ADHD and Addiction

Howard Wetsman reacts to a study linking ADHD to tobacco addiction, suggesting that ADHD is a risk factor for tobacco addiction.

What if ADHD, a disorder of low midbrain dopamine tone, wasn’t ADHD? What if it was a disorder in which a person with lowered dopamine tone and the accompanying symptoms (poor attention, poor motivation, poor attachment except to sources of dopamine, difficulty shifting sets, lowered hedonic tone, etc.) was able to actually raise midbrain dopamine through hyperactive behavior? What if there were some people with low midbrain dopamine that didn’t need an external drug at first to raise dopamine but could raise it by jumping up and down or spinning around in circles? Wouldn’t those people attach to their behavior in the same way a low dopamine person attaches to taking a drug that raises dopamine? Does the brain really care if the dopamine comes from a shot of heroin, a cigarette, a chocolate cake, or spinning in circles? The science of the midbrain suggests it not only doesn’t care, but that there’s no way it can tell the difference.

So what if such a person had a cigarette?

He suggests we have the causal chain backwards.

The study basically says that ADHD is a risk factor for smoking. It’s an A causes B argument. I think it’s not A causes B, but rather C causes A and B. It’s not that ADHD is a risk for addiction, but rather we’ve chosen ADHD to be the label we put on the disease of addiction before it finds a drug that we call a drug. Once we start looking at the illness as a biological entity rather than a set of arbitrarily defined behaviors we’ll have better treatment that is just about as obvious.