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Chao T, Todman M, Foltin RW, Evans SM, Bedi G. Laboratory method to induce state boredom increases impulsive choice in people who use cocaine and controls. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:42-53. [PMID: 37921613 DOI: 10.1080/00952990.2023.2248544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/12/2023] [Indexed: 11/04/2023]
Abstract
Background: Impulsive choice is associated with both cocaine use and relapse. Little is known about the influence of transient states on impulsive choice in people who use cocaine (PWUC).Objective: This study investigated the direct effects of induced boredom on impulsive choice (i.e., temporal discounting) in PWUC relative to well-matched community controls.Methods: Forty-one PWUC (≥1× cocaine use in past 3 months; 7 females) and 38 demographically matched controls (5 females) underwent two experimental conditions in counterbalanced order. Temporal discounting was assessed immediately after a standardized boredom induction task (peg-turning) and a self-selected video watched for the same duration (non-boredom). Subjective mood state and perceived task characteristics were assessed at baseline, during experimental manipulations, and after the choice task.Results: PWUC and controls were well matched on sex, age, and socioeconomic status. Groups were also similar in reported use of drugs other than cocaine, except for recent cigarette and alcohol use (PWUC > controls). As expected, peg-turning increased boredom in the sample overall, with higher boredom reported during peg-turning than the video (p < .001, η2p = .20). Participants overall exhibited greater impulsive choice after boredom than non-boredom (p = .028, η2p = .07), with no preferential effects in PWUC (p > .05, BF01 = 2.9).Conclusion: Experimentally induced boredom increased state impulsivity irrespective of cocaine use status - in PWUC and carefully matched controls - suggesting a broad link between boredom and impulsive choice. This is the first study to show that transient boredom directly increases impulsive choice. Data support a viable laboratory method to further parse the effects of boredom on impulsive choice.
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Affiliation(s)
- Thomas Chao
- Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - McWelling Todman
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Richard W Foltin
- Division on Substance Use Disorders, New York State Psychiatric Institute, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Suzette M Evans
- Division on Substance Use Disorders, New York State Psychiatric Institute, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Gillinder Bedi
- Centre for Youth Mental Health, The University of Melbourne and Substance Use Research Group, Melbourne, Orygen, Australia
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2
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Young S, Abbasian C, Al-Attar Z, Branney P, Colley B, Cortese S, Cubbin S, Deeley Q, Gudjonsson GH, Hill P, Hollingdale J, Jenden S, Johnson J, Judge D, Lewis A, Mason P, Mukherjee R, Nutt D, Roberts J, Robinson F, Woodhouse E, Cocallis K. Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement. World J Psychiatry 2023; 13:84-112. [PMID: 37033892 PMCID: PMC10075023 DOI: 10.5498/wjp.v13.i3.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/19/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.
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Affiliation(s)
- Susan Young
- Department of Psychology, Psychology Services Limited, Croydon CR9 7AE, United Kingdom
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Cyrus Abbasian
- Psychiatry-UK Limited, Cornwall PL33 9ET, United Kingdom
| | | | - Polly Branney
- ADHD and Autism, Oxford ADHD & Autism Centre, Headington OX3 7BX, United Kingdom
| | - Bill Colley
- CLC Consultancy, Dunkeld PH8 0AY, United Kingdom
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Sally Cubbin
- Adult ADHD, Adult ADHD Clinic Ltd, Oxford OX3 7RP, United Kingdom
| | - Quinton Deeley
- Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London Institute of Psychiatry, London SE5 8AF, United Kingdom
| | - Gisli Hannes Gudjonsson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Peter Hill
- Department of Psychiatry, University of London, London WC1E 7HU, United Kingdom
| | - Jack Hollingdale
- Department of Psychology, Compass Psychology Services Ltd, London BR1 9DX, United Kingdom
| | | | - Joe Johnson
- Halton and Knowsley Adult ADHD Team, Merseycare NHS Foundation Trust, Winwick WA2 9WA, United Kingdom
| | | | - Alexandra Lewis
- Department of Psychiatry, Fulbourn Hospital, Cambridge CB21 5EF, United Kingdom
| | - Peter Mason
- Department of Psychiatry, Dr Peter Mason ADHD & Psychiatry Services Limited, Liverpool L1 9AR, United Kingdom
| | - Raja Mukherjee
- Adult Neurodevelopmental Service, Horizon House, Epsom KT17 4QJ, United Kingdom
| | - David Nutt
- Department of Psychiatry, Imperial College London, London WS12 0NN, United Kingdom
| | - Jane Roberts
- Service User Representative, Gloucestershire GL1 3NN, United Kingdom
| | - Fiona Robinson
- Drug & Alcohol Services, Surrey & Borders Partnership Trust, Leatherhead KT22 7AD, United Kingdom
| | - Emma Woodhouse
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Kelly Cocallis
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington NE63 9JJ, United Kingdom
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3
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Palma-Álvarez RF, Barta C, Carpentier PJ, Carruthers S, Crunelle CL, Demetrovics Z, Dom G, Faraone SV, Franck J, Johnson B, Kapitány-Fövény M, Kaye S, Konstenius M, Matthys F, Moggi F, Møller M, Schellekens A, Skutle A, van de Glind G, van Emmerik-van Oortmerssen K, Verspreet S, Schoevers RA, Wallhed S, Levin FR, Grau-López L, Casas M, van den Brink W, Ramos-Quiroga JA. Validity of the ADHD module of the Mini International Neuropsychiatric Interview PLUS for screening of adult ADHD in treatment seeking substance use disorder patients: ADHD screening with MINI-Plus. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:11-15. [PMID: 32561156 DOI: 10.1016/j.rpsm.2020.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aims to assess the validity of the ADHD module of the Mini-International Neuropsychiatric Interview (MINI-Plus) in patients with substance use disorders (SUD), using the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as the external criterion. METHOD A cross sectional international multi-center study in 10 countries was conducted in treatment seeking SUD patients. A sample of 1263 patients with both MINI-Plus and CAADID was analyzed to determine the psychometric properties of the MINI-Plus. RESULTS According to the CAADID, 179 patients (14.2%) met criteria for adult ADHD, whereas according to the MINI-Plus 227 patients (18.0%) were identified as having adult ADHD. Sensitivity of the MINI-Plus ADHD module was 74%, specificity was 91%, positive predictive value was 60% and negative predictive value was 96%. Kappa was 0.60. CONCLUSION The MINI-Plus has acceptable criterion validity for the screening of adult ADHD in treatment seeking SUD patients. SCIENTIFIC SIGNIFICANCE On the basis of the results, The MINI-Plus may be used for the screening of ADHD in SUD patients.
