The goal of this K23 Mentored Patient-Oriented Research Career Development Award is to broaden the candidate's expertise in smoking and psychiatric comorbidity research, particularly as it relates to Attention-Deficit/Hyperactivity Disorder (ADHD). Individuals with ADHD smoke cigarettes at a higher rate, initiate smoking at an earlier age, and have greater difficulty quitting compared to those without ADHD. Despite ADHD being a risk factor for such smoking outcomes, the mechanisms underlying this comorbidity are poorly understood. Delineating the role of these mechanisms is important for targeted treatment development. Emotion dysregulation is hypothesized to be a key behavioral mechanism that maintains cigarette smoking in ADHD smokers. Specifically, emotion dysregulation may worsen following smoking abstinence and make smoking more negatively reinforcing among smokers with ADHD, but this has yet to be empirically investigated. Training objectives will include gaining expertise in behavioral and psychopharmacological methods to measure behavioral mechanisms in smoking and ADHD, measuring emotion dysregulation in substance use and comorbid psychopathology research, bidirectional translation for future research building on laboratory-based findings, and statistical proficiency in clinical research. These objectives will be met through mentoring, research, and coursework, which will result in an independently funded program of research to (1) elucidate underlying behavioral mechanisms, including emotion dysregulation, involved in comorbid smoking psychiatric populations such as ADHD and (2) develop innovative cigarette smoking treatment for comorbid psychiatric populations. Dr. Scott Kollins, the primary mentor for this application, has a strong record of clinical research assessing the relationship between cigarette smoking and ADHD. He is also the director of the established research training site where the applicant will be trained. The research plan involves evaluating the association between cigarette smoking and emotion dysregulation in a mixed 2 (group status: ADHD, non- ADHD smokers) x 2 (smoking status: satiated, abstinent) factorial design. The primary hypothesis predicts that emotion dysregulation is more likely to worsen following a period of 24-hour smoking abstinence among ADHD smokers in comparison to non-ADHD smokers. In addition, abstinence-induced changes in emotion dysregulation are predicted to be associated with increasing the immediately reinforcing effects of cigarette smoking among those higher in ADHD symptoms. If these hypotheses are supported, this would suggest that treatment and prevention efforts for ADHD smokers need to target emotion dysregulation. Given that emotion dysregulation is a transdiagnostic construct, findings associated with ADHD can serve as a prototype for investigating the role of emotion dysregulation among other psychiatric populations with comorbid nicotine dependence.

Public Health Relevance

Cigarette smoking is the leading preventable cause of death in the US and individuals with ADHD smoke at significantly higher rates than people without ADHD. This project will help to identify why people smoke in the service of developing a better understanding of the relationship between ADHD and smoking/nicotine dependence, which has the potential to inform prevention and treatment programs.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Lin, Yu
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Duke University
Schools of Medicine
United States
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Hechtman, Lily; Swanson, James M; Sibley, Margaret H et al. (2016) Functional Adult Outcomes 16 Years After Childhood Diagnosis of Attention-Deficit/Hyperactivity Disorder: MTA Results. J Am Acad Child Adolesc Psychiatry 55:945-952.e2
Lasky, Arielle K; Weisner, Thomas S; Jensen, Peter S et al. (2016) ADHD in context: Young adults' reports of the impact of occupational environment on the manifestation of ADHD. Soc Sci Med 161:160-8
Mitchell, John T; Sweitzer, Maggie M; Tunno, Angela M et al. (2016) ""I Use Weed for My ADHD"": A Qualitative Analysis of Online Forum Discussions on Cannabis Use and ADHD. PLoS One 11:e0156614
Mitchell, John T; Zylowska, Lidia; Kollins, Scott H (2015) Mindfulness Meditation Training for Attention-Deficit/Hyperactivity Disorder in Adulthood: Current Empirical Support, Treatment Overview, and Future Directions. Cogn Behav Pract 22:172-191
Knouse, Laura E; Mitchell, John T (2015) Incautiously Optimistic: Positively-Valenced Cognitive Avoidance in Adult ADHD. Cogn Behav Pract 22:192-202
Mitchell, John T; Schick, Robert S; Hallyburton, Matt et al. (2014) Combined ecological momentary assessment and global positioning system tracking to assess smoking behavior: a proof of concept study. J Dual Diagn 10:19-29
Mitchell, John T; McIntyre, Elizabeth M; McClernon, F Joseph et al. (2014) Smoking motivation in adults with attention-deficit/hyperactivity disorder using the Wisconsin inventory of smoking dependence motives. Nicotine Tob Res 16:120-5
Mitchell, John T; Dennis, Michelle F; English, Joseph S et al. (2014) Ecological momentary assessment of antecedents and consequences of smoking in adults with attention-deficit/hyperactivity disorder. Subst Use Misuse 49:1446-56
Robertson, Christopher D; Miskey, Holly; Mitchell, John et al. (2013) Variety of self-injury: is the number of different methods of non-suicidal self-injury related to personality, psychopathology, or functions of self-injury? Arch Suicide Res 17:33-40
Mitchell, John T; McIntyre, Elizabeth M; English, Joseph S et al. (2013) A Pilot Trial of Mindfulness Meditation Training for ADHD in Adulthood: Impact on Core Symptoms, Executive Functioning, and Emotion Dysregulation. J Atten Disord :

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