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Ramji AV, Runswick OR, Dommett EJ. Exercise Dependency and Overuse Injuries in Attention Deficit Hyperactivity Disorder. J Nerv Ment Dis 2024; 212:190-195. [PMID: 38412245 DOI: 10.1097/nmd.0000000000001762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT Attention deficit hyperactivity disorder (ADHD) is a common condition, but current medications have limitations, pushing a drive for alternative approaches. Different exercise-focused approaches have shown promise, but concern has also been raised about individuals with ADHD showing greater risk of addiction, including exercise dependency. Using an online survey, we examined current exercise practices, including exercise dependency and the presence of overuse injury, which could result from overexercising, in 114 adults with ADHD. We found that most were regularly exercising. None were classified as exercise dependent, but 38.9% were deemed symptomatic nondependent. Hyperactive-impulsive symptoms were a predictor of the level of exercise withdrawal experienced, and the co-occurrence of autism spectrum disorder was associated with greater risk of overuse injuries. The data indicate that ADHD may confer some greater risk of exercise dependency, aligning with previous studies investigating other addictions and suggesting further research is critical.
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Affiliation(s)
- Anusha V Ramji
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Capusan AJ, Bendtsen P, Marteinsdottir I, Larsson H. Comorbidity of Adult ADHD and Its Subtypes With Substance Use Disorder in a Large Population-Based Epidemiological Study. J Atten Disord 2019; 23:1416-1426. [PMID: 26838558 DOI: 10.1177/1087054715626511] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: The objective of the study is to explore the role and possible substance preference in ADHD and subtypes in substance use disorder (SUD). Method: Using self-report data on ADHD Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) symptoms and SUD (alcohol, illicit drugs, and nicotine) in 18,167 Swedish twins, aged 20 to 45 years, we obtained odds ratios (OR) from mixed effect logistic regression, controlling for age, sex, education, and nonindependence of twin data. Results: Increased ADHD symptoms were significantly associated with increased odds for all SUD. ORs ranged between 1.33 for regular nicotine (95% confidence interval [CI] = [1.12, 1.59]); 2.54 for multiple drug use (95% CI = [2.00, 3.23]), and 3.58 for alcohol dependence (95% CI = [2.86, 4.49]). Conclusion: ADHD symptoms and subtypes in the population are associated with increased risks for all SUD outcomes, with no difference between ADHD subtypes, no substance preference, and no sex differences for the comorbidity. Clinicians need to consider ADHD evaluation and treatment as part of management of SUD in adults.
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Affiliation(s)
- Andrea J Capusan
- 1 Department of Psychiatry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- 2 Department of Medical Specialist and Department of Medicine and Health Sciences, Linköping University, Motala, Sweden
| | - Ina Marteinsdottir
- 3 Centre for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Goldenson NI, Pang RD, Leventhal AM. Associations between ADHD symptoms and smoking outcome expectancies in a non-clinical sample of daily cigarette smokers. Am J Addict 2016; 25:152-9. [PMID: 26871681 DOI: 10.1111/ajad.12343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/18/2015] [Accepted: 01/18/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Smoking outcome expectancies for positive reinforcement (PR: beliefs that smoking produces desirable outcomes) and negative reinforcement (NR: beliefs that smoking alleviates negative affect) are modifiable cognitive manifestations of affect-mediated smoking motivation. Based on prior data and theory, we hypothesized that NR and PR expectancies are associated with ADHD symptom levels in a non-clinical sample of cigarette smokers. (Am J Addict 2016; XX:XX -XX) METHODS: Daily cigarette smokers (N = 256) completed self-report measures of ADHD symptoms and smoking outcome expectancies. Cross-sectional associations of overall ADHD symptomatology and the ADHD symptom dimensions of inattention (IN: difficulty concentrating and distractibility) and hyperactivity impulsivity (HI: poor inhibitory control and motor activity restlessness) with PR and NR smoking outcome expectancies were examined. RESULTS Higher levels of overall, IN and HI ADHD symptoms were positively associated with NR smoking expectancies after statistically controlling for anxiety, depression, alcohol/drug use problems, nicotine dependence, and other smoking expectancies. Although neither HI nor IN symptom dimensions exhibited empirically unique relations to NR expectancies over and above one another, the collective variance across IN and HI was associated with NR expectancies. PR expectancies were not associated with ADHD symptoms. DISCUSSION AND CONCLUSIONS Although PR and NR expectancies may be important etiological influences in the overall population of smokers, NR outcome expectancies appear to be disproportionately expressed in smokers with elevated ADHD symptoms. Cognitive manifestations of NR motivation, which may be modifiable via intervention, are prominent in smokers with elevated ADHD symptoms. SCIENTIFIC SIGNIFICANCE Beliefs that smoking alleviates negative affect may underlie ADHD-smoking comorbidity.
