Long-term relationship between methylphenidate and tobacco consumption and nicotine craving in adults with ADHD in a prospective cohort study

Eur Neuropsychopharmacol. 2013 Jun;23(6):542-54. doi: 10.1016/j.euroneuro.2012.06.004. Epub 2012 Jul 17.


Patients with Attention-Deficit/Hyperactivity disorder (ADHD) have higher smoking rates, a younger age of smoking onset, and increased difficulty to stop smoking as compared to controls. Methylphenidate induced acute effects of increased smoking in laboratory studies, but long-term effects are unknown. We studied the acute and long-term relationship between methylphenidate use and tobacco consumption and nicotine craving among ADHD patients naïve for methylphenidate (N=325). Patients filled out the Smoking Questionnaire (SQ) at baseline, and after two-weeks and three-months of methylphenidate use. The SQ involved questions on demographics, tobacco consumption, nicotine craving, life events, psychiatric diagnoses and use of medication. At baseline, smoking prevalence of ADHD patients was twice as high (50.2%) as the national norm (25.6%; p<.001). Tobacco consumption increased with 1.3 cigarettes per day after three-months of methylphenidate use. When translated into pack years, tobacco consumption increased by about 23 packs per year. Reports of increased nicotine craving after methylphenidate, increased with 20.3% after two weeks and 29.2% after three months. Light smokers (1-12 cigarettes/day) were especially at risk for increased tobacco consumption (p<.05). Thus although methylphenidate is the drug of choice in medical treatment for ADHD, tobacco consumption and nicotine craving increased acutely and stabilized at increased levels after three-months of methylphenidate use. Although the net effect of methylphenidate on smoking behavior and craving should be further investigated within a randomized, placebo-controlled design, the results suggest that active prevention of increased smoking is needed in patients prescribed methylphenidate.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Attention Deficit Disorder with Hyperactivity / complications
  • Attention Deficit Disorder with Hyperactivity / drug therapy*
  • Central Nervous System Stimulants / administration & dosage
  • Central Nervous System Stimulants / adverse effects*
  • Central Nervous System Stimulants / therapeutic use
  • Cohort Studies
  • Delayed-Action Preparations / administration & dosage
  • Delayed-Action Preparations / adverse effects
  • Diagnostic and Statistical Manual of Mental Disorders
  • Dopamine Uptake Inhibitors / administration & dosage
  • Dopamine Uptake Inhibitors / adverse effects*
  • Dopamine Uptake Inhibitors / therapeutic use
  • Dose-Response Relationship, Drug
  • Female
  • Follow-Up Studies
  • Humans
  • Lost to Follow-Up
  • Male
  • Methylphenidate / administration & dosage
  • Methylphenidate / adverse effects*
  • Methylphenidate / therapeutic use
  • Middle Aged
  • Pilot Projects
  • Severity of Illness Index
  • Smoking / adverse effects*
  • Time Factors
  • Tobacco Use Disorder / complications*
  • Tobacco Use Disorder / physiopathology
  • Young Adult


  • Central Nervous System Stimulants
  • Delayed-Action Preparations
  • Dopamine Uptake Inhibitors
  • Methylphenidate