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Kaye S, Gilsenan J, Young JT, Carruthers S, Allsop S, Degenhardt L, van de Glind G, van den Brink W. Risk behaviours among substance use disorder treatment seekers with and without adult ADHD symptoms. Drug Alcohol Depend 2014; 144:70-7. [PMID: 25193717 DOI: 10.1016/j.drugalcdep.2014.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/06/2014] [Accepted: 08/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Impulsivity and consequent risk-taking are features of both Attention Deficit Hyperactivity Disorder (ADHD) and substance use disorder (SUD). To date there are no data on the impact of comorbid ADHD on the likelihood and frequency of risk-taking behaviour among individuals with SUD. The current study aimed to examine drug-related, sexual and driving-related risk behaviours in people seeking treatment for SUD with co-occurring symptoms of Attention Deficit Hyperactivity Disorder (ADHD), taking into account potential confounders. METHODS 489 Australian adult SUD treatment seekers were administered a structured interview assessing demographics, drug use and SUD treatment history, psychiatric history, self-reported adult ADHD symptoms and self-reported drug-related, sexual and driving-related risk behaviours. RESULTS Almost a third (32%) screened positive for adult ADHD symptoms with onset prior to age 12. Those screening positive were more likely to report early onset (<15 years) nicotine and illicit drug use and to have a prior diagnosis of childhood ADHD, anxiety, depression and personality disorder. ADHD symptom status was not independently associated with injecting drug use-related or sexual risk-taking in the preceding month, but was an independent predictor of a greater overall number of driving offences, a higher frequency of driving without a seatbelt, a greater likelihood of having driven without a valid licence, more at-fault accidents and having one's licence disqualified at the time of interview. CONCLUSIONS These findings suggest that the risk-taking behaviour that is common among people with SUD is further increased among those with comorbid ADHD symptoms, particularly with respect to dangerous driving practices.
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Affiliation(s)
- Sharlene Kaye
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia.
| | - Joanne Gilsenan
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia
| | - Jesse Tyler Young
- National Drug Research Institute, Curtin University, Perth, Australia; Centre for Health Services Research, University of Western Australia, Perth, Australia
| | - Susan Carruthers
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Geurt van de Glind
- Trimbos-instituut and ICASA Foundation, Utrecht, The Netherlands; Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim van den Brink
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Pedersen MU, Hesse M, Thylstrup B. Research in substance abuse treatment: Contributions by the Centre for Alcohol and Drug Research. DRUGS-EDUCATION PREVENTION AND POLICY 2013. [DOI: 10.3109/09687637.2013.840460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Nunes EV, Covey LS, Brigham G, Hu MC, Levin FR, Somoza E, Winhusen T. Treating nicotine dependence by targeting attention-deficit/ hyperactivity disorder (ADHD) with OROS methylphenidate: the role of baseline ADHD severity and treatment response. J Clin Psychiatry 2013; 74:983-90. [PMID: 24229749 PMCID: PMC3946795 DOI: 10.4088/jcp.12m08155] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 02/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine whether treatment of attention-deficit/hyperactivity disorder (ADHD) with osmotic-release oral system (OROS) methylphenidate promotes abstinence from smoking among smokers with ADHD who have greater severity of ADHD symptoms at baseline or greater improvement in ADHD during treatment. METHOD This is a secondary analysis of data from a randomized, double-blind, 11-week trial conducted between December 2005 and January 2008 at 6 clinical sites; the original trial was sponsored by the National Drug Abuse Clinical Trials Network. Adult cigarette smokers (aged 18-55 years) who met DSM-IV criteria for ADHD were randomly assigned to OROS methylphenidate (72 mg/d) (n = 127) or matching placebo (n = 128). All participants received nicotine patches (21 mg/d) and weekly individual smoking cessation counseling. Logistic regression was used to model prolonged abstinence from smoking (ascertained by self-report and breath carbon monoxide testing) as a function of treatment, baseline ADHD Rating Scale-IV (ADHD-RS) score, change in ADHD-RS score during treatment, and their interactions. RESULTS Treatment interacted with both ADHD-RS score at baseline (P = .01) and change in ADHD-RS score during treatment (P = .008). Among patients with higher ADHD-RS scores (> 36) at baseline and the most improvement in ADHD during treatment (ADHD-RS change score ≥ 24), 70.0% of those who took OROS methylphenidate achieved abstinence from smoking compared to 36.8% of those who took placebo (P = .02). In contrast, among patients with the lowest ADHD-RS baseline scores (≤ 30), 30.3% of those who took OROS methylphenidate achieved abstinence from smoking compared to 60.7% of those who took placebo (P = .02). CONCLUSIONS OROS methylphenidate, in combination with nicotine patch, may be an effective treatment for nicotine dependence among smokers with more severe ADHD and more robust response of ADHD symptoms to medication. OROS methylphenidate may be counterproductive among smokers with lower severity of ADHD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00253747.
