title: Assessing the role of attention-deficit/hyperactivity disorder symptoms in smokers with and without posttraumatic stress disorder.
abstract: BACKGROUND
  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-deficit/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 significantly 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 increase positive affect.
  
  
  CONCLUSIONS
  Taken together, these findings suggest that ADHD symptoms may increase affective dysregulation difficulties already faced by smokers, particularly those with PTSD, which may, in turn, confer increased risk for smoking relapse in those with higher levels of symptomatology of both disorders.
authors.affiliation: Duke ADHD Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705, USA. john.mitchell@duke.edu
authors.forename: John T
authors.initials: JT
authors.lastname: Mitchell
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Van Voorhees
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Dennis
authors.forename: F Joseph
authors.initials: FJ
authors.lastname: McClernon
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Calhoun
authors.forename: Scott H
authors.initials: SH
authors.lastname: Kollins
authors.forename: Jean C
authors.initials: JC
authors.lastname: Beckham
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D000368:Aged; D001007:Anxiety; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology