Childhood trauma exposure in substance use disorder patients with and without ADHD

Associated and intermediate factors between genetic variants of the dopaminergic D2 receptor gene and harmful alcohol use in young adults

Dopamine receptor D2 (DRD2) and ankyrin repeat and kinase domain-containing protein 1 (ANKK1) genes have received considerable attention for their involvement in alcohol use disorder (AUD), but many questions remain on their exact role. We conducted a population-based case-control and genetic association study in a large sample of young adults. Our aim was to assess the association between DRD2 and ANKK1 single nucleotide polymorphisms (SNPs) and harmful alcohol use, disentangling associated and possible intermediate factors. A total of 1841 college students from the French region Champagne-Ardennes, aged between 18 and 21 years and who reported at least one lifetime alcohol consumption, were included in this study. Allele frequencies were analysed according to harmful alcohol use (assessed through the Alcohol Use Disorder Identification Test [AUDIT] questionnaire). Different substance use disorders, including nicotine and cannabis dependences, were also assessed through questionnaires, as was a list of potential associated factors (e.g., major depressive episode, conduct disorder, attention-deficit/hyperactivity disorder [ADHD], school failure, sugar consumption, sexual trauma, parents' use of alcohol, tobacco or cannabis). We found that DRD2 rs1800498 was associated with harmful alcohol use. Many factors were detected, but a global path analysis revealed that DRD2 rs1800498 had a significant direct effect on harmful alcohol use and that early age at first alcohol consumption and depressive symptoms moderated this effect. This study suggests an interplay between harmful alcohol use, DRD2 genotypes and other risk factors that, with a full understanding, could be useful for preventive purposes.

The translational genetics of ADHD and related phenotypes in model organisms

Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder resulting from the interaction between genetic and environmental risk factors. It is well known that ADHD co-occurs frequently with other psychiatric disorders due, in part, to shared genetics factors. Although many studies have contributed to delineate the genetic landscape of psychiatric disorders, their specific molecular underpinnings are still not fully understood. The use of animal models can help us to understand the role of specific genes and environmental stimuli-induced epigenetic modifications in the pathogenesis of ADHD and its comorbidities. The aim of this review is to provide an overview on the functional work performed in rodents, zebrafish and fruit fly and highlight the generated insights into the biology of ADHD, with a special focus on genetics and epigenetics. We also describe the behavioral tests that are available to study ADHD-relevant phenotypes and comorbid traits in these models. Furthermore, we have searched for new models to study ADHD and its comorbidities, which can be useful to test potential pharmacological treatments.

Drinking alcohol to cope with hyperactive ADHD? Self-reports vs. continuous performance test in patients with ADHD and/or alcohol use disorder

Rationale

Attention deficit/hyperactivity disorder (ADHD) is common in alcohol use disorder (AUD). Continuous performance tests (CPTs) allow to measure ADHD related deficits in a laboratory setting. Most studies on this topic focused on CPTs measuring inattention or impulsivity, disregarding hyperactivity as one of the core symptoms of ADHD.

Methods

We examined N = 47 in three groups (ADHD N = 19; AUD N = 16; ADHD + AUD N = 12) with questionnaires on ADHD core symptoms, executive functioning (EF), mind wandering, and quality of life (QoL). N = 46 (ADHD N = 16; AUD N = 16; ADHD + AUD N = 14) were examined with a CPT (QbTest^®) that also measures motor activity objectively.

Results

Inattention and impulsivity were significantly increased in AUD vs. ADHD and in AUD vs. ADHD + AUD. Hyperactivity was significantly higher in ADHD + AUD vs. ADHD and ADHD + AUD vs. AUD, but not in ADHD vs. AUD. EF was lower in both ADHD groups vs. AUD. Mind wandering was increased in both ADHD groups vs. AUD. QoL was significantly lower in ADHD + AUD compared to AUD. In contrast, results of the QbTest were not significantly different between groups.