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Affiliation(s)
- Raul Felipe Palma-Álvarez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology, Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | | | - Susan Carruthers
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Cleo L Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium; Toxicological Center, Antwerp University, Antwerp, Belgium
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Geert Dom
- Antwerp University (UA), Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium; Psychiatric Center Mutiversum, Boechout, Belgium
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Johan Franck
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brian Johnson
- Departments of Psychiatry and of Anesthesia, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Máté Kapitány-Fövény
- Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary; Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Sharlene Kaye
- National Drug and Alcohol Research Center, University of New South Wales, Sydney, Australia
| | - Maija Konstenius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Frieda Matthys
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Merete Møller
- Department for Substance Abuse Treatment, Østfold Hospital Trust, Norway
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behavior, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | | | | | - Katelijne van Emmerik-van Oortmerssen
- Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sara Wallhed
- Stockholm Centre for Dependency Disorders, Sweden
| | - Frances R Levin
- Columbia University, the New York State Psychiatric Institute, New York, NY, USA
| | - Lara Grau-López
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel Casas
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wim van den Brink
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
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4
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Effat S, Elshahawi H, Refaat G, Rabie M, Nasr A, Elrassas H. Adult attention-deficit hyperactivity disorder among patients with substance use disorders. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00249-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Attention-deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder that persists into adulthood. ADHD is a well-known risk factor for substance use disorder (SUD). However, the actual contribution of comorbidity is largely unknown. The current study investigated the prevalence of ADHD in a sample of abstinent patients compared to healthy controls.
Compared to 51 healthy controls, 51 patients seeking medical treatment for SUD were abstinent from any substance for at least 1 month, interviewed by the use of the ICD-10 symptom checklist, the Social Classification Scale, the Addiction Severity Index, Conners adult ADHD Rating Scales Self-Report (CAARS-S:L), and the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL).
Results
Using CAARS-S:L, the ADHD index showed that 9 subjects (17.6%) were diagnosed with adult ADHD. Using K-SADS-PL, 8 of the participants (15.7%) were found to have an adult ADHD diagnosis. Lower scores of the ADHD index are related to increased patients’ age, while increased scores of the ADHD index are related to more alcohol-related problems of the patients. The strongest predicting factors of increased ADHD index were drug problems and legal status.
Conclusions
The current study provides evidence of an increased diagnosis of adult ADHD in patients with substance use disorder, regardless of the type of substance abuse.
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Badrfam R, Zandifar A, Barkhori Mehni M, Farid M, Rahiminejad F. Comorbidity of adult ADHD and substance use disorder in a sample of inpatients bipolar disorder in Iran. BMC Psychiatry 2022; 22:480. [PMID: 35854247 PMCID: PMC9295524 DOI: 10.1186/s12888-022-04124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS The study of the relationship between adult Attention deficit hyperactivity disorder (ADHD) and bipolar disorder has received more attention in recent years and there is limited information in this area. On the other hand, there is a significant comorbidity between ADHD and bipolar disorder with substance use disorder. In this study, we investigated the prevalence of comorbidity of adult ADHD and substance use disorder among a group of bipolar patients admitted to a psychiatric hospital. METHODS One hundred fifty patients from a total of 200 consecutive patients who were referred to the emergency department of Roozbeh Psychiatric Hospital in Tehran, diagnosed with bipolar disorder based on the initial psychiatric interview and needed hospitalization, were evaluated again by an experienced faculty member psychiatrist by using a subsequent interview based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5). They were evaluated using the Structured Clinical Interview for DSM-5 (SCID-5) questionnaire to confirm the diagnosis of bipolar disorder and the comorbidity of adult ADHD and substance use disorder. RESULTS From 150 patients diagnosed with bipolar disorder, 106 patients (70.7%) had adult ADHD. 89 patients (59.3%) had substance use disorder and 58 patients (38.7%) had both of these comorbidities with bipolar disorder. Comorbidity of adult ADHD was associated with the earlier onset of the first mood episode in bipolar disorder (p value = 0.025). There was no statistically significant relationship between substance use disorder and age of onset of the first episode. (P value = 0.57). CONCLUSIONS Due to the limitations of studies on adult ADHD comorbidity with bipolar disorder, especially in hospital settings, as well as the increased risk of association with substance use disorder, further multicenter studies in this area with larger sample sizes can increase awareness in this regard.
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Affiliation(s)
- Rahim Badrfam
- grid.411705.60000 0001 0166 0922Department of Psychiatry, Faculty of Medicine, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Zandifar
- grid.411705.60000 0001 0166 0922Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran ,grid.411705.60000 0001 0166 0922Department of Psychiatry, Imam Hossein Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahdi Barkhori Mehni
- grid.411705.60000 0001 0166 0922Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Farid
- grid.411705.60000 0001 0166 0922Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran ,grid.411705.60000 0001 0166 0922Non Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Rahiminejad
- Department of Psychiatry, Faculty of Medicine, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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van Kernebeek MW, Vorspan F, Crunelle CL, van den Brink W, Dom G, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Ramos-Quiroga JA, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F, Icick R. Consensus International sur le dépistage, le diagnostic et le traitement des patients avec troubles de l’usage de substances en cas de comorbidité avec un trouble du déficit de l’attention avec ou sans hyperactivité. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Therribout N, Karsinti E, Morel A, Dereux A, Vorspan F, Romo L, Icick R. Feasibility of an Extensive Strategy for Adult Diagnosis of Attention Deficit Hyperactivity Disorder Among Patients Suffering From Substance Use Disorders. Front Psychiatry 2022; 13:803227. [PMID: 35836660 PMCID: PMC9273821 DOI: 10.3389/fpsyt.2022.803227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Attention Deficit Hyperactivity Disorder (ADHD) is found in up to 20% adults with Substance Use Disorder (SUD). ADHD + SUD is associated with a more complex clinical presentation and poorer outcomes than each disorder alone. In the presence of SUD, adult ADHD is particularly difficult to diagnose as both disorders can mimic or hide the symptoms of each other. Our university hospital in Paris recently started an extensive outpatient diagnostic procedure for adult patients with SUD to ascertain or refute ADHD diagnosis and to provide therapeutic guidance. Here, we report the acceptability of the assessment procedure for patients and the preliminary description of the current and lifetime clinical profiles as a function of the final diagnosis "ADHD vs. no ADHD." METHOD Adult SUD patients with suspected ADHD were included in the current pilot study after stating they had no objection that their de-identified data were used for research purposes, according to French ethical procedures. Patients were evaluated for ADHD, comorbid mental disorders, cognitive state and dimensional psychological variables. They were assessed by trained psychologists and psychiatrists using standardized tools over a day. ADHD diagnosis was mainly based on the Diagnostisch Interview Voor ADHD for DSM-5 (DIVA-5). RESULTS Out of 18 eligible patients, 17 were included in the cohort (1 excluded) and none was opposed to using their data. Thirteen (76%) participants were diagnosed with ADHD. All patients appointed for the ADHD diagnostic procedure came, respected schedules and finished the evaluation. All patients were impaired on cognitive functioning and were highly comorbid, but ADHD patients seems to suffer even more from those conditions, especially for cannabis and stimulant use disorders. DISCUSSION Preliminary results show high acceptability of the procedure by ADHD-SUD patients. This result could be explained by all the organization adapted to the psychopathology. Patients' baseline motivation to participate also represents an uncontrolled variable that could promote the ability to follow the procedure. Acceptance results of the protocol are promising and represent a starting point to identify the best procedures to design patient-centered pharmacological and non-pharmacological therapies.
