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Park TW, Baul TD, Morgan JR, Wilens TE, Yule AM. Trends in Attention-Deficit Hyperactivity Disorder Diagnosis and Pharmacotherapy Among Adults With Opioid Use Disorder. Psychiatr Serv 2024; 75:214-220. [PMID: 37789727 PMCID: PMC11175591 DOI: 10.1176/appi.ps.20220400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE This study aimed to assess nationwide trends in attention-deficit hyperactivity disorder (ADHD) diagnoses and pharmacotherapy among patients with opioid use disorder and ADHD and to examine factors predicting receipt of stimulant medications among patients receiving medications for opioid use disorder (MOUDs). METHODS A claims-based database of commercially insured patients ages 13-64 was used to conduct two analyses: an annual cross-sectional study of 387,980 patients diagnosed as having opioid use disorder (2007-2017) to estimate the prevalence of ADHD diagnoses and pharmacotherapy, and a retrospective cohort study of 158,591 patients receiving MOUDs to test, with multivariable regression, the association between patient characteristics and receipt of stimulant medication. RESULTS From 2007 to 2017, the prevalence of ADHD diagnoses increased from 4.6% to 15.1% and the rate of ADHD pharmacotherapy increased from 42.6% to 51.8% among patients with opioid use disorder. Among all patients receiving MOUDs, 10.5% received at least one prescription stimulant during the study period. Female sex; residence in the southern United States; and ADHD, mood, and anxiety disorder diagnoses were associated with increased likelihood of stimulant receipt. Stimulant use disorder and other substance use disorder diagnoses were associated with decreased likelihood of stimulant receipt. CONCLUSIONS ADHD diagnoses and pharmacotherapy among patients with opioid use disorder have increased. A minority of patients with ADHD and taking MOUDs received a stimulant. Further study is needed of the benefits and risks of ADHD pharmacotherapy for patients with opioid use disorder.
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Affiliation(s)
- Tae Woo Park
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213
| | - Tithi D. Baul
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118
| | - Jake R. Morgan
- Boston University School of Public Health, Boston, MA 02118
| | - Timothy E. Wilens
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Amy M. Yule
- Department of Psychiatry, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118
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2
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Vold JH, Halmøy A, Chalabianloo F, Pierron MC, Løberg EM, Johansson KA, Fadnes LT. Attention-deficit/hyperactivity disorder (ADHD) symptoms and their relation to diagnosed ADHD, sociodemographic characteristics, and substance use among patients receiving opioid agonist therapy: a Norwegian cohort study. BMC Psychiatry 2023; 23:479. [PMID: 37386438 PMCID: PMC10308780 DOI: 10.1186/s12888-023-04980-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) symptoms may challenge sufficient treatment of substance use and mental disorders. The literature on the extent of such symptoms among patients receiving opioid agonist therapy (OAT) is scarce. This study examined ADHD symptoms using the ADHD self-report scale (ASRS) and the association between the 'ASRS-memory' and 'ASRS-attention' scores and substance use and sociodemographic characteristics among patients receiving OAT. METHODS We used data from assessment visits of a cohort of patients in Norway. In total, 701 patients were included from May 2017 to March 2022. All patients responded at least once to two ASRS questions assessing memory and attention, respectively. Ordinal regression analyses were performed to investigate whether the two obtained scores were associated with age, sex, frequent substance use, injecting use, housing status, and educational attainment at baseline, i.e., the first assessment, and over time. The results are presented as odds ratios (OR) with 95% confidence intervals (CI). Additionally, a subsample of 225 patients completed an extended interview, including the ASRS-screener and collection of registered mental disorder diagnoses from the medical records. Standard cutoffs were used to define the presence of each ASRS symptom or a positive ASRS-screener ('ASRS-positive'). RESULTS At baseline, 428 (61%) and 307 (53%) patients scored over the cutoffs on the 'ASRS-memory' and 'ASRS-attention,' respectively. Frequent cannabis use was associated with higher 'ASRS-memory' (OR: 1.7, 95% CI: 1.1-2.6) and 'ASRS-attention' (1.7, 1.1-2.5) scores compared with less or no use at baseline, though reduced score on the 'ASRS-memory' over time (0.7, 0.6-1.0). At baseline, frequent stimulant use (1.8, 1.0-3.2) and low educational attainment (0.1, 0.0-0.8) were associated with higher 'ASRS-memory' scores. In the subsample fulfilling the ASRS-screener, 45% of the patients were 'ASRS-positive,' of whom 13% with a registered ADHD diagnosis. CONCLUSIONS Our findings illustrate a relationship between the ASRS-memory and -attention scores and frequent cannabis and stimulant use. Furthermore, nearly half of the subsample was 'ASRS-positive.' Patients receiving OAT might benefit from being further assessed for ADHD, but improved diagnostic methods are required.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Anne Halmøy