Conclusion

Questionnaires are more useful in assessing ADHD core symptoms than the QbTest^®. Hyperactivity appears to be a relevant symptom in ADHD + AUD, suggesting a possible pathway from ADHD to AUD. The lower QoL in ADHD + AUD emphasizes the need for routine screening, diagnostic procedures and treatment strategies for this patient group.

Examination of childhood trauma and self-esteem of individuals who applied to the probation office due to substance use

Substance use is increasing worldwide, and this creates serious social, economic and psychological problems. This study aims to examine the sociodemographic, childhood trauma (CT), self-esteem level and clinical data of individuals diagnosed with substance use disorder (SUD) who applied to the Probation Unit and the control group and it also aims to compare these data. In this prospective cohort study, 73 individuals diagnosed with SUD, and a control group consisting of 73 simple randomly selected healthy individuals. It was determined that the participants in the SUD group had extremely significantly lower self-esteem and had a high level of CT exposure compared to the control group. When all the cases were examined in the study, it was observed that as the level of self-esteem decreased, the rate of exposure of CT was significantly higher. Participants with SUD were more exposed to emotional abuse, physical abuse, physical neglect, and physical abuse compared to control group. It was determined that those with substance use had a high rate of childhood trauma and low self-esteem. In effective fight against substance abuse, it was thought that sociocultural programs should be implemented, and accessibility of these programs should be expanded in order to increase individuals' self-esteem levels.

Experiencias adversas en la infancia y el uso de drogas en la adolescencia y adultez: un análisis de la evidencia

El objetivo de este estudio es la revisión de la evidencia actual sobre la relación entre la vivencia de experiencias adversas en la infancia y el posterior uso de drogas en la adolescencia y adultez, y sus características. La metodología utilizada fue una revisión sistemática de publicaciones científicas, entre el periodo 2013-2017, disponibles en la base de datos Scopus sobre experiencias adversas en la infancia y el uso de drogas en la adolescencia y adultez que arrojó un total de 69 publicaciones incluidas en el estudio. Las experiencias adversas en la infancia presentan una elevada relación con el uso y/o abuso de drogas en la adolescencia y adultez. El consumo de drogas en adolescentes y adultos expuestos a experiencias traumáticas en la infancia se da principalmente en hombres. Las drogas mayormente usadas son alcohol, tabaco, cannabis y fármacos no recetados y, en menor medida, opioides, cocaína y anfetaminas. Las drogas, en este sentido, cumplen el rol de barrera química para distanciar el dolor emocional que deriva del recuerdo de las experiencias traumáticas y su intensa carga psíquica. Se requieren acciones de promoción del buen trato en la infancia, así como el abordaje terapéutico temprano de niños expuestos a experiencias traumáticas.

Exploring the mediating role of methamphetamine use in the relationship between adverse childhood experiences and attempted suicide

OBJECTIVE

Methamphetamine (METH) use and adverse childhood experiences (ACEs) has been associated with an increased risk of suicidal behaviour. However, whether METH use underlies the risk of suicide attributable to ACEs is unknown and warrants investigation to inform preventive interventions. In this study, we examined the mediating role of METH use in the relationship between attempted suicide and ACEs.

METHOD

METH users recruited from a mandatory detoxification center (n = 346) and healthy controls (n = 342) both completed a survey related to 9 types of ACE, which was based the Family Health Questionnaire. A lifetime history of attempted suicide was obtained using the Chinese version of the Composite International Diagnostic Interview. We conducted a bootstrapped mediation analysis to examine the mediating effect of METH use on the association between ACEs and attempted suicide.

RESULTS

Female gender, METH use, and having multiple (≥3) ACEs were associated with an increased risk of attempted suicide. A dose-response relationship between the number of ACEs and suicide rate was observed among individuals with METH use. METH use significantly mediated the association between ACEs and attempted suicide in those with multiple (2 and 3 ACEs respectively with proportion mediated 0.16 and 0.42) and specific types of ACEs (physical abuse, witnessing maternal battering, household substance abuse, sexual abuse, and parental separation with proportion mediated 0.25, 0.35, 0.38, 0.48, 0.47 respectively).