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Affiliation(s)
- Norman Therribout
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,Laboratoire Clipsyd EA 4430, Université Paris-Nanterre, Nanterre, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Emily Karsinti
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,Laboratoire Clipsyd EA 4430, Université Paris-Nanterre, Nanterre, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Alix Morel
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Alexandra Dereux
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Florence Vorspan
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
| | - Lucia Romo
- Laboratoire Clipsyd EA 4430, Université Paris-Nanterre, Nanterre, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.,CESP, U1018 INSERM UPS UVSQ, Villejuif, France
| | - Romain Icick
- Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.,Université de Paris Cité, INSERM UMR-S1144, Paris, France.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France
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Cavicchioli M, Ogliari A, Movalli M, Maffei C. Persistent Deficits in Self-Regulation as a Mediator between Childhood Attention-Deficit/Hyperactivity Disorder Symptoms and Substance Use Disorders. Subst Use Misuse 2022; 57:1837-1853. [PMID: 36096483 DOI: 10.1080/10826084.2022.2120358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The link between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) has been largely demonstrated. Some scholars have hypothesized that self-regulation mechanisms might play a key role in explaining this association. Objective(s): The current study tested the hypothesis that retrospective childhood ADHD symptoms might lead to more severe SUDs and this association should be mediated by current self-ratings of behavioral disinhibition, inattention, and emotional dysregulation among 204 treatment-seeking adults (male: 67.3%; female: 32.7%) with a primary diagnosis of alcohol use disorder and other SUDs. Methods: The mediational model was estimated through self-report measures of childhood ADHD symptoms (independent variable; WURS), current self-regulation mechanisms (mediators)-behavioral disinhibition (BIS-11 motor subscale), difficulties with attention regulation (MAAS) and emotion regulation (DERS)-and severity of SUDs (dependent variable; SPQ alcohol, illicit and prescribed drugs). Results: The analysis showed that alterations in the self-regulation system fully mediated the association between the severity of childhood ADHD symptoms and SUDs in adulthood. Behavioral disinhibition and difficulties in attention regulation were the most representative alterations in self-regulation processes that explained this association. Conclusions: These findings suggest it is useful to implement several therapeutic approaches (e.g. behavioral, mindfulness-based, and pharmacological) to increase the self-regulation abilities of children and adolescents with ADHD in order to reduce the probability of SUD onset in adulthood. However, future longitudinal neuroimaging and neuropsychological studies are needed to further support the role of self-regulation mechanisms in explaining the prospective association between childhood ADHD symptoms and SUDs in adulthood.
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Affiliation(s)
- Marco Cavicchioli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Anna Ogliari
- Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy.,Child in Mind Lab, University "Vita-Salute San Raffaele", Milan, Italy
| | - Mariagrazia Movalli
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Cesare Maffei
- Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.,Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
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Onandia-Hinchado I, Pardo-Palenzuela N, Diaz-Orueta U. Cognitive characterization of adult attention deficit hyperactivity disorder by domains: a systematic review. J Neural Transm (Vienna) 2021; 128:893-937. [PMID: 33620582 DOI: 10.1007/s00702-021-02302-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is reportedly the most frequent neurodevelopmental disorder diagnosed during childhood, and it is recognized as a common condition in adulthood. We review the evidence to help identify cognitive domains associated to deficits in adult ADHD. A systematic review with narrative synthesis was performed, assessing studies on adult ADHD, neuropsychology and research on involved cognitive domains in adults 18+ years old with an established diagnosis of ADHD, in seven electronic databases (PubMed, PsychInfo, WebOfScience, Embase, Scopus, OvidSPMedline, and Teseo), and Worldcat and OpenGrey grey literature databases. 93 studies were included for this review, encompassing findings from a total 5574 adults diagnosed only with ADHD, medication-naïve or non-medicated at the moment of the assessment and 4880 healthy controls. Adults diagnosed with ADHD may show, when compared to healthy controls, a cognitive profile characterized by deficits across all attention modalities, processing speed, executive function (mainly working memory and inhibition with emphasis on reward delay and interference control), verbal memory, reading skills, social cognition and arithmetic abilities. A cognitive characterization of adult ADHD by domains is established beyond the sole consideration of attention and executive function problems. Along with these, verbal memory, language (mainly reading), social cognition and arithmetic abilities may also contribute to a more comprehensive characterization of the cognitive profile in adult ADHD.
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Affiliation(s)
| | | | - Unai Diaz-Orueta
- Department of Psychology, Maynooth University, Room 3.11, John Hume Building, North Campus, Maynooth, Co. Kildare, Ireland.
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Gupta S, Bhatia G, Sarkar S, Chatterjee B, Balhara YPS, Dhawan A. Adult attention-deficit hyperactivity disorders and its correlates in patients with opioid dependence: An exploratory study. Indian J Psychiatry 2020; 62:501-508. [PMID: 33678830 PMCID: PMC7909024 DOI: 10.4103/psychiatry.indianjpsychiatry_705_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/07/2020] [Accepted: 06/17/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Adult attention-deficit hyperactivity disorder (ADHD) often remains undiagnosed and undertreated among patients with substance use disorders (SUDs). Research is lacking with regard to adult ADHD in individuals with SUD. The current work was intended to study the prevalence of adult ADHD among individuals with opioid dependence and its correlates, and to assess the attitude of the individuals with adult ADHD toward its treatment. METHODS This cross-sectional survey was conducted in 132 consecutive inpatients with opioid-dependence syndrome. Patients were assessed using the Mini International Neuropsychiatric Interview. 5.0, adult ADHD Self-Report Screening Scale, and Maudsley Addiction Profile. Those who screened positive for adult ADHD (ADHD+) were compared with those screened negative (ADHD-) on a number of sociodemographic, substance use, and clinical variable. Furthermore, attitude toward the treatment for ADHD was assessed among the ADHD+ individuals. RESULTS About a fifth (n=24, 18.2%) of the patients with opioid dependence screened positive for adult ADHD. One-third of the participants (n=8, 33.3%) were willing for the treatment of any kind, and only a half (n=3) was willing to pay. Earlier age of onset of opioid use (relative risk: 0.01; 95% confidence interval: 0.003, 0.85; P = 0.036) had higher likelihood to ADHD+ status. CONCLUSION Despite a high rate of ADHD screen positivity among individuals with opioid dependence, a majority were not willing to receive the treatment. Sensitization of: (1) addiction psychiatrist to routinely screen for ADHD, especially in the presence of certain correlates and (2) patients-caregivers about the potential benefit of treatment in effectively addressing the symptoms of ADHD effectively in this population.
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Affiliation(s)
- Snehil Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Gayatri Bhatia
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Biswadip Chatterjee
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anju Dhawan
- Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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11
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Adorjan K, Pogarell O. [What needs to be considered in diagnostics and therapy]. MMW Fortschr Med 2020; 162:42-51. [PMID: 32221872 DOI: 10.1007/s15006-020-0005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Kristina Adorjan
- Institut für Psychiatrische Phänomik und Genomik (IPPG), Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Nussbaumstr. 7, D-80336, München, Deutschland.
| | - Oliver Pogarell
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Deutschland
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12
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Adorjan K, Karch S, Martin G, Plörer D, Winter C, Hantschk I, Koller G, Erbas B, Pogarell O. [Adult attention deficit hyperactivity disorder (ADHD) with comorbid addictive disorder. Therapeutic challenges using the example of a survey of clinical practice]. MMW Fortschr Med 2019; 161:7-12. [PMID: 31313269 DOI: 10.1007/s15006-019-0740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/06/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND ADHD in childhood and adolescence is characterized by the symptoms hyperactivity, impulsivity, and inattentiveness; these symptoms may persist into adulthood or may manifest as restlessness, emotional instability, and disorganized behavior. In adults ADHD often occurs with increased substance use and is associated with an early onset of substance use, development of severe addiction, and decreased treatment effectiveness. METHOD This overview will present and critically discuss current study results and evidence-based and consensus-oriented recommendations that ensure the most adequate care for patients with ADHD and addictive disorder. RESULTS AND CONCLUSIONS For drug therapy, the current S3 guideline recommends methylphenidate, amphetamine salts, and atomoxetine, among others. Treatment of adult patients with ADHD and addiction with stimulants tends to be viewed critically; if required, long-acting medications should be used. Integrated treatment of ADHD and addiction, consisting of a combination of pharmacotherapy and psychotherapy, is recommended.
