The co-occurrence of
attention-deficit hyperactivity disorder (
ADHD) and
nicotine dependence is common. Individuals with
ADHD are more likely to initiate smoking and become dependent on
nicotine than their non-
ADHD counterparts, and recent evidence suggests that they may have more difficulty quitting smoking. Little is known about how to best approach treating these co-morbidities to optimize clinical outcome. Clinicians treating individuals with either
ADHD or
nicotine dependence should be aware of their common co-occurrence and the need to address both in treatment. This review of
ADHD and
nicotine dependence provides an overview of relevant epidemiology, bidirectional interactions and implications for pharmacological and adjunctive psychosocial treatment. Incorporating the current evidence base and their clinical experience, the authors propose a stepwise approach to treating patients with co-morbid
ADHD and
nicotine dependence. Given the potential for
ADHD symptoms to interfere with smoking cessation success, the first priority is to stabilize
ADHD. The first-line pharmacological approach should be a long-acting psychostimulant. Upon
ADHD stabilization, motivational techniques should be used to encourage readiness for a smoking cessation attempt. In the context of behavioural cessation interventions sensitive to the patient's needs and developmental stage, pharmacological intervention targeting smoking cessation may be initiated. The authors recommend
varenicline as a first-line agent, given its superior effect size among available medication treatments. Symptoms of
ADHD, as well as
nicotine withdrawal and craving symptoms, should be monitored closely during the cessation attempt, and adjustments to
therapy should be considered if warranted. The authors conclude that, while current treatments may potentially be effective for co-morbid
ADHD and
nicotine dependence, further research is needed to parse the complex associations between these disorders and prospectively study combined treatments.