CONCLUSION

Our study is the first to demonstrate that METH use partially mediates the association between ACEs and attempted suicide. Addressing METH use in people with ACEs could reduce their suicide risk.

Early life adversity and increased antisocial and depressive tendencies in young adults with family histories of alcohol and other substance use disorders: Findings from the Family Health Patterns project

•

Family histories of alcohol/drug use disorders are linked to risk-related traits.

•

Early life adversity was linked to additive increases in antisocial tendencies.

•

Similar results were seen for depressive tendencies.

•

Early life adversity may strongly contribute to family history associated risk.

Background

Individuals with a family history of alcohol and other substance use disorders (FH+) are several times more likely to develop alcohol problems compared to individuals with no such family histories (FH–). Here we sought to evaluate associations of early life adversity (ELA) with two key risk-related FH+ phenotypic characteristics: increased antisocial and depressive tendencies.

Methods

We examined data from 1187 FH+ and FH– young adults (average age 23.6 years old) with and without personal histories of substance use disorders. Antisocial tendencies were evaluated with the Socialization scale of the California Personality Inventory (CPI-So), while depressive tendencies were evaluated with the Beck Depression Inventory II (BDI).

Results

In general, being FH+, having a personal substance use disorder history, and experiencing greater levels of ELA were associated with lower CPI-So scores (indicating more antisocial tendencies) and higher BDI scores (indicating more depressive tendencies).

Conclusions

These results suggest that ELA is linked to increased antisocial and depressive tendencies observed in FH+ persons. Given that FH+ individuals are disproportionately exposed to ELA, this increased exposure may be a major contributor to these and other risk-related characteristics commonly present in FH+ individuals. Additional studies are needed to evaluate the impact of ELA on risk-related phenotypic characteristics, including prospective studies in early childhood and mechanistic studies evaluating pathways by which ELA exerts its effects on FH phenotypic characteristics.

Alcohol use disorders and ADHD

Despite a growing literature on the complex bidirectional relationship of ADHD and substance use, reviews specifically focusing on alcohol are scarce. ADHD and AUD show a significant genetic overlap, including genes involved in gluatamatergic and catecholaminergic neurotransmission. ADHD drives risky behavior and negative experiences throughout the lifespan that subsequently enhance a genetically increased risk for Alcohol Use Disorders (AUD). Impulsive decisions and a maladaptive reward system make individuals with ADHD vulnerable for alcohol use and up to 43 % develop an AUD; in adults with AUD, ADHD occurs in about 20 %, but is vastly under-recognized and under-treated. Thus, routine screening and treatment procedures need to be implemented in AUD treatment. Long-acting stimulants or non-stimulants can be used to treat ADHD in individuals with AUD. However, it is crucial to combine medical treatment for ADHD with pharmacotherapy and psychotherapy for AUD, and other comorbid disorders. Identification of individuals at risk for AUD, especially those with ADHD and conduct disorder or oppositional defiant disorder, is a key factor to prevent negative outcomes.

ADHD symptoms as risk factor for PTSD in inpatients treated for alcohol use disorder

Attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) are more common in alcohol use disorder (AUD) patients than in the general population. Still, there is a lack of knowledge about the relationship between the two conditions in these patients. The main objective of this study was to examine the prevalence of ADHD symptoms, and the relationship between ADHD symptoms and PTSD in AUD inpatients in treatment. Data from 85 AUD patients were collected. The Adult ADHD Self-Report Scale (ASRS) was used to measure ADHD symptoms in all patients. Differences between groups split by PTSD diagnosis and by ASRS clinical cut-off were described, and the relationship between ADHD symptom level and PTSD was tested in a multiple regression model. Almost half the patients scored above ASRS cut-off and 14% had PTSD. Of the patients whose score was above cut-off on the ASRS 23% had PTSD, versus 7% among those below cut-off. Higher ASRS score was associated with PTSD even when age, sex and trauma were adjusted for. This study confirms the high level of ADHD symptoms in AUD patients in treatment. Diagnostic evaluation of PTSD is recommended in patients with ADHD attending inpatient treatment programs for AUD.