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Affiliation(s)
- Kristina Adorjan
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Nußbaumstraße 7, 80336, München, Deutschland.
- Institut für Psychiatrische Phänomik und Genomik (IPPG), Klinikum der Universität München (LMU), München, Deutschland.
| | - Susanne Karch
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Nußbaumstraße 7, 80336, München, Deutschland
| | - Gabi Martin
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Nußbaumstraße 7, 80336, München, Deutschland
| | - Diana Plörer
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Nußbaumstraße 7, 80336, München, Deutschland
| | - Catja Winter
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Nußbaumstraße 7, 80336, München, Deutschland
| | - Irmgard Hantschk
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Nußbaumstraße 7, 80336, München, Deutschland
| | - Gabi Koller
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Nußbaumstraße 7, 80336, München, Deutschland
| | - Beate Erbas
- Bayerische Akademie für Sucht- und Gesundheitsfragen (BAS) München, München, Deutschland
| | - Oliver Pogarell
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München (LMU), Nußbaumstraße 7, 80336, München, Deutschland
- Bayerische Akademie für Sucht- und Gesundheitsfragen (BAS) München, München, Deutschland
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Nankoo MMA, Palermo R, Bell JA, Pestell CM. Examining the Rate of Self-Reported ADHD-Related Traits and Endorsement of Depression, Anxiety, Stress, and Autistic-Like Traits in Australian University Students. J Atten Disord 2019; 23:869-886. [PMID: 29502467 DOI: 10.1177/1087054718758901] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the rate of ADHD-related traits among young adults in an Australian university, and to examine whether higher endorsement of ADHD-related symptoms is associated with self-reported symptoms of depression, anxiety, distress, and autistic-like traits. METHOD In total, 1,002 students aged 17 to 25 years completed the Conners' Adult ADHD Rating Scale (CAARS), the Depression, Anxiety, and Stress Scale (DASS), and the Autism Quotient (AQ). RESULTS About 17.3% of students reported "at-risk" levels of ADHD-related symptoms. Regression analyses revealed that CAARS scores explained unique variance in self-reported levels of depression, anxiety, stress, and autism-related traits. CONCLUSION The rate of self-reported ADHD symptoms is higher in Australian undergraduate students than that reported in previous studies using the CAARS to investigate rates of diagnosed students. Problems with self-concept accounted for the most unique variance in DASS subscale scores. Hyperactivity/restlessness and inattention/memory problems accounted for the most unique variance in AQ-Social and AQ-Attention-to-Detail scores, respectively.
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Affiliation(s)
| | - Romina Palermo
- 1 The University of Western Australia, Crawley, Australia
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14
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Flores-García L, Lensing MB, Ytterstad E, Eisemann M. Quality of life in substance use disorder patients with and without attention deficit hyperactivity disorder 12 months after treatment: a naturalistic follow-up study. ACTA ACUST UNITED AC 2019; 11:299-310. [PMID: 30903585 DOI: 10.1007/s12402-019-00297-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/01/2019] [Indexed: 12/15/2022]
Abstract
There is sparse research on quality of life (QoL) as an outcome measure in patients with substance use disorders (SUD), with or without attention deficit hyperactivity disorder (ADHD). We aimed to investigate whether SUD patients with and without ADHD (SUD + ADHD vs. SUD - ADHD) differed in QoL at baseline and at a 12-month follow-up after SUD treatment. The groups were additionally compared with data from a national population sample (NPS). From a sample of 16 SUD + ADHD and 87 SUD - ADHD patients originally recruited between 2010 and 2012, eight SUD + ADHD (50.0%) and 28 SUD - ADHD (32.2%) patients were reached at follow-up. QoL was measured with the short version of the World Health Organization QoL instrument (WHOQOL-BREF). Cross-sectional data on QoL from NPS was utilized. Compared to NPS, SUD patients reported significantly lower QoL at baseline and follow-up. Furthermore, QoL was similar at baseline in SUD + ADHD and SUD - ADHD patients. At a 12-month follow-up after SUD treatment, SUD + ADHD patients 'QoL had improved, however, not significantly differing from SUD - ADHD patients or the NPS. SUD - ADHD patients' QoL remained significantly lower. At follow-up, SUD + ADHD patients' QoL improved nominally compared to SUD - ADHD patients, but not the NPS. The clinical and functional relevance of these findings should be investigated further.
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Affiliation(s)
- Lizbett Flores-García
- Division of Mental Health and Substance Abuse, Section for Substance Use Disorders, University Hospital of Northern Norway, Postbox 6124, 9291, Tromsø, Norway.
- Department of Psychology, Faculty of Health Sciences, UiT, The Arctic University of Norway, 9037, Tromsø, Norway.
| | - Michael B Lensing
- Division of Pediatric and Adolescent Medicine, NevSom- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Postboks 4956, 0424, Nydalen, Oslo, Norway
| | - Elinor Ytterstad
- Department of Mathematics and Statistics, Faculty of Science and Technology, UiT, The Arctic University of Norway, 9037, Tromsø, Norway
| | - Martin Eisemann
- Department of Psychology, Faculty of Health Sciences, UiT, The Arctic University of Norway, 9037, Tromsø, Norway
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Screening for adult attention-deficit/hyperactivity disorder in alcohol dependent patients: Underreporting of ADHD symptoms in self-report scales. Drug Alcohol Depend 2019; 195:52-58. [PMID: 30583265 DOI: 10.1016/j.drugalcdep.2018.11.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a common comorbid disorder that is frequently overlooked in adults with alcohol use disorder (AUD). Moreover, identifying ADHD in AUD patients is time-consuming and difficult. The aim of this study was to assess the clinical utility of two self-report screening instruments for adult ADHD in AUD patients. METHODS 404 adults seeking residential treatment for AUD were screened using the Conners' Adult ADHD Rating Scale Screening Self-Rating (CAARS-S-SR) and the Adult ADHD Rating Scale (ASRS). Results were compared with ADHD diagnosis obtained from a stepped approach: first, a structured interview (Diagnostic Interview for ADHD in adults 2.0.; DIVA) was applied; second, probable ADHD diagnoses had to be confirmed by two expert clinicians. RESULTS At the previously reported cut-off values, ASRS and CAARS-S-SR showed low sensitivities of 57.1 and 70.6%. A high number of false negative results (NPV ASRS: 89.5%; CAARS-S-SR: 92.3%) indicates underreporting of ADHD symptoms. Sensitivity improved at lower cut-off (ASRS ≥ 11; CAARS-S-SR ≥60) or with a combination of both instruments at lower cut-offs. Area Under the Curve (AUC) for the combination of ASRS and CAARS-S-SR was superior to the AUCs of the single questionnaires. CONCLUSIONS Underreporting of ADHD symptoms in ASRS and CAARS-S-SR of AUD patients requires lower cut-off values to detect the majority of ADHD, albeit at the expense of an increased rate of false-positive results. Cut-off values should be adjusted to the clinical setting. Clinicians should take into consideration that a negative screening result does not necessarily imply absence of ADHD.