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Affiliation(s)
- Edward V. Nunes
- Columbia University, Department of Psychiatry, New York, NY, New York State Psychiatric Institute, New York, NY,Corresponding Author: Edward V. Nunes, M.D. New York State Psychiatric Institute 1051 Riverside Drive, Unit 51, Room 3717 New York, NY 10032 phone: 212-543-5581 fax: 212-543-5326
| | - Lirio S. Covey
- Columbia University, Department of Psychiatry, New York, NY, New York State Psychiatric Institute, New York, NY
| | - Gregory Brigham
- Maryhaven, Inc., Columbus, OH, University of Cincinnati College of Medicine, Department of Psychiatry and Behavioral Neuroscience, Cincinnati, OH
| | - Mei-Chen Hu
- Columbia University, Department of Psychiatry, New York, NY
| | - Frances R. Levin
- Columbia University, Department of Psychiatry, New York, NY, New York State Psychiatric Institute, New York, NY
| | - Eugene Somoza
- University of Cincinnati College of Medicine, Department of Psychiatry and Behavioral Neuroscience, Cincinnati, OH, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH
| | - Theresa Winhusen
- University of Cincinnati College of Medicine, Department of Psychiatry and Behavioral Neuroscience, Cincinnati, OH
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Moura HF, Faller S, Benzano D, Szobot C, von Diemen L, Stolf AR, Souza-Formigoni ML, Cruz MS, Brasiliano S, Pechansky F, Kessler FHP. The Effects of ADHD in Adult Substance Abusers. J Addict Dis 2013; 32:252-62. [DOI: 10.1080/10550887.2013.824359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Helena Ferreira Moura
- a Center for Drug and Alcohol Research , Hospital de Clínicas of Porto Alegre and Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Sibele Faller
- a Center for Drug and Alcohol Research , Hospital de Clínicas of Porto Alegre and Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Daniela Benzano
- a Center for Drug and Alcohol Research , Hospital de Clínicas of Porto Alegre and Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Cláudia Szobot
- a Center for Drug and Alcohol Research , Hospital de Clínicas of Porto Alegre and Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Lisia von Diemen
- a Center for Drug and Alcohol Research , Hospital de Clínicas of Porto Alegre and Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Anderson Ravy Stolf
- a Center for Drug and Alcohol Research , Hospital de Clínicas of Porto Alegre and Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | | | - Marcelo Santos Cruz
- c Psychiatric Institute , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Sílvia Brasiliano
- d Women Drug Dependent Treatment Center , University of São Paulo , São Paulo , Brazil
| | - Flavio Pechansky
- a Center for Drug and Alcohol Research , Hospital de Clínicas of Porto Alegre and Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Felix Henrique Paim Kessler
- a Center for Drug and Alcohol Research , Hospital de Clínicas of Porto Alegre and Federal University of Rio Grande do Sul , Porto Alegre , Brazil
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Kaye S, Darke S, Torok M. Attention deficit hyperactivity disorder (ADHD) among illicit psychostimulant users: a hidden disorder? Addiction 2013; 108:923-31. [PMID: 23227816 DOI: 10.1111/add.12086] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 03/28/2012] [Accepted: 12/03/2012] [Indexed: 01/08/2023]
Abstract
AIMS To estimate the prevalence, nature and correlates of symptomatology consistent with adult attention deficit hyperactivity disorder (ADHD) among illicit psychostimulant users. DESIGN Cross-section survey. SETTING Sydney, Australia. PARTICIPANTS 269 regular illicit psychostimulant users. MEASUREMENTS Structured interview assessing demographics, drug use and treatment history, psychostimulant dependence and self-reported symptoms consistent with adult ADHD. FINDINGS Almost half (45%) screened positive for adult ADHD (ADHD+). Symptoms of inattention (90%) were more prevalent than symptoms of hyperactivity/impulsivity (57%). Of those who screened positive for adult ADHD, only 17% had received a prior diagnosis of ADHD. The ADHD+ group differed from other participants in several respects: an earlier initiation of substance use and injecting drug use; more extensive polydrug use; a higher frequency of recent stimulant use and injecting drug use; a greater likelihood of stimulant dependence; and a greater likelihood of having received treatment for drug dependence. After controlling for other factors, screening positive for ADHD was associated independently with fewer years of education, earlier initiation of regular tobacco use and more extensive life-time polydrug use. CONCLUSIONS Clinicians should be aware of the potential for patients of drug and alcohol treatment services to have undiagnosed and/or untreated ADHD that may impact on their compliance with, and retention in, treatment.
