Association of smoking reduction with comorbid psychiatric symptoms including ADHD, depression, anxiety, and alcohol use disorder

Background Current literature supports the hypothesis that patients with comorbid psychiatric symptoms are at pronounced risk of relapse. Studies investigating the co-occurrence of psychiatric symptoms and smoking cessation success in the general population are limited. We aimed to investigate the associations between smoking reduction (including cessation) and various psychiatric diagnoses, including Attention-Deficit/Hyperactivity Disorder (ADHD), depression, anxiety and Alcohol Use Disorder (AUD), among adult smokers 12 months after a smoking cessation attempt. Methods Sixty-eight patients enrolled in a 3-month smoking cessation intervention were classified in one of the three outcome groups: abstinent, high reduction (reduction in the number of cigarettes smoked 50-99% baseline) or low reduction (reduction in the number of cigarettes smoked < 50% baseline). The Adult ADHD Self-Report Scale (ASRS) , Wender Utah Rating Scale (WURS), Hospital Anxiety and Depression Scale (HAD), Alcohol Use DIsorders Test (AUDIT) and Impulsive Behavior Scale (UPPS-P) were utilized. Results At month 12 after a cessation attempt, low-reduction participants had a higher depression score compared to high reduction participants, but not from abstainers (p=0.037). At month 3, childhood ADHD scores were significantly higher in low-reduction participants compared to abstainers and high reduction participants (p=0.014). Cigarette consumption was positively correlated with AUD symptoms and childhood ADHD scores at 3 and 12 months (p=0.006, p=0.047, p=0.007, p=0.01, respectively), and also with adult ADHD symptoms at 3 months (p=0.039). Depression and childhood as well as adult ADHD symptoms were positively correlated with both negative and positive urgency (p=0.03, p<0.001, p=0.06, p<0.001, p=0.002, p=0.002, respectively). Conclusion Childhood ADHD may intensify negative states and increase the risk of smoking cessation failure . Higher levels of impulsivity may likewise represent a pejorative factor in future attempts at smoking cessation. Adequate assessment and management of ADHD and high impulsivity, as early as possible, may enhance the chances for smoking cessation success.