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Sex, ADHD symptoms, and smoking outcomes: an integrative model.

Publication ,  Journal Article
Van Voorhees, EE; Mitchell, JT; McClernon, FJ; Beckham, JC; Kollins, SH
Published in: Med Hypotheses
May 2012

Both females and individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) have been found to be at increased risk for a range of smoking outcomes, and recent empirical findings have suggested that women with ADHD may be particularly vulnerable to nicotine dependence. On a neurobiological level, the dopamine reward processing system may be implicated in the potentially unique interaction of nicotine with sex and with ADHD status. Specifically, nicotine appears to mitigate core ADHD symptoms through interaction with the dopamine reward processing system, and ovarian hormones have been found to interact with nicotine within the dopamine reward processing system to affect neurotransmitter release and functioning. This article synthesizes data from research examining smoking in women and in individuals with ADHD to build an integrative model through which unique risk for cigarette smoking in women with ADHD can be systematically explored. Based upon this model, the following hypotheses are proposed at the intersection of each of the three variables of sex, ADHD, and smoking: (1) individuals with ADHD have altered functioning of the dopamine reward system, which diminishes their ability to efficiently form conditioned associations based on environmental contingencies; these deficits are partially ameliorated by nicotine; (2) nicotine interacts with estrogen and the dopamine reward system to increase the positive and negative reinforcement value of smoking in female smokers; (3) in adult females with ADHD, ovarian hormones interact with the dopamine reward system to exacerbate ADHD-related deficits in the capacity to form conditioned associations; and (4) during different phases of the menstrual cycle, nicotine and ovarian hormones may interact differentially with the dopamine reward processing system to affect the type and value of reinforcement smoking provides for women with ADHD. Understanding the bio-behavioral mechanisms underlying cigarette addiction in specific populations will be critical to developing effectively tailored smoking prevention and cessation programs for these groups. Overall, the goal of this paper is to examine the interaction of sex, smoking, and ADHD status within the context of the dopamine reward processing system not only to elucidate potential mechanisms specific to female smokers with ADHD, but also to stimulate consideration of how the examination of such individual differences can inform our understanding of smoking more broadly.

Duke Scholars

Published In

Med Hypotheses

DOI

EISSN

1532-2777

Publication Date

May 2012

Volume

78

Issue

5

Start / End Page

585 / 593

Location

United States

Related Subject Headings

  • Tobacco Use Disorder
  • Smoking
  • Sex Characteristics
  • Reward
  • Reinforcement, Psychology
  • Neurology & Neurosurgery
  • Models, Psychological
  • Menstrual Cycle
  • Male
  • Humans
 

Citation

APA
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ICMJE
MLA
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Van Voorhees, E. E., Mitchell, J. T., McClernon, F. J., Beckham, J. C., & Kollins, S. H. (2012). Sex, ADHD symptoms, and smoking outcomes: an integrative model. Med Hypotheses, 78(5), 585–593. https://doi.org/10.1016/j.mehy.2012.01.034
Van Voorhees, Elizabeth E., John T. Mitchell, F Joseph McClernon, Jean C. Beckham, and Scott H. Kollins. “Sex, ADHD symptoms, and smoking outcomes: an integrative model.Med Hypotheses 78, no. 5 (May 2012): 585–93. https://doi.org/10.1016/j.mehy.2012.01.034.
Van Voorhees EE, Mitchell JT, McClernon FJ, Beckham JC, Kollins SH. Sex, ADHD symptoms, and smoking outcomes: an integrative model. Med Hypotheses. 2012 May;78(5):585–93.
Van Voorhees, Elizabeth E., et al. “Sex, ADHD symptoms, and smoking outcomes: an integrative model.Med Hypotheses, vol. 78, no. 5, May 2012, pp. 585–93. Pubmed, doi:10.1016/j.mehy.2012.01.034.
Van Voorhees EE, Mitchell JT, McClernon FJ, Beckham JC, Kollins SH. Sex, ADHD symptoms, and smoking outcomes: an integrative model. Med Hypotheses. 2012 May;78(5):585–593.
Journal cover image

Published In

Med Hypotheses

DOI

EISSN

1532-2777

Publication Date

May 2012

Volume

78

Issue

5

Start / End Page

585 / 593

Location

United States

Related Subject Headings

  • Tobacco Use Disorder
  • Smoking
  • Sex Characteristics
  • Reward
  • Reinforcement, Psychology
  • Neurology & Neurosurgery
  • Models, Psychological
  • Menstrual Cycle
  • Male
  • Humans