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16
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Fairman KA, Davis LE, Peckham AM, Sclar DA. Diagnoses of Cardiovascular Disease or Substance Addiction/Abuse in US Adults Treated for ADHD with Stimulants or Atomoxetine: Is Use Consistent with Product Labeling? Drugs Real World Outcomes 2018; 5:69-79. [PMID: 29305714 PMCID: PMC5825392 DOI: 10.1007/s40801-017-0129-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Among US adults, utilization of pharmacotherapy for attention-deficit hyperactivity disorder (ADHD) has increased more than ninefold since 1995–1996. Potential contraindications to ADHD pharmacotherapy include serious cardiovascular disease (CVD) and, for stimulants, addictions and bipolar disorder (BPD). Objective To assess the prevalence of potential contraindications among adults treated with ADHD pharmacotherapy. Methods A retrospective cohort analysis was performed using the Truven Health MarketScan® database. Subjects filled ≥ 1 prescription for atomoxetine or ≥ 1 stimulant in 2014–2015, were aged 18–64 years, commercially insured throughout observation, and diagnosed with ADHD on two or more medical claims. Diagnoses and medical procedures were measured in the 12 months prior to pharmacotherapy initiation. Metrics included serious CVD (cardiomegaly, cardiomyopathy, cerebrovascular occlusion, congestive heart failure, myocardial infarction, pacemaker, or valvular disorder) and any CVD (serious CVD, other atherosclerotic CVD, arrhythmia, congenital heart anomaly, or hypertensive heart disease). Rates of substance addiction or abuse were measured in a range to address nonspecific diagnostic coding. Results Only 2.0% of treated adults (n = 91,588) had one or more diagnosis indicating serious CVD. CVD prevalence increased monotonically with age. Of patients aged 55–64 years (n = 5,237), 7.2% had serious CVD; 15.9% had any CVD; and 1.9% had been hospitalized with one or more CVD. Of patients treated with stimulants (n = 87,167), 11.3–18.5% were diagnosed with addiction/abuse and 4.1% with BPD. Conclusions CVD prevalence is generally low among adults using ADHD medication but increases with age. Although difficult to estimate precisely, the rate of addiction/abuse among stimulant-treated patients appears unexpectedly high. Further research should assess cardiovascular events and other potential harms associated with contraindicated use in high-risk adults. Electronic supplementary material The online version of this article (10.1007/s40801-017-0129-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathleen A Fairman
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University-Glendale, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA.
| | - Lindsay E Davis
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University-Glendale, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA
| | - Alyssa M Peckham
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University-Glendale, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA
| | - David A Sclar
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University-Glendale, 19555 N. 59th Avenue, Glendale, AZ, 85308, USA
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Crunelle CL, van den Brink W, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F. International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder. Eur Addict Res 2018; 24:43-51. [PMID: 29510390 PMCID: PMC5986068 DOI: 10.1159/000487767] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/18/2018] [Indexed: 12/22/2022]
Abstract
Adult attention deficit/hyperactivity disorder (ADHD) often co-occurs with substance use disorders (SUD) and is associated with early onset and more severe development of SUD and with reduced treatment effectiveness. Screening tools allow for a good recognition of possible ADHD in adults with SUD and should be used routinely, followed by an ADHD diagnostic process initiated as soon as possible. Simultaneous and integrated treatment of ADHD and SUD, using a combination of pharmaco- and psychotherapy, is recommended. Long-acting methylphenidate, extended-release amphetamines, and atomoxetine with up-titration to higher dosages may be considered in patients unresponsive to standard doses. This paper includes evidence- and consensus-based recommendations developed to provide guidance in the screening, diagnosis and treatment of patients with ADHD-SUD comorbidity.
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Affiliation(s)
- Cleo L. Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium,Toxicological Center, Antwerp University, Antwerp, Belgium
| | - Wim van den Brink
- Amsterdam Institute of Addiction Research (AIAR), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Franz Moggi
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | | | | | - Frances R. Levin
- Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Corné Coetzee
- Department of Pharmacy, University of Limpopo, Sovenga, South Africa
| | - Mathias Luderer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behavior, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | | | - Frieda Matthys
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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van Emmerik-van Oortmerssen K, Vedel E, Kramer FJ, Koeter MW, Schoevers RA, van den Brink W. Diagnosing ADHD during active substance use: Feasible or flawed? Drug Alcohol Depend 2017; 180:371-375. [PMID: 28957778 DOI: 10.1016/j.drugalcdep.2017.07.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Katelijne van Emmerik-van Oortmerssen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands; Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; Jellinek Substance Abuse Treatment Center, Amsterdam, The Netherlands.
| | - Ellen Vedel
- Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; Jellinek Substance Abuse Treatment Center, Amsterdam, The Netherlands
| | - Floor J Kramer
- Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; Jellinek Substance Abuse Treatment Center, Amsterdam, The Netherlands
| | - Maarten W Koeter
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, 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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Rief W. Neurofeedback in adults with attention-deficit hyperactivity disorder. Lancet Psychiatry 2017; 4:650-651. [PMID: 28803031 DOI: 10.1016/s2215-0366(17)30314-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Winfried Rief
- Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany.
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Tamburin S, Federico A, Morbioli L, Faccini M, Casari R, Zamboni L, Briguglio G, Lugoboni F. Screening for adult attention deficit/hyperactivity disorder in high-dose benzodiazepine dependent patients. Am J Addict 2017; 26:610-614. [DOI: 10.1111/ajad.12573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/09/2017] [Accepted: 05/13/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine, and Movement Sciences; University of Verona; Verona Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine, and Movement Sciences; University of Verona; Verona Italy
| | - Laura Morbioli
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
| | - Marco Faccini
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
| | - Rebecca Casari
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
| | - Lorenzo Zamboni
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
| | - Giuseppe Briguglio
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
| | - Fabio Lugoboni
- Department of Medicine, Addiction Medicine Unit; Verona University Hospital; Verona Italy
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21
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Lugoboni F, Levin FR, Pieri MC, Manfredini M, Zamboni L, Somaini L, Gerra G, Gruppo InterSert Collaborazione Scientifica Gics. Co-occurring Attention Deficit Hyperactivity Disorder symptoms in adults affected by heroin dependence: Patients characteristics and treatment needs. Psychiatry Res 2017; 250:210-216. [PMID: 28473157 PMCID: PMC5518312 DOI: 10.1016/j.psychres.2017.01.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/25/2016] [Accepted: 01/20/2017] [Indexed: 12/30/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a risk for substance use disorders. The aim of this study was to investigate the association between adult ADHD symptoms, opioid use disorder, life dysfunction and co-occurring psychiatric symptoms. 1057 heroin dependent patients on opioid substitution treatment participated in the survey. All patients were screened for adult ADHD symptoms using the Adult ADHD Self-Report Scale (ASRS-v1.1). 19.4% of the patients screened positive for concurrent adult ADHD symptoms status and heroin dependence. Education level was lower among patients with ADHD symptoms, but not significant with respect to non-ADHD patients. Patients with greater ADHD symptoms severity were less likely to be employed. A positive association was observed between ADHD symptoms status and psychiatric symptoms. Patients with ADHD symptoms status were more likely to be smokers. Patients on methadone had a higher rate of ADHD symptoms status compared to buprenorphine. Those individuals prescribed psychoactive drugs were more likely to have ADHD symptoms. In conclusion, high rate of ADHD symptoms was found among heroin dependent patients, particularly those affected by the most severe form of addiction. These individuals had higher rates of unemployment, other co-morbid mental health conditions, heavy tobacco smoking. Additional psychopharmacological interventions targeting ADHD symptoms, other than opioid substitution, is a public health need.