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Affiliation(s)
- Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Raina D Pang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California.,Department of Psychology, University of Southern California, Los Angeles, California
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Kutlu MG, Parikh V, Gould TJ. Nicotine Addiction and Psychiatric Disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2015; 124:171-208. [PMID: 26472530 DOI: 10.1016/bs.irn.2015.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Even though smoking rates have long been on the decline, nicotine addiction still affects 20% of the US population today. Moreover, nicotine dependence shows high comorbidity with many mental illnesses including, but are not limited to, attention deficit hyperactivity disorder, anxiety disorders, and depression. The reason for the high rates of smoking in patients with mental illnesses may relate to attempts to self-medicate with nicotine. While nicotine may alleviate the symptoms of mental disorders, nicotine abstinence has been shown to worsen the symptoms of these disorders. In this chapter, we review the studies from animal and human research examining the bidirectional relationship between nicotine and attention deficit hyperactivity disorder, anxiety disorders, and depression as well as studies examining the roles of specific subunits of nicotinic acetylcholine receptors (nAChRs) in the interaction between nicotine and these mental illnesses. The results of these studies suggest that activation, desensitization, and upregulation of nAChRs modulate the effects of nicotine on mental illnesses.
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Affiliation(s)
| | - Vinay Parikh
- Temple University, Philadelphia, Pennsylvania, USA
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Ameringer KJ, Chou CP, Sussman S, Unger JB, Leventhal AM. Identifying Shared Latent Dimensions of Psychological Symptoms: Implications for the Psychological Correlates of Smoking. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015; 37:454-468. [PMID: 26478654 PMCID: PMC4606875 DOI: 10.1007/s10862-014-9467-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Shared latent dimensions may account for the co-occurrence of multiple forms of psychological dysfunction. However, this conceptualization has rarely been integrated into the smoking literature, despite high levels of psychological symptoms in smokers. In this study, we used confirmatory factor analysis to compare three models (1-factor, 2-factor [internalizing-externalizing], and 3-factor [low positive affect-negative affect-disinhibition]) of relations among nine measures of affective and behavioral symptoms implicated in smoking spanning depression, anxiety, happiness, anhedonia, ADHD, aggression, and alcohol use disorder symptoms. We then examined associations of scores from each of the manifest scales and the latent factors from the best-fitting model to several smoking characteristics (i.e., experimentation, lifetime established smoking [≥100 cigarettes lifetime], age of smoking onset, cigarettes/day, nicotine dependence, and past nicotine withdrawal). We used two samples: (1) College Students (N =288; mean age =20; 75 % female) and (2) Adult Daily Smokers (N=338; mean age=44; 32 % female). In both samples, the 3-factor model separating latent dimensions of deficient positive affect, negative affect, and disinhibition fit best. In the college students, the disinhibition factor and its respective indicators significantly associated with lifetime smoking. In the daily smokers, low positive and high negative affect factors and their respective indicators positively associated with cigarettes/day and nicotine withdrawal symptom severity. These findings suggest that shared features of psychological symptoms may be parsimonious explanations of how multiple manifestations of psychological dysfunction play a role in smoking. Implications for research and treatment of co-occurring psychological symptoms and smoking are discussed.
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Affiliation(s)
- Katherine J. Ameringer
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, 2250 Alcazar Street CSA 240, Los Angeles, CA 90033, USA
| | - Chih-Ping Chou
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, 2250 Alcazar Street CSA 240, Los Angeles, CA 90033, USA
| | - Steve Sussman
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, 2250 Alcazar Street CSA 240, Los Angeles, CA 90033, USA
| | - Jennifer B. Unger
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, 2250 Alcazar Street CSA 240, Los Angeles, CA 90033, USA
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, 2250 Alcazar Street CSA 240, Los Angeles, CA 90033, USA
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Bidwell LC, Ameringer KJ, Leventhal AM. Associations of attention-deficit hyperactivity disorder symptom dimensions with smoking deprivation effects in adult smokers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:182-92. [PMID: 24731115 PMCID: PMC4183136 DOI: 10.1037/a0035369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Identifying relations of attention deficit hyperactivity disorder (ADHD) symptom dimensions to individual facets of the tobacco withdrawal syndrome could elucidate the mechanisms linking ADHD and regular smoking. This study examined the unique relations of inattention (IN) and hyperactivity-impulsivity (HI) symptom dimensions of ADHD to a variety of tobacco withdrawal symptoms. One hundred thirty-two community-dwelling adult smokers recruited without regard to ADHD status completed a self-report measure of ADHD symptoms experienced over the past 6 months at a baseline visit. At two subsequent experimental sessions (one following overnight tobacco deprivation and one nondeprived; order counterbalanced), participants completed measures of tobacco withdrawal symptoms, mood, and desire to smoke. Preliminary analyses showed that higher levels of IN and HI symptoms were both associated with higher levels of negative affect and concentration difficulties during nondeprived ("baseline") states (ps < .01). Over and above nondeprived ratings, higher levels of HI symptoms were associated with larger deprivation-induced increases in negative affect, concentration problems, and desire to smoke, particularly for negative affect relief, during deprived states (ps < .01). ADHD symptoms, particularly HI symptoms, are associated with more severe exacerbations in abstinence-induced withdrawal symptoms, which could be an important mechanism of ADHD-smoking comorbidity. These findings suggest the need for clinical studies examining the role of these unique and potentially more severe withdrawal profiles experienced by smokers with high-levels of ADHD symptoms in smoking reinstatement and cessation outcomes.
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Affiliation(s)
- L. Cinnamon Bidwell
- Center for Alcohol and Addition Studies, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Providence, RI
| | - Katherine J. Ameringer
- University of Southern California, Keck School of Medicine, Departments of Preventive Medicine and Psychology, Los Angeles, CA 90033
| | - Adam M. Leventhal
- University of Southern California, Keck School of Medicine, Departments of Preventive Medicine and Psychology, Los Angeles, CA 90033
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