Investigating causality between liability to ADHD and substance use, and liability to substance use and ADHD risk, using Mendelian randomization

Attention-deficit hyperactivity disorder (ADHD) has consistently been associated with substance use, but the nature of this association is not fully understood. To inform intervention development and public health messages, a vital question is whether there are causal pathways from ADHD to substance use and/or vice versa. We applied bidirectional Mendelian randomization, using summary-level data from the largest available genome-wide association studies (GWAS) on ADHD, smoking (initiation, cigarettes per day, cessation, and a compound measure of lifetime smoking), alcohol use (drinks per week, alcohol problems, and alcohol dependence), cannabis use (initiation), and coffee consumption (cups per day). Genetic variants robustly associated with the "exposure" were selected as instruments and identified in the "outcome" GWAS. Effect estimates from individual genetic variants were combined with inverse-variance weighted regression and five sensitivity analyses (weighted median, weighted mode, MR-Egger, generalized summary data-based MR, and Steiger filtering). We found evidence that liability to ADHD increases likelihood of smoking initiation and heaviness of smoking among smokers, decreases likelihood of smoking cessation, and increases likelihood of cannabis initiation. There was weak evidence that liability to ADHD increases alcohol dependence risk but not drinks per week or alcohol problems. In the other direction, there was weak evidence that smoking initiation increases ADHD risk, but follow-up analyses suggested a high probability of horizontal pleiotropy. There was no clear evidence of causal pathways between ADHD and coffee consumption. Our findings corroborate epidemiological evidence, suggesting causal pathways from liability to ADHD to smoking, cannabis use, and, tentatively, alcohol dependence. Further work is needed to explore the exact mechanisms mediating these causal effects.

Behavioral processes and risk for problem substance use in adolescents

This narrative review examines associations of delay discounting, response inhibition, sensation-seeking, and urgency with adolescent problem substance use. Each of these processes is linked to adult substance use disorders, is associated with conditions linked to increased risk for adolescent problem substance use, and predicts problem substance use. Notably, all processes are linked to early life adversity (ELA) exposure and most appear to help explain links between ELA exposure and problem substance use. These findings are consistent with a growing body of literature indicating ELA interferes with the development of neural circuits crucial to cognitive functioning and emotion regulation. Further, developmental trajectories of these processes generally align with maturational imbalance hypotheses of adolescent risk. Ongoing and pending large longitudinal studies may be essential for better understanding how ELA and other influences shapes these processes and the role of these processes in risk for problem substance use in adolescence and beyond. Finally it is possible that risk-related processes may be useful metrics in the context of implementing and evaluating strategies to prevent problem substance use in adolescence.

The International Collaboration on ADHD and Substance Abuse (ICASA): Mission, Results, and Future Activities

BACKGROUND

The International Collaboration on ADHD and Substance Abuse (ICASA) is a network of 28 centers from 16 countries initiated to investigate the link between attention deficit-hyperactivity disorder (ADHD) and substance use disorder (SUD). In this article, we present the mission, the results of finished studies, and the current and future research projects of ICASA.

METHODS

During the past 10 years, 3 cross-sectional studies were conducted: two International ADHD in Substance use disorders Prevalence (IASP-1 and IASP-2) studies, directed at the screening, diagnosis, and the prevalence of adult ADHD in treatment-seeking patients with SUD, and the Continuous performance test for ADHD in SUD Patients (CASP) study, testing a novel continuous performance test in SUD patients with and without adult ADHD. Recently, the prospective International Naturalistic Cohort Study of ADHD and Substance Use Disorders (INCAS) was initiated, directed at treatment provision and treatment outcome in SUD patients with adult ADHD.

