For decades, research has shown that individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to use tobacco, start smoking earlier and face greater difficulties quitting than the general population (Kollins et al., 2005; Wilens et al., 2008). These patterns have positioned nicotine use squarely as a public health concern for this community.

That view, while valid, is incomplete. A growing body of research suggests a more complex story, one in which nicotine may, paradoxically, provide short-term relief for some ADHD symptoms.

Nicotine and ADHD: What the Science Suggests

On November 15, 2024, I came across an Instagram video by Dr. Russell Barkley, one of the world’s foremost ADHD experts, with more than 20 books and hundreds of papers to his name. In the post, Barkley said plainly: “Nicotine treats ADHD; it does work.”

He explained that nicotine can temporarily improve attention, focus and executive function effects that help explain why someone with ADHD turn to smoking as a form of self-medication (Barkley, 2021). Barkley also noted that at least three pharmaceutical companies were currently developing modified nicotine molecules to preserve these cognitive benefits while minimizing addictive potential.

The scientific foundation for this claim is robust. A large meta-analysis confirmed that acute nicotine administration reliably enhances attention, working memory and other executive functions in humans (Heishman et al., 2010). These effects are explained by nicotine’s action on neuronal nicotinic acetylcholine receptors (nAChRs), which stimulate the release of dopamine, norepinephrine and acetylcholine, all neurotransmitters critical to focus and self-regulation (Wilens, 2007).

Pharmaceutical efforts have tried to harness this biology directly. Early clinical trials with compounds such as ABT-418 and ABT-089, which are selective nicotinic receptor agonists, showed measurable improvements in ADHD symptoms in adults, lending clinical weight to the theory (Wilens et al., 1999). While these drugs were never fully developed due to safety and tolerability concerns, they demonstrated that targeted activation of nicotinic pathways can reduce core ADHD symptoms.  The story does not end with nicotine alone. Cigarette smoke contains additional pharmacological components, including monoamine oxidase inhibitors (MAOIs), which enhance dopamine availability and make smoking especially reinforcing. This synergy likely contributes to the higher rates of tobacco dependence among people with ADHD (Taylor, 2022).

Importantly, nicotine’s profile differs sharply from alcohol. While nicotine shows evidence of improving attention and executive function in ADHD, alcohol has been clinically shown to worsen symptoms (Sobanski, 2006). To put it bluntly: tobacco may hold underexplored medicinal properties, while alcohol remains unequivocally detrimental to body and mind.

A Personal Perspective

As someone who lived much of his life with undiagnosed ADHD, Barkley’s words resonated deeply. For more than 25 years, cigars have been more than a hobby for me, they have been a ritual that helps me manage my symptoms. To the casual observer, cigar smoking may appear as simple leisure. But for me, it is one of the few practices that slows my racing mind. ADHD is often described as having a “Ferrari engine for a brain but bicycle brakes and no windshield wipers” (Hallowell & Ratey, 1994). That metaphor captures my daily reality.

When I light a cigar, something shifts. My thoughts decelerate. I listen more attentively between puffs. I resist interrupting. I can sit still, sometimes for two hours reading, reflecting, or working with a level of focus that often eludes me otherwise. Cigarettes, consumed quickly and habitually, never provide this effect. Cigars, by contrast, demand patience, presence, and mindfulness.  For me, cigar smoking has become a meditative practice: a structured, grounding ritual that delivers calm within the turbulence of ADHD.

My experience is not unique. While in Singapore with friends Ferdinand Piet and Didier Houvenhagel, I met Tony Coughlan of League of Fat Bastards cigars. Through him, I was introduced to founder Adam Levine, whose company donates 40% of its profits to men’s mental health initiatives in the countries where they operate. I also had a chance to meet and co-host him in Hong Kong in mid 2025 for an event at a local cigar lounge.  Their brand explicitly connects cigars with mental health, affirming what I had long suspected: cigars can serve as a bridge to conversation, community, and support.  Their vision reminded me of how many men live with ADHD, depression or anxiety, often silently and often undiagnosed. For them, a cigar lounge may be more than a social space. It can be a refuge, a place to slow down, connect and find perspective.

Clinical Implications and Caution

The nicotine–ADHD link has two important clinical implications. First, it helps explain elevated smoking rates among people with ADHD and their pronounced difficulty quitting. Second, it clarifies why pharmaceutical research continues to explore selective nicotinic modulators: the goal is not to encourage tobacco use, but to develop safer medications that confer cognitive benefits without the addictive and health risks of smoking.  Studies also suggest that while cessation aids such as varenicline (a partial nAChR agonist) can help, ADHD symptoms often interfere with quitting success, underscoring the need for tailored approaches (Bidwell et al., 2017; Green et al., 2023).

Final Thoughts

To be absolutely clear, I am not suggesting cigars as a medical treatment for ADHD. The health risks of tobacco are well established, and nothing in this article should be construed as medical advice.  What I am offering is a personal story: cigars, like exercise, yoga or meditation, have become a ritual that brings focus and calm to my restless mind. My experience aligns with a growing body of research showing that nicotine interacts with ADHD brains in complex, sometimes paradoxical ways.  Cigars may never be prescribed medicine. But for some of us, they are something equally meaningful: a ritual of balance, a tool for mindfulness and a way to experience life at its natural pace.

References

• Barkley, R. A. (2021). ADHD: A Handbook for Diagnosis and Treatment (5th ed.). Guilford Press.
• Bidwell, L. C., et al. (2017). ADHD symptoms impact smoking outcomes and response to pharmacotherapy (varenicline). Nicotine & Tobacco Research.
• Green, R. J., et al. (2023). ADHD symptoms and smoking cessation outcomes: secondary analysis of varenicline trials. Addictive Behaviors.
• Hallowell, E. M., & Ratey, J. J. (1994). Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder. Pantheon.
• Heishman, S. J., Kleykamp, B. A., & Singleton, E. G. (2010). Meta-analysis of the acute effects of nicotine and smoking on human performance. Psychopharmacology.
• Kollins, S. H., McClernon, F. J., & Fuemmeler, B. F. (2005). Association between smoking and ADHD symptoms in a population-based sample of young adults. Archives of General Psychiatry, 62(10), 1142–1147.
• Sobanski, E. (2006). Psychiatric comorbidity in adults with ADHD. European Archives of Psychiatry and Clinical Neuroscience, 256(i1), i26–i31.
• Taylor, M. R. (2022). Tobacco and ADHD: the role of MAO-inhibition in nicotine reinforcement. Frontiers in Neuroscience.
• Wilens, T. E. (2007). Neuronal nicotinic receptor agonists for the treatment of ADHD. Biochemical Pharmacology.
• Wilens, T. E., et al. (1999). A pilot controlled clinical trial of ABT-418, a cholinergic agonist, for adult ADHD. American Journal of Psychiatry.
• Wilens, T. E., Vitulano, M., Upadhyaya, H., & Adamson, J. J. (2008). Cigarette smoking associated with ADHD. Journal of Clinical Psychiatry, 69(9), 1525–1530.

By Jorge Tapies

Disclaimer: The opinions expressed herein are solely the author’s. Anyone dealing with ADHD or any other mental or physical health issue should consult a qualified medical professional for diagnosis and treatment