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marianne Cook Pierron
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021 Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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3
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Ramey OL, Bonny AE, Silva Almodóvar A, Nahata MC. Gaps in Evidence-based Treatment of Concurrent Attention Deficit Hyperactivity Disorder and Opioid Use Disorder: A Scoping Review. Ann Pharmacother 2022:10600280221141065. [PMID: 36510631 DOI: 10.1177/10600280221141065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To describe the effectiveness of medications for the treatment of opioid use disorder (OUD) and attention deficit/hyperactivity disorder (ADHD). DATA SOURCES Literature search of PubMed, Embase, Web of Science, CINAHL, Medline, PsycINFO, and Google Scholar was performed for studies published from inception to October 25, 2022. STUDY SELECTION AND DATA EXTRACTION Studies were included if patients were diagnosed with OUD and ADHD and had pharmacotherapy for either condition. Abstracts, commentaries, reviews, case reports, case series, non-English articles, and animal studies were omitted. DATA SYNTHESIS This review found 18 studies. Treatment of ADHD was evaluated for impact on ADHD and OUD outcomes, while treatment of OUD was evaluated for OUD-related outcomes. Outcomes assessed included markers for symptom intensity, adherence, and treatment failure. While results were mixed, treatment of ADHD was largely associated with improvements in ADHD severity and retention in OUD treatment programs. ADHD severity was associated with higher rates of illicit substance abuse and worse OUD-related outcomes. It could not be determined which medications for treatment of OUD should be prioritized. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review summarized key findings from studies that treated ADHD or OUD among dually diagnosed patients and highlighted methodological considerations for future research. CONCLUSIONS Treatment of ADHD is warranted among patients with OUD and ADHD to improve retention in OUD treatment programs and reduce illicit substance abuse. Pharmacotherapy for the treatment of ADHD or OUD should continue to be determined based on patients' characteristics and the capabilities of the treatment program.
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Affiliation(s)
- Olivia L Ramey
- Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Andrea E Bonny
- Division of Adolescent Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Armando Silva Almodóvar
- Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH, USA
| | - Milap C Nahata
- Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH, USA.,College of Medicine, The Ohio State University, Columbus, OH, USA
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4
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Karlsson AT, Vederhus JK, Clausen T, Weimand B, Solli KK, Tanum L. Levels of Impulsivity, Hyperactivity, and Inattention and the Association with Mental Health and Substance Use Severity in Opioid-Dependent Patients Seeking Treatment with Extended-Release Naltrexone. J Clin Med 2021; 10:jcm10194558. [PMID: 34640572 PMCID: PMC8509800 DOI: 10.3390/jcm10194558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 01/10/2023] Open
Abstract
The level of impulsivity, hyperactivity, and inattention (IHI) is higher among patients with substance use disorder (SUD) than in the general population. However, the prevalence of such symptoms in patients seeking treatment with an opioid antagonist, such as extended-release naltrexone (XR-NTX), is unknown. We screened 162 patients with opioid use disorder (OUD) seeking treatment with XR-NTX in Norway using the Adult ADHD Self-Report Scale (ASRS) to estimate the prevalence of IHI alongside an assessment of mental and physical health and substance use. Sixty-six patients scored above the clinical cut-off on the ASRS. Higher levels of IHI were significantly associated with a longer history of frequent amphetamine use, current alcohol use, and greater mental distress. Mental distress was the strongest factor associated with higher levels of IHI. The introduction of screening for IHI and mental distress in opioid maintenance treatment and XR-NTX would likely improve the quality of care and enable clinicians to tailor interventions to the needs of patients with high levels of IHI to prevent treatment discontinuation.
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Affiliation(s)
- Ann Tarja Karlsson
- Addiction Unit, Sørlandet Hospital HF, 4604 Kristiansand, Norway; (J.-K.V.); (T.C.)
- Correspondence: ; Tel.: +47-381-32-600
| | - John-Kåre Vederhus
- Addiction Unit, Sørlandet Hospital HF, 4604 Kristiansand, Norway; (J.-K.V.); (T.C.)
| | - Thomas Clausen
- Addiction Unit, Sørlandet Hospital HF, 4604 Kristiansand, Norway; (J.-K.V.); (T.C.)
