title: Adult attention-deficit/hyperactivity disorder and nicotine withdrawal: a qualitative study of patient perceptions.
abstract: Nicotine use has been reported to ameliorate symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Furthermore, adults with ADHD have a relatively high prevalence of cigarette smoking and greater difficulty abstaining from smoking. Overall, though, there is scant literature investigating the beliefs, perceptions and experiences of smokers with ADHD regarding smoking cessation and withdrawal.
  
  
  
  Our participants (n = 20) fulfilling criteria for ADHD and a past or current dependence from nicotine were recruited from the in- and outpatient clinic of the Zurich University Psychiatric Hospital and the Psychiatric Services Aargau (Switzerland). We conducted in-depth interviews to explore their motivations to quit, past experiences with and expectations about quitting using a purposeful sampling plan. The sample was selected to provide diversity in relation to level of nicotine dependence, participation in a smoking-cessation program, gender, age, martial status and social class. Mayring's qualitative content analysis approach was used to evaluate findings.
  
  
  
  Adult smokers with ADHD had made several attempts to quit, experienced intense withdrawal symptoms, and relapsed early and often. They also often perceived a worsening of ADHD symptoms with nicotine abstinence. We identified three motives to quit smoking: 1) health concerns, 2) the feeling of being addicted, and 3) social factors. Most participants favored a smoking cessation program specifically designed for individuals with ADHD because they thought ADHD complicated their nicotine withdrawal and that an ADHD-specific smoking cessation program should address specific symptoms of this disorder.
  
  
  
  Since treatment initiation and adherence associate closely with perception, we hope these findings will result in better cessation interventions for the vulnerable subgroup of smokers with ADHD.
authors.affiliation: Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Falkenplatz 16-18, Bern, 3012, Switzerland. Michael.Liebrenz@fpd.unibe.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Liebrenz
authors.affiliation: Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA.
authors.forename: Carl Erik
authors.initials: CE
authors.lastname: Fisher
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Romilda
authors.initials: R
authors.lastname: Nellen
authors.affiliation: Institute for General Practice and Health Services Research, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
authors.forename: Anja
authors.initials: A
authors.lastname: Frei
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Anne-Catherine
authors.initials: AC
authors.lastname: Biechl
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Nina
authors.initials: N
authors.lastname: Hiestand
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Alice
authors.initials: A
authors.lastname: Huber
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Anna
authors.initials: A
authors.lastname: Buadze
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Dominique
authors.initials: D
authors.lastname: Eich
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009538:Nicotine / Q000009:adverse effects* / Q000627:therapeutic use; D036301:Qualitative Research; D016540:Smoking Cessation / Q000523:psychology*; D013375:Substance Withdrawal Syndrome / Q000523:psychology*; D014029:Tobacco Use Disorder / Q000523:psychology
chemical_list: D009538:Nicotine
keywords: ADHD; Narrative; Nicotine; Qualitative; Subjective; Withdrawal