RESULTS

The IASP studies have shown that approximately 1 in 6 adult treatment-seeking SUD patients also have ADHD. In addition, those SUD patients with adult ADHD compared to SUD patients without ADHD report more childhood trauma exposure, slower infant development, greater problems controlling their temperament, and lower educational attainment. Comorbid patients also reported more risk-taking behavior, and a higher rate of other psychiatric disorders compared to SUD patients without ADHD. Screening, diagnosis, and treatment of this patient group are possible even before abstinence has been achieved. The results of the CASP study are reported separately in this special issue.

CONCLUSIONS

The ICASA research to date has demonstrated a high prevalence of comorbid ADHD and SUD, associated with elevated rates of additional comorbidities and risk factors for adverse outcomes. More research is needed to find the best way to treat these patients, which is the main topic of the ongoing INCAS study.

Attention Deficit/Hyperactivity Disorder and Global Severity Profiles in Treatment-Seeking Patients with Substance Use Disorders

INTRODUCTION

Comorbid attention deficit/hyperactivity disorder (ADHD) is present in 15-25% of all patients seeking treatment for substance use disorders (SUDs). Some studies suggest that comorbid ADHD increases clinical severity related to SUDs, other psychiatric comorbidities, and social impairment, but could not disentangle their respective influences.

OBJECTIVES

To investigate whether comorbid adult ADHD in treatment-seeking SUD patients is associated with more severe clinical profiles in these domains assessed altogether.

METHODS

Treatment-seeking SUD patients from 8 countries (N = 1,294: 26% females, mean age 40 years [SD = 11 years]) were assessed for their history of DSM-IV ADHD, SUDs, and other psychiatric conditions and sociodemographic data. SUD patients with and without comorbid ADHD were compared on indicators of severity across 3 domains: addiction (number of SUD criteria and diagnoses), psychopathological complexity (mood disorders, borderline personality disorder, lifetime suicidal thoughts, or behavior), and social status (education level, occupational and marital status, and living arrangements). Regression models were built to account for confounders for each severity indicator.

RESULTS

Adult ADHD was present in 19% of the SUD patients. It was significantly associated with higher SUD severity, more frequent comorbid mood or borderline personality disorder, and less frequent "married" or "divorced" status, as compared with the absence of comorbid ADHD. ADHD comorbidity was independently associated with a higher number of dependence diagnoses (OR = 1.97) and more psychopathology (OR = 1.5), but not marital status.

CONCLUSIONS

In treatment-seeking SUD patients, comorbid ADHD is associated with polysubstance dependence, psychopathological complexity, and social risks, which substantiates the clinical relevance of screening, diagnosing, and treating ADHD in patients with SUDs.

ADHD Is Associated with a Higher Risk for Traumatic Events, Self-Reported PTSD, and a Higher Severity of PTSD Symptoms in Alcohol-Dependent Patients

INTRODUCTION

Alcohol dependence (AD) is frequently associated with attention-deficit/hyperactivity disorder (ADHD) as well as with posttraumatic stress disorder (PTSD).

OBJECTIVE

Aim of this study was to investigate whether in patients with AD, ADHD is associated with an increased rate of exposure to potentially traumatic events (PTEs) and PTSD, with increased PTSD severity and higher impact on daily functioning.

METHODS

Patients with AD were thoroughly assessed for ADHD during long-term residential treatment. Participants also completed the Posttraumatic Diagnostic Scale (PDS). The PDS is a 49-item self-report instrument that assesses exposure to different PTEs, DSM-IV criteria for PTSD, severity of PTSD, and related functional impairment.

RESULTS

Of 341 patients with AD, 66 were diagnosed with ADHD (19%). ADHD was associated with a more frequent exposure to PTEs (88 vs. 65%, p < 0.001). In patients with PTEs (n = 237), odds for PTSD were higher in ADHD versus no-ADHD patients (OR 8.9, 95% CI 3.9-20.5). Furthermore, PTSD severity and functional impairment were increased in ADHD patients.