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Affiliation(s)
- Fabio Lugoboni
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona 37134, Italy
| | - Frances Rudnick Levin
- Division of Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | | | | | - Lorenzo Zamboni
- Department of Internal Medicine, Addiction Unit, Verona University Hospital, Verona 37134, Italy
| | - Lorenzo Somaini
- Addiction Treatment Centre, Local Health Service, Cossato, Biella, Italy.
| | - Gilberto Gerra
- Drug Prevention and Health Branch, United Nations Office on Drugs and Crime (UNODC), Vienna
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Evaluate pharmacologic treatment of attention deficit/hyperactivity disorder (ADHD) in patients with substance use disorder (SUD) • Assess the causes of the diminished efficacy of ADHD medication in patients with comorbid SUD OBJECTIVE: Substance use disorder (SUD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, and the presence of ADHD complicates the treatment of the addiction. Pharmacotherapy is a potent intervention in childhood and adult ADHD, but findings have been mixed in adolescent and adult ADHD patients with SUDs. This review focuses on several contributing factors and possible explanations, with implications both for future research and for clinical practice. METHOD This systematic review examined all randomized, placebo-controlled trials of pharmacotherapy for ADHD in adult and adolescent SUD patients. RESULTS The number of studies is limited, and several studies are hampered by qualitative flaws. The results, in general, are inconclusive for most medications studied, but more recent trials using psychostimulants in robust dosing have demonstrated significantly positive results. CONCLUSION In reviewing these trials, possible explanations relating to the particular characteristics and problems of this complex patient group are discussed. Several factors, including ADHD symptom severity, psychiatric comorbidity, persistent drug use, choice of medication, and concomitant psychosocial intervention, influence study results. Taking these factors into account may improve the likelihood of detecting significant effects in future research, as the recent positive trials have indicated, and may help in the appropriate selection of pharmacotherapy in clinical practice.
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Addiction severity pattern associated with adult and childhood Attention Deficit Hyperactivity Disorder (ADHD) in patients with addictions. Psychiatry Res 2016; 246:656-662. [PMID: 27842945 DOI: 10.1016/j.psychres.2016.10.071] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 09/12/2016] [Accepted: 10/30/2016] [Indexed: 12/14/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is highly prevalent among adults with addictive disorders, but little is known about addiction patterns associated with ADHD diagnosis. This study examined addiction severity in patients with co-occurring addictive disorders and ADHD controlling for the potential influence of associated psychiatric comorbidity. Data were collected in French outpatient addiction treatment centers. A total of 217 patients seeking treatment for substance or gambling addiction were included. At treatment entry, participants were interviewed with the Addiction Severity Index, the Conners Adult ADHD Diagnosis Interview for the DSM-IV (CAADID), the Mini International Neuropsychiatric Interview (MINI) and the Structured Clinical Interview for DSM-IV Axis II for borderline personality disorder (SCID II). History of ADHD was associated with an earlier onset of addiction, poly-dependence (defined by presence of at least two current substance dependence diagnoses in addition to tobacco dependence if present) and borderline personality disorder. Persistence of ADHD during adulthood was associated with a higher prevalence of poly-dependence. This study highlights the need for early implementation of preventive interventions for substance use or behavioral addiction in children/adolescents with ADHD and the need to consider ADHD in the treatment of addictive disorders.
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Rolland B, Da Fonseca D, Fatseas M, Simon N. Attention-deficit/hyperactivity disorder (ADHD) in adults: Specific clinical and therapeutic issues. Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) was initially considered as a childhood psychiatric disorder. However, longitudinal observations have revealed that ADHD symptoms may persist in adulthood among approximately 50% of the patients . Adult ADHD is associated with impaired social outcome and frequent comorbidities such as mood disorders, personality disorders, and substance use disorders [2,3]. Correctly identifying and treating ADHD can significantly improve the global functioning and cognition of adult subjects, and reduce the intensity and frequency of the comorbid states [2,3]. Nonetheless, the clinical features of adult ADHD are clearly different from the youth form [1,2], and ADHD symptoms are easily mixed up in adults with symptoms of the comorbid conditions [2,3]. These clinical intricacies can make the diagnosis of ADHD difficult in adults. Moreover, the management of methylphenidate in adult subjects is also associated with specific risks and pitfalls, such as abuse and tampering behaviors, and additional safety risks . Put together, it appears crucial to identify and treat ADHD in adults, but the clinical and therapeutic complexities of adult ADHD require improved expertise and caution from adult psychiatrists and addiction specialists. In this thematic session of the 2015 French Psychiatry Congress, three French leading experts of adult ADHD will address the aforementioned clinical and therapeutic issues of the adulthood form of this disorder. David Da Fonseca, professor of child psychiatry in Marseille, will disentangle the clinical features of adult ADHD from the typical symptoms observed in the youth form. Mélina FATSEAS, associate professor of psychiatry and addiction medicine in Bordeaux, will specifically focus on the many and complex relationships observed between adult ADHD and substance use disorders. Last, Nicolas Simon, professor of addiction medicine and psychopharmacology in Marseille, will synthesize what are the very risks and issues with prescribing methylphenidate in adults.
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ADHD and addictive disorders: What links? Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The links between ADHD and addictive disorders have been the subject of a large number of studies showing a high prevalence rate of ADHD in substance abusing populations as well as an increased risk of substance use disorder (SUD) in ADHD patients that may be independent of other psychiatric conditions. High prevalence of ADHD has also been highlighted among individuals suffering from other addictive disorders such as pathological gambling. Adequate diagnosis of ADHD in SUD patients is challenged by phenomenological aspects of addiction and by 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. Finally, it should be noticed that when SUD occurs with ADHD, it is associated with a greater severity of SUD compared to other SUD patients. This has been shown with an earlier age at onset, antisocial behavior, risk for depression, chronicity of substance use, need for hospitalization and likelihood of a complicated course. Recent data suggest that the effects of ADHD on SUD outcomes are independent of other psychiatric comorbidities. This highlights the need of an earlier implementation of preventive interventions for substance use or behavioral addiction in children/adolescents with ADHD and the necessity to consider this disorder in the treatment of addictive disorders. Benefices and risk of MPH in adult patients with addiction and ADHD are discussed.
