADHD symptoms (e. g., inattention, impulsivity), moods (e. g., happiness, sadness, anger), arousal (i. e., tired, alertness), location (e. g., home, school, work), activity (e. g., read/write, talk, walk), and consumption (e. g., alcohol, caffeine, food) during smoking and nonsmoking occasions. Smoking will be monitored by an electronic cigarette case. Such electronic monitoring is less subject to memory bias and distortions than conventional assessments and will be linked to the CPT in the laboratory in order to assess validity.

The study will delineate the reinforcing mechanisms associated with smoking in laboratory and natural settings. Identifying the reinforcing mechanisms of smoking in interaction with stimulant medication will contribute to a better understanding of nicotine addiction and facilitate the development of targeted smoking cessation and prevention programs for individuals with ADHD and other people with deficiencies in impulse control and excessive risk taking.

Official title: The Reinforcing Mechanisms of Smoking in Adult ADHD

Study design: Basic Science, Randomized, Double Blind (Subject, Investigator), Crossover Assignment

Primary outcome: The effects of smoking versus abstinence in interaction with stimulant medication versus placebo on ADHD symptoms, moods, and behavior.

Secondary outcome: To examine associations between smoking-induced task performance assessed by the CPT and smoking-induced changes in ADHD symptoms assessed by the electronic diary.

Minimum age: 18 Years. Maximum age: 45 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- An age of 18 to 45 years

- A history of ADHD

- Current diagnosis of ADHD according to clinical criteria

- Current treatment with stimulant medication

- Smoking of 10 cigarettes or more per day

Exclusion Criteria:

- Smokers will be excluded if they smoke more than 20 cigarettes per day in order to

reduce the effects of pharmacological dependence and withdrawal and increase the number of nonsmoking events

- Treatment for any major medical illness such as cancer, heart disease, diabetes, skin

diseases, current major depressive episode, and schizophrenia even if currently controlled by medication

- Current pregnancy, as measured by a pregnancy test (Clear Blue Easy, Unipath, Bedford,

UK), or planning to become pregnant within the next 6 months. These individuals will not be included because smoking may cause harm to the unborn fetus

- Nursing mothers

- Non-English speaking people, because the majority of measurements used in the study

have not been validated in languages other than English

Jean G Gehricke, Ph.D., Phone: 949-824-1834, Email: jgehrick@uci.edu

Department of Psychiatry, Irvine, California 92612, United States; Recruiting
Jean G Gehricke, Ph.D., Phone: 949-824-1834, Email: jgehrick@uci.edu
Nuong Hong, Phone: 949-824-8216, Email: nhong@uci.edu
Jean G Gehricke, Ph.D., Principal Investigator

Starting date: September 2006
Ending date: August 2009
Last updated: December 11, 2008