CONCLUSIONS

ADHD in patients with AD is associated with a higher frequency of PTEs and PTSD with more severe and more impairing PTSD symptoms. In alcohol-dependent patients with ADHD, regular screening for PTSD should be considered.

Attention Deficit Hyperactivity Disorder, Impulsivity, Anxiety, and Depression Symptoms Mediating the Relationship Between Childhood Trauma and Symptoms Severity of Obsessive-Compulsive Disorder

Introduction

A growing body of research associates childhood trauma with obsessive-compulsive disorder (OCD). The aim of this study was to investigate the relationships between childhood trauma and OCD, including both its severity and OCD patients' comorbid impulsivity, ADHD, anxiety, and depressive symptoms.

Methods

A convenient sample consisting of 106 patients with OCD was given the Childhood Trauma Questionnaire (CTQ), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Wender Utah Rating Scale (WURS), Hamilton Rating Scale for Depression (HAM-D), Beck Anxiety Inventory (BAI), and Barratt Impulsivity Scale-11 (BIS-11).

Results

The results showed that childhood trauma indirectly predicts the severity of OCD and directly predicts comorbidities in OCD patients, including anxiety, ADHD, WURS, and impulsivity. Patients with childhood trauma had higher WURS, BAI, and BIS-11 scores and fewer years of education. Ongoing adult ADHD was more common in individuals with childhood trauma.

Conclusion

A history of childhood trauma in OCD patients has indirect effects on the severity of OCD and depressive symptoms and is associated with more severe anxiety, higher levels of impulsivity, higher prevalence of ADHD, and lower levels of education. More research is needed to clarify the effects of childhood trauma on OCD severity and comorbidity.

Diagnosis and treatment of patients with comorbid substance use disorder and adult attention-deficit and hyperactivity disorder: a review of recent publications

PURPOSE OF REVIEW

Attention-deficit and hyperactivity disorder (ADHD) often presents with comorbid substance use disorders (SUD). Due to similarities in key symptoms of both disorders and suboptimal efficacy of the available treatments, clinicians are faced with difficulties in the diagnosis and treatment of these patients with both disorders. This review addresses recent publications between 2017 and 2019 on the etiology, prevalence, diagnosis and treatment of co-occurring ADHD and SUD.

RECENT FINDINGS

ADHD is diagnosed in 15-20% of SUD patients, mostly as ADHD with combined (hyperactive/inattentive) presentation. Even during active substance use, screening with the Adult ADHD Self-Report Scale (ASRS) is useful to address whether further diagnostic evaluation is needed. After SUD treatment, the diagnosis of ADHD generally remains stable, but ADHD subtype presentations are not. Some evidence supports pharmacological treatment with long-acting stimulants in higher than usual dosages. Studies on psychological treatment remain scarce, but there are some promising findings on integrated cognitive behaviour therapy.

SUMMARY

Diagnosis and treatment of patients with comorbid ADHD and SUD remain challenging. As ADHD presentations can change during active treatment, an active follow-up is warranted to provide treatment to the individuals' personal strengths and weaknesses.

Early life adversity and increased delay discounting: Findings from the Family Health Patterns project