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Liebrenz M, Gamma A, Ivanov I, Buadze A, Eich D. Adult attention-deficit/hyperactivity disorder: Associations between subtype and lifetime substance use - a clinical study. F1000Res 2015; 4:407. [PMID: 27853503 PMCID: PMC5089146 DOI: 10.12688/f1000research.6780.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/20/2022] Open
Abstract
ADHD is the one of the most prevalent childhood disorders and has been associated with impairments persisting into adulthood. Specifically, childhood ADHD is an independent clinical risk factor for the development of later substance use disorders (SUD). Moreover, adults who meet diagnostic criteria for ADHD have shown high rates of comorbid SUDs. Few studies, however, have reported on the relationship between ADHD subtypes and SUD in adult samples. The purpose of this study was to characterize a clinical sample of adults with ADHD and to identify possible associations between ADHD subtypes, lifetime substance use, and if ADHD subtypes may be preferentially associated with specific substances of abuse. We recruited 413 adult ADHD patients, performed an evaluation of their ADHD and conducted an interview on their use of psychotropic substances. Complete data was obtained for 349 patients. Lifetime substance abuse or dependence was 26% and occasional use was 57% in this sample. The inattentive subtype was significantly less likely to abuse or be dependent on cocaine than the combined subtype. Our findings underscore the high rate of comorbidity between substance use and ADHD in adults. The more frequent abuse/dependence of cocaine by adult patients with hyperactive-impulsive symptoms should be kept in mind when treating this patient group.
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Affiliation(s)
- Michael Liebrenz
- Institute of Forensic Medicine, Department of Forensic Psychiatry, University of Bern, Bern, 3012, Switzerland
| | - Alex Gamma
- Institute of Forensic Medicine, Department of Forensic Psychiatry, University of Bern, Bern, 3012, Switzerland
| | - Iliyan Ivanov
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, 10029, USA
| | - Anna Buadze
- Psychiatric University Hospital, Research Group on ADHD, Zurich, 8032, Switzerland
| | - Dominique Eich
- Psychiatric University Hospital, Research Group on ADHD, Zurich, 8032, Switzerland
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Clinical, Psychopathological, and Personality Characteristics Associated with ADHD among Individuals Seeking Treatment for Gambling Disorder. BIOMED RESEARCH INTERNATIONAL 2015; 2015:965303. [PMID: 26229967 PMCID: PMC4502275 DOI: 10.1155/2015/965303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/08/2015] [Indexed: 12/29/2022]
Abstract
Objectives. (1) To assess the current presence of ADHD symptoms among patients seeking treatment for gambling disorder; (2) to explore clinical and sociodemographic differences between patients who score high and low on the measure of ADHD symptoms; (3) to analyze whether the presence of ADHD symptoms is associated with more severe psychopathology and with specific personality traits; (4) to analyze the mediating role of ADHD symptoms in the relationship between novelty seeking and gambling severity. Method. A total of 354 consecutive patients were administered an extensive battery assessing gambling behavior, psychopathology, and personality traits. Results. Male and female gamblers did not differ significantly in their mean scores on the ADHD measure. However, younger participants aged 18–35 scored higher. Higher ADHD scores were also associated with greater severity of gambling disorder and more general psychopathology. Regarding personality traits, high persistence and self-directedness were negatively related to ADHD scores, while in women alone a positive correlation was found between ADHD scores and scores on harm avoidance and self-transcendence. Conclusion. The presence of ADHD symptoms in both male and female gambling disorder patients may act as an indicator of the severity of gambling, general psychopathology, and dysfunctional personality traits.
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Young JT, Carruthers S, Kaye S, Allsop S, Gilsenan J, Degenhardt L, van de Glind G, van den Brink W, Preen D. Comorbid attention deficit hyperactivity disorder and substance use disorder complexity and chronicity in treatment-seeking adults. Drug Alcohol Rev 2015; 34:683-93. [PMID: 25790353 DOI: 10.1111/dar.12249] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 01/08/2015] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND AIMS Attention deficit hyperactivity disorder (ADHD) is a known risk factor for substance use disorder (SUD); however, the potential additive contribution of comorbid ADHD to drug-specific dependence in SUD populations is largely unknown. The current study aimed to assess this association between ADHD symptoms and drug-specific SUD complexity and chronicity. DESIGN AND METHODS A cross-sectional survey was administered to a convenience sample of 489 adults receiving SUD treatment at 16 Australian drug and alcohol treatment centres between September 2010 and August 2011. Participants were screened for adult ADHD symptoms using the Adult ADHD Self-Report Scale. Associations between ADHD screening status and drug-specific SUD complexity and chronicity were assessed using multivariate logistic and modified Poisson regression analysis, controlling for a range of potential confounders. RESULTS Overall, 215 (44%) patients screened positive for concurrent adult ADHD and SUD. After Simes' correction, a significant positive association was observed between ADHD screening status and current amphetamine SUD (odds ratio (OR) = 1.85; 95% confidence interval (CI): 1.19-2.36). Patients who screened positive for ADHD were significantly more likely to report SUD history for heavy alcohol use (OR = 2.05; 95% CI: 1.21-3.45) and amphetamine (OR = 1.96; 95% CI: 1.26-3.06) as well as significantly increased risk of moderate (3-4 years) duration for benzodiazepine and amphetamine SUDs and long (≥5 years) duration for alcohol, opiates other than heroin or methadone, and amphetamine SUDs. DISCUSSION AND CONCLUSIONS The findings provide evidence that there is increased drug dependence complexity and chronicity in treatment-seeking SUD patients who screen positively for ADHD, specifically for amphetamine, alcohol, opiates other than heroin or methadone, and benzodiazepines.
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Affiliation(s)
- Jesse Tyler Young
- National Drug Research Institute, Curtin University, Perth, Australia.,Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Parkville, Parkville, Australia
| | - Susan Carruthers
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Joanne Gilsenan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Parkville, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Geurt van de Glind
- Trimbos-Instituut, 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
| | - David Preen
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Australia
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Mao AR, Findling RL. Comorbidities in adult attention-deficit/hyperactivity disorder: a practical guide to diagnosis in primary care. Postgrad Med 2014; 126:42-51. [PMID: 25295649 DOI: 10.3810/pgm.2014.09.2799] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diagnosis and management of attention-deficit/hyperactivity disorder (ADHD) in adults is complex and challenging because of the frequent comorbidity of other psychiatric disorders that have symptoms overlapping with those of ADHD. The presence of comorbidities can create challenges to making an accurate diagnosis and also impact treatment options and outcomes. This review discusses disorders that may be comorbid with ADHD in adults, including anxiety, mood, substance use disorder, antisocial personality disorder, and borderline personality disorder. Suggestions for recognizing these comorbidities and distinguishing them from ADHD and perspectives on their possible impact on ADHD treatment are included. Adjunctive nonpharmacologic modalities may be especially helpful in the case of comorbid mood, anxiety, substance abuse, or personality disorders.
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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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Pérez de los Cobos J, Siñol N, Pérez V, Trujols J. Pharmacological and clinical dilemmas of prescribing in co-morbid adult attention-deficit/hyperactivity disorder and addiction. Br J Clin Pharmacol 2014; 77:337-56. [PMID: 23216449 DOI: 10.1111/bcp.12045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 11/20/2012] [Indexed: 12/21/2022] Open
Abstract
The present article reviews whether available efficacy and safety data support the pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD) in patients with concurrent substance use disorders (SUD). Arguments for and against treating adult ADHD with active SUD are discussed. Findings from 19 large open studies and controlled clinical trials show that the use of atomoxetine or extended-release methylphenidate formulations, together with psychological therapy, yield promising though inconclusive results about short term efficacy of these drugs in the treatment of adult ADHD in patients with SUD and no other severe mental disorders. However, the efficacy of these drugs is scant or lacking for treating concurrent SUD. No serious safety issues have been associated with these drugs in patients with co-morbid SUD-ADHD, given their low risk of abuse and favourable side effect and drug-drug interaction profile. The decision to treat adult ADHD in the context of active SUD depends on various factors, some directly related to SUD-ADHD co-morbidity (e.g. degree of diagnostic uncertainty for ADHD) and other factors related to the clinical expertise of the medical staff and availability of adequate resources (e.g. the means to monitor compliance with pharmacological treatment). Our recommendation is that clinical decisions be individualized and based on a careful analysis of the advantages and disadvantages of pharmacological treatment for ADHD on a case-by-case basis in the context of active SUD.
