Effects of Transdermal Nicotine on Symptoms, Moods, and Cardiovascular Activity in the Everyday Lives of Smokers and Nonsmokers With Attention-Deficit/Hyperactivity Disorder Jean-G. Gehricke, Nuong Hong, Carol K. Whalen, Kenneth Steinhoff and Timothy L. Wigal University of California, Irvine The aim of the study was to test the self-medication hypothesis by examining the effects of nicotine in the everyday lives of smokers and nonsmokers with attention-deficit/hyperactivity disorder (ADHD). Fifty-two adults with ADHD (25 abstinent smokers and 27 nonsmokers) participated in a double-blind placebo controlled study with one nicotine patch condition and one placebo patch condition in counter- balanced order. Each condition continued for two consecutive days in which patches were administered each morning. The effects of nicotine on ADHD symptoms, moods, and side effects were assessed with electronic diaries. Cardiovascular activity was recorded with ambulatory blood pressure monitors and physical activity was monitored with actigraphs. Nicotine reduced reports of ADHD symptoms by 8% and negative moods by 9%, independent of smoking status. In addition, nicotine increased cardiovascular activity during the first 3 to 6 hours after nicotine patch administration. The results support the self-medication hypothesis for nicotine in adults with ADHD and suggest that smoking cessation and prevention efforts for individuals with ADHD will need to address both the symptom reducing and mood enhancing effects of nicotine. Keywords: smoking, self-medication, treatment, withdrawal, side effects Smoking is a major public health problem and cause of prevent- able disease worldwide (World Health Organization, 2003). Smok- ing causes five million deaths per year, and it is estimated that 10 million people per year will die from smoking-related illness by 2025 (Hatsukami, Stead, & Gupta, 2008). The Centers for Disease Control and Prevention reported that between 1997 and 2001 smoking caused 440,000 premature deaths annually in the United States (Centers for Disease Control and Prevention, 2003). Al- though smoking prevalence rates in the general population have shown a steady decline in the United States from 41.9% in 1965 to 20.8% in 2006 (Centers for Disease Control and Prevention, 2009), they may have reached a plateau. This plateau may be because of a core of individuals with attentional and emotional dysfunction who continue to smoke at high rates (Gehricke et al., 2007). Many studies suggest that individuals with attention-deficit/ hyperactivity disorder (ADHD) are not only at a higher risk for smoking initiation and subsequent nicotine dependence, but also less successful with smoking cessation (Fuemmeler, Kollins, & McClernon, 2007; Kollins, McClernon, & Fuemmeler, 2005; Pomerleau et al., 2003; Pomerleau, Downey, Stelson, & Pomer- leau, 1995; Wilens et al., 2008). ADHD is characterized by inat- tention, impulsivity, and hyperactivity (American Psychiatric As- sociation, 2000), and studies suggest that smokers with ADHD may self-medicate with nicotine to reduce their inattentive symp- toms (Bekker, Bocker, Van Hunsel, van den Berg, & Kenemans, 2005; Gehricke et al., 2007; Gehricke, Whalen, Jamner, Wigal, & Steinhoff, 2006; Khantzian, 1997; Pomerleau, Marks, & Pomer- leau, 2000). This reduction in inattentive symptoms is similar to that observed from stimulant medication in those with ADHD (Gehricke et al., 2007; Gehricke et al., 2006). In smokers, the ADHD symptom-reducing effects of nicotine compared with placebo may be confounded by withdrawal relief. Nicotine withdrawal symptoms include difficulty concentrating and restlessness, which are typical symptoms of ADHD, as well as increases in negative affect and heart rate (Benowitz, 1993). One approach to resolving this confound is to study the effects of nicotine in nonsmokers who are not addicted to nicotine. Levin, Conners, Silva, Canu, and March (2001) reported nicotine-induced reductions in behavioral measures of inattention in nonsmokers but did not have a comparison group of smokers. ADHD is often comorbid with other disorders such as opposi- tional defiant, conduct, mood, and anxiety disorders (Biederman, Newcorn, & Sprich, 1991; Birnbaum et al., 2005; Chang & Chuang, 2000; Costello, Mustillo, Erkanli, Keeler, & Angold, 2003; Faraone et al., 2001; Harada, Yamazaki, & Saitoh, 2002; Harty, Miller, Newcorn, & Halperin, 2009; MTA, 1999; Palacio et al., 2004; Pliszka, 2000; Swensen et al., 2003; Wilens & Dodson, 2004), which may play a role in the initiation and maintenance of smoking. Research has shown that individuals with ADHD and comorbid disorders are more prone to smoking compared to those Jean-G. Gehricke and Nuong Hong, Department of Psychiatry and Human Behavior, Carol K. Whalen, Department of Psychology and Social Behavior, Kenneth Steinhoff and Timothy L. Wigal, Department of Pedi- atrics, University of California, Irvine, Irvine, California. This study was supported by a Research Project Award from the Tobacco-Related Disease Research Program (14RT-0147) to Jean-G. Ge- hricke. We appreciate the valuable contributions of Larry D. Jamner and Vivien Chan. Correspondence concerning this article should be addressed to Jean-G. Gehricke, Department of Psychiatry and Human Behavior, 19722 MacArthur Boulevard, Irvine, CA 92612. E-mail: jgehrick@uci.edu Psychology of Addictive Behaviors © 2009 American Psychological Association 2009, Vol. 23, No. 4, 644 – 655 0893-164X/09/$12.00 DOI: 10.1037/a0017441 644