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Heroin Addiction and Related Clinical Problems: 2026, 28: 147-160

Attentional impulsivity as a mediator between nicotine dependence and addiction severity: evidence from individuals with methamphetamine use disorder

Yiming Ji, Yilian Zhao, Hengyu Li, Chuansheng Wang, Xian Li, Desheng Zhai, Lai Wei, Junqiang Zhao, Xiaojie Zhang, Mohd Afifuddin Bin Mohamad Mohamad, Mohammad Farris Iman Leong Bin Abdullah, Ruiling Zhang, and Bin Zhao

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2026-18

Summary: Background: Nicotine dependence and trait impulsivity are associated with the severity and progression of substance use disorders, particularly opioid and amphetamine use disorders. However, the precise magnitude of the correlation between these aspects remains unclear. In this study, the mediating role of trait impulsivity between nicotine dependence and addiction severity was explored among Chinese participants with methamphetamine use disorder (MUD). Methods: This study screened 1230 participants from five drug rehabilitation centres in China. After semi-structured interviews and standardized tests, 163 participants were analysed and divided into three groups based on MUD severity. Trait impulsivity was evaluated using the Chinese version of Barratt Impulsiveness Scale, 11th version. Results: The mediation analyses revealed that the positive direct effect of nicotine dependence on MUD severity was 0.308 (95% CI: 0.206, 0.412), and the positive indirect effect of nicotine dependence on MUD severity via impulsivity was 0.067 (95% CI: 0.027, 0.120), accounting for 17.87% of the total effect. However, the parallel multiple mediation analysis indicated that the indirect effects via motor impulsivity and non-planning impulsivity were invalid (P>0.05). The positive indirect effect via attentional impulsivity was 0.040 (95% CI: 0.003, 0.086), accounting for 10.67% of the total effect. Conclusions: Trait impulsivity, especially attentional impulsivity, mediated the positive effects of nicotine dependence on MUD severity in Chinese participants from rehabilitation centres. Cognitive instability and sustained attention deficits may represent a shared vulnerability that exacerbates the severity of polysubstance use. Future longitudinal studies including individuals with opioid use disorder are warranted to validate the proposed causal pathways.

Keywords: Nicotine Dependence; Attentional Impulsivity; Methamphetamine Use Disorder; Substance Use Disorder; Mediation Analysis