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Affiliation(s)
- José Pérez de los Cobos
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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van de Glind G, Van Emmerik‐van Oortmerssen K, Carpentier PJ, Levin FR, Koeter MW, Barta C, Kaye S, Skutle A, Franck J, Konstenius M, Bu E, Moggi F, Dom G, Demetrovics Z, Fatséas M, Schillinger A, Kapitány‐Fövény M, Verspreet S, Seitz A, Johnson B, Faraone SV, Ramos‐Quiroga JA, Allsop S, Carruthers S, Schoevers RA, van den Brink W. The International ADHD in Substance Use Disorders Prevalence (IASP) study: background, methods and study population. Int J Methods Psychiatr Res 2013; 22:232-44. [PMID: 24022983 PMCID: PMC4085151 DOI: 10.1002/mpr.1397] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 12/05/2012] [Accepted: 01/16/2013] [Indexed: 11/06/2022] Open
Abstract
Attention deficit/hyperactivity disorder (ADHD) is an increasingly recognized comorbid condition in subjects with substance use disorders (SUDs). This paper describes the methods and study population of the International ADHD in Substance Use Disorders Prevalence (IASP) study. Objectives of the IASP are to determine the prevalence of ADHD in adult treatment seeking patients with SUD in different countries and SUD populations, determine the reliability and validity of the Adult ADHD Self-report Scale V 1.1 (ASRS) as ADHD screening instrument in SUD populations, investigate the comorbidity profile of SUD patients with and without ADHD, compare risk factors and protective factors in SUD patients with and without a comorbid diagnosis of ADHD, and increase our knowledge about the relationship between ADHD and the onset and course of SUD. In this cross-sectional, multi-centre two stage study, subjects were screened for ADHD with the ASRS, diagnosed with the Conner's Adult ADHD Diagnostic Interview for DSM-IV (CAADID), and evaluated for SUD, major depression, bipolar disorder, anti social personality disorder and borderline personality disorder. Three thousand five hundred and fifty-eight subjects from 10 countries were included. Of these 40.9% screened positive for ADHD. This is the largest international study on this population evaluating ADHD and comorbid disorders.
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Affiliation(s)
- Geurt van de Glind
- Trimbos‐instituut and ICASA FoundationUtrechtThe Netherlands
- Amsterdam Institute for Addiction research, Department of Psychiatry, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
| | - Katelijne Van Emmerik‐van Oortmerssen
- ArkinAmsterdamThe Netherlands
- Amsterdam Institute for Addiction research, Department of Psychiatry, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
| | | | - Frances R. Levin
- Columbia University/The New York State Psychiatric InstituteNew YorkUSA
| | - Maarten W.J. Koeter
- Amsterdam Institute for Addiction research, Department of Psychiatry, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
| | - Csaba Barta
- Institute of PsychologyEötvös Loránd UniversityBudapestHungary
| | - Sharlene Kaye
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
| | | | - Johan Franck
- Department of Clinical NeuroscienceDivision of Psychiatry, Karolinska InstitutetStockholmSweden
| | - Maija Konstenius
- Department of Clinical NeuroscienceDivision of Psychiatry, Karolinska InstitutetStockholmSweden
| | | | - Franz Moggi
- University Hospital of Psychiatry Berne and Department of PsychologyUniversity of FribourgSwitzerland
| | - Geert Dom
- Collaborative Antwerp Psychiatry Research Institute (CAPRI, UA)PC Alexian BrothersBoechoutBelgium
| | | | - Mélina Fatséas
- Laboratoire de psychiatrie Département d'addictologieUniversité de BordeauxFrance
| | - Arild Schillinger
- Østfold Hospital TrustDepartment for Substance abuse treatmentNorway
| | | | - Sofie Verspreet
- Collaborative Antwerp Psychiatry Research Institute (CAPRI, UA)PC Alexian BrothersBoechoutBelgium
| | - Andrea Seitz
- University Hospital of PsychiatryBerneSwitzerland
| | - Brian Johnson
- Departments of Psychiatry and of Neuroscience and PhysiologySUNY Upstate Medical UniversitySyracuseNYUSA
| | - Stephen V. Faraone
- Departments of Psychiatry and of Neuroscience and PhysiologySUNY Upstate Medical UniversitySyracuseNYUSA
| | - J. Antoni Ramos‐Quiroga
- Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of PsychiatryUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Steve Allsop
- National Drug Research Institute/Curtin University of TechnologyPerthAustralia
| | - Susan Carruthers
- National Drug Research Institute/Curtin University of TechnologyPerthAustralia
| | - Robert A. Schoevers
- Department of PsychiatryUniversity Medical Centre Groningen, University of GroningenGroningenThe Netherlands
| | - Iasp Research Group
- Apart from the authors the following persons participated in this study: Eva Karin Løvaas, Kari Lossius, Anneke van Wamel, Geert Bosma, David Hay, Sara Wallhed, Marc Auriacombe, Marion Malivert, Romain Debrabant, Therese Dahl, Miguel Casas, Constanza Daigre, Rutger‐Jan van der Gaag, Atul Beniwal, Louisa Degenhardt, Joanne Cassar, Jesse Young, Merete Möller
| | - Wim van den Brink
- Amsterdam Institute for Addiction research, Department of Psychiatry, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
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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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Endocannabinoid/GABA interactions in the entopeduncular nucleus modulates alcohol intake in rats. Brain Res Bull 2013; 91:31-7. [DOI: 10.1016/j.brainresbull.2012.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/27/2012] [Accepted: 11/28/2012] [Indexed: 01/31/2023]
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35
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Leikauf J, Ivanov I. A Young Man with History of ADHD and Methamphetamine Use. Psychiatr Ann 2013. [DOI: 10.3928/00485713-20130109-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Male adolescent substance use disorder and attention-deficit hyperactivity disorder: a review of the literature. ISRN ADDICTION 2012; 2013:815096. [PMID: 25969828 PMCID: PMC4403620 DOI: 10.1155/2013/815096] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 10/16/2012] [Indexed: 11/17/2022]
Abstract
Approximately, one-third of male adolescents in treatment for a substance use disorder (SUD) also have an Attention-Deficit Hyperactivity Disorder (ADHD). This strongly suggests that ADHD is a major risk factor for the development of SUD which practitioners must address if they are to provide adequate treatment for adolescents with SUD/ADHD. This paper supports a causal role for ADHD in the development of SUD and examines the developmental mechanisms whereby ADHD increases risk for SUD. These mechanisms include increased risk for conduct disorder, academic failure, deviant peer affiliation, engaging in risk behaviors, and self-medication. Assessment and treatment recommendations for those comorbid for SUD/ADHD are provided.
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