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Affiliation(s)
- Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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The diagnostic accuracy of attention-deficit/hyperactivity disorder in adults with substance use disorders. Curr Opin Psychiatry 2012; 25:219-25. [PMID: 22449768 DOI: 10.1097/yco.0b013e3283523d7c] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Adult attention deficit/hyperactivity disorder (ADHD) is a common comorbid condition to substance use disorder (SUD) and is associated with worse prognosis and quality of life. This review summarizes recent work assessing ADHD diagnosis reliability in SUD patients and provides arguments to enhance the accuracy of detecting this disorder. RECENT FINDINGS Adequate diagnosis of ADHD in SUD patients is challenged by phenomenological aspects of addiction and frequently associated other psychiatric disorders that overlap with key symptoms of ADHD. A detailed comprehensive search for child and adult symptoms including the temporal relationship of ADHD, substance use and other psychiatric disorders should maximize the validity and the reliability of adult ADHD diagnosis in this population. Further, a follow-up evaluation of ADHD symptoms during treatment of SUD may reduce the likelihood of misdiagnosis. SUMMARY Considering the high rate of ADHD comorbidity among SUD patients, it is crucial to promote a systematic diagnostic approach to this disorder in specialized addiction treatment settings. However, overlapping symptoms between disorders frequently challenge the accuracy of adult ADHD diagnosis. Areas in need of further investigations include the development of valid screening procedures, associated neuropsychological factors and effective treatment strategies for these populations.
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Hodgkins P, Arnold LE, Shaw M, Caci H, Kahle J, Woods AG, Young S. A systematic review of global publication trends regarding long-term outcomes of ADHD. Front Psychiatry 2012; 2:84. [PMID: 22279437 PMCID: PMC3260478 DOI: 10.3389/fpsyt.2011.00084] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 12/29/2011] [Indexed: 01/29/2023] Open
Abstract
There is increased global recognition of attention deficit hyperactivity disorder (ADHD) as a serious medical condition with long-term consequences. Although originally conceived of as a childhood disorder, ADHD is being increasingly recognized in adults. Individual geographic regions may have specific interests and objectives for the study of ADHD. A systematic review of long-term outcomes (LTOs) in ADHD was conducted to evaluate research on ADHD LTOs on a global scale. Studies that were at least 2 years in duration were examined. A total of 351 studies were identified in the final analysis. We identified nine outcomes of interest and classified studies by specific geographical regions, age groups studied and study design by region and over time. Published studies of LTOs in ADHD have increased in all geographical regions over the past three decades, with a peak number of 42 publications in 2008. This rise in publications on ADHD LTOs may reflect a rise in global interest and recognition of consequences and impairment associated with ADHD. Although many world regions have published on ADHD LTOs, the majority of studies have emerged from the US and Canada, followed by Europe. While investigators in the US and Canada were predominantly interested in drug addiction as a LTO, European researchers were more interested in antisocial behavior, and Eastern Asian investigators focused on both of these LTOs as well as self-esteem. Geographical differences in the focus of ADHD LTO studies may reflect regional variations in cultural values. Proportionally fewer prospective longitudinal studies and proportionally more retrospective and cross-sectional studies have been published in more recent decades. Finally, more studies focusing on ADHD in adolescents and adults have been conducted in recent years, and particularly adolescents in Eastern Asia. These changes in basic study design may reflect an increase in the recognition that ADHD is a lifetime chronic disorder. This systematic review analysis of publication trends in ADHD LTOs reflects geographically based interests that change over time.
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Affiliation(s)
- Paul Hodgkins
- Shire Development Inc., Global Health Economics and Outcomes ResearchWayne, PA, USA
| | - L. Eugene Arnold
- Research Unit on Pediatric Psychopharmacology, Nisonger Center, The Ohio State UniversityColumbus, OH, USA
| | | | - Hervé Caci
- Hôpitaux Pédiatriques de Nice CHU LenvalNice, France
| | | | - Alisa G Woods
- BPS InternationalSan Diego, CA, USA
- Biochemistry and Proteomics Laboratory, Chemistry and Biomolecular Science, Clarkson UniversityPotsdam, NY, USA
| | - Susan Young
- King’s College London, Institute of PsychiatryLondon, UK
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