Increased discounting (devaluing) of delayed rewards is associated with nearly all types of substance use disorders (SUDs) and is also present in individuals with family histories of SUDs. Early life adversity (ELA) likely contributes to these findings as it is common in both individuals with SUDs and their children and is linked to increased delay discounting and other neurocognitive impairments in human and animal studies. Here we examined data from 1192 healthy young adults (average age 23.6 years old) with (SUDs+) and without (SUDs-) histories of SUDs and with (FH+) and without (FH-) family histories of SUDs. A 2-way ANOVA was conducted to examine the effects of SUDs (SUDs-, SUDs+) and FH (FH-, FH+) on delay discounting followed by an examination of the effects of adding ELA to the model. First, we replicated findings that SUDs+ and FH+ participants had increased rates of delay discounting. After taking ELA into account, the effect of SUDs and FH on delay discounting were both reduced but still significant. The association of ELA and delay discounting was similar in magnitude among both SUDs+ and SUDs- participants and FH+ and FH- participants; those with higher levels of ELA had increased delay discounting. Collectively, these findings indicate that increased ELA is closely associated with the increased delay discounting seen in SUDs+ and FH+ individuals and suggests ELA may be contributing to the increased delay discounting seen in these populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Enhanced Amygdala-Striatal Functional Connectivity during the Processing of Cocaine Cues in Male Cocaine Users with a History of Childhood Trauma

BACKGROUND AND AIMS

Childhood trauma is associated with increased levels of anxiety later in life, an increased risk for the development of substance use disorders, and neurodevelopmental abnormalities in the amygdala and frontostriatal circuitry. The aim of this study was to investigate the (neurobiological) link among childhood trauma, state anxiety, and amygdala-frontostriatal activity in response to cocaine cues in regular cocaine users.

METHODS

In this study, we included 59 non-treatment seeking regular cocaine users and 58 non-drug using controls. Blood oxygenation level-dependent responses were measured using functional magnetic resonance imaging while subjects performed a cue reactivity paradigm with cocaine and neutral cues. Psychophysiological interaction analyses were applied to assess functional connectivity between the amygdala and other regions in the brain. Self-report questionnaires were used to measure childhood trauma, state anxiety, drug use, drug use severity, and craving.

RESULTS

Neural activation was increased during the presentation of cocaine cues, in a widespread network including the frontostriatal circuit and amygdala in cocaine users but not in controls. Functional coupling between the amygdala and medial prefrontal cortex was reduced in response to cocaine cues, in both cocaine users and controls, which was further diminished with increasing state anxiety. Importantly, amygdala-striatal connectivity was positively associated with childhood trauma in regular cocaine users, while there was a negative association in controls. At the behavioral level, state anxiety was positively associated with cocaine use severity and craving related to negative reinforcement.

CONCLUSION

Childhood trauma is associated with enhanced amygdala-striatal connectivity during cocaine cue reactivity in regular cocaine users, which may contribute to increased habit behavior and poorer cognitive control. While we cannot draw conclusions on causality, this study provides novel information on how childhood trauma may contribute to the development and persistence of cocaine use disorder.

Diagnosing ADHD during active substance use: Feasible or flawed?

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is highly prevalent in patients with a substance use disorder (SUD). Because of possible problems with validity, diagnostic assessment of ADHD is usually postponed until after a period of abstinence, which may jeopardize adequate and timely treatment. The aim of this study is to investigate how a diagnostic assessment of ADHD in patients who are actively using substances compares to the results of a second assessment after a period of full or partial abstinence.

METHODS

Prospective test-retest study in a SUD treatment center among 127 treatment seeking adult SUD patients with a comorbid diagnosis of adult ADHD. Conners' Adult ADHD Diagnostic Interview for DSM-IV was administered at intake and after four SUD treatment sessions.

RESULTS

The mean time interval between intake and retest assessment was 78days (SD=32; range 31-248). At the second ADHD assessment, substance use had decreased to about 50% of baseline consumption. Of the 127 patients with an initial diagnosis of ADHD, 121 patients (95.3%) still fulfilled DSM-IV adult ADHD criteria at re-diagnosis. Subtyping of ADHD was less stable (Cohen's Kappa=0.53). Agreement on the number of childhood and adult ADHD symptoms between both assessments was good (intraclass correlation coefficient of 0.69 and 0.65, respectively). Sensitivity analyses in subgroups of patients who were fully abstinent during the second assessment yielded very similar results.

CONCLUSIONS

These findings strongly suggest that a pragmatic approach, in which patients are evaluated for ADHD even when they are not (yet) abstinent, is feasible and justifiable.