- Norwegian Centre for Addiction Research, University of Oslo, 0315 Oslo, Norway;
| | - Bente Weimand
- Mental Health Services, Akershus University Hospital, Lørenskog, 1478 Oslo, Norway;
- Center for Mental Health and Substance Abuse, University of South-Eastern Norway, 3040 Drammen, Norway
| | - Kristin Klemmetsby Solli
- Norwegian Centre for Addiction Research, University of Oslo, 0315 Oslo, Norway;
- Vestfold Hospital Trust, 3103 Toensberg, Norway
- Department of R&D in Psychiatric Health Care, Akershus University Hospital, 1478 Oslo, Norway;
| | - Lars Tanum
- Department of R&D in Psychiatric Health Care, Akershus University Hospital, 1478 Oslo, Norway;
- Faculty for Health Science, Oslo Metropolitan University, 0130 Oslo, Norway
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5
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Freda PJ, Moore JH, Kranzler HR. The phenomics and genetics of addictive and affective comorbidity in opioid use disorder. Drug Alcohol Depend 2021; 221:108602. [PMID: 33652377 PMCID: PMC8059867 DOI: 10.1016/j.drugalcdep.2021.108602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/21/2022]
Abstract
Opioid use disorder (OUD) creates significant public health and economic burdens worldwide. Therefore, understanding the risk factors that lead to the development of OUD is fundamental to reducing both its prevalence and its impact. Significant sources of OUD risk include co-occurring lifetime and current diagnoses of both psychiatric disorders, primarily mood disorders, and other substance use disorders, and unique and shared genetic factors. Although there appears to be pleiotropy between OUD and both mood and substance use disorders, this aspect of OUD risk is poorly understood. In this review, we describe the prevalence and clinical significance of addictive and affective comorbidities as risk factors for OUD development as a basis for rational opioid prescribing and OUD treatment and to improve efforts to prevent the disorder. We also review the genetic variants that have been associated with OUD and other addictive and affective disorders to highlight targets for future study and risk assessment protocols.
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Affiliation(s)
- Philip J. Freda
- University of Pennsylvania, Biostatistics, Epidemiology, & Informatics, The Perelman School of Medicine, University of Pennsylvania A201 R…, Philadelphia, Pennsylvania 19104, United States
| | - Jason H. Moore
- Edward Rose Professor of Informatics, Director, Institute for Biomedical Informatics, Director, Division of Informatics, Department of Biostatistics, Epidemiology, & Informatics, Senior Associate Dean for Informatics, The Perelman School of Medicine, University of Pennsylvania, Contact Information: D202 Richards Building, 3700 Hamilton Walk, University of Pennsylvania, Philadelphia, PA 19104-6116
| | - Henry R. Kranzler
- Benjamin Rush Professor in Psychiatry, Department of Psychiatry, University of Pennsylvania, Treatment Research Center, 3535 Market Street, Suite 500, Philadelphia, PA 19104-6178
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Federico A, Mantovani E, Casari R, Bertoldi A, Lugoboni F, Tamburin S. Adult attention-deficit/hyperactivity disorder symptoms, cognitive dysfunction and quality of life in high-dose use of benzodiazepine and Z-drug. J Neural Transm (Vienna) 2020; 128:1109-1119. [PMID: 33331955 PMCID: PMC8295124 DOI: 10.1007/s00702-020-02285-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/30/2020] [Indexed: 12/11/2022]
Abstract
High-dose use of benzodiazepines (BZDs) and Z-drugs was found to be associated with adult attention deficit/hyperactivity disorder (ADHD) and multidomain cognitive deficits, but the interplay between these factors and its effect on quality of life (QoL) is unclear. We explored (a) whether cognitive dysfunction differs in high-dose BZD/Z-drug users with and without adult ADHD and (b) the impact of cognitive deficits and adult ADHD on QoL in this substance-use disorder (SUD). From January 2015 to December 2019, we recruited 207 high-dose BZD/Z-drug users seeking treatment. We assessed the presence of adult ADHD with a screening tool, which was validated in SUD patients, and collected demographic, clinical and QoL data from the 76 included patients. A neuropsychological battery explored five cognitive domains. We found that: (a) screening for adult ADHD was frequently positive; (b) Short Form-36 (SF-36), a self-administered QoL questionnaire, was worse than the general population and worse in patients positive (ADHD+) vs. those negative (ADHD−) to ADHD screening tool; (c) executive function was significantly worse in ADHD+ than ADHD− patients; (d) some SF-36 dimensions were negatively influenced by executive dysfunction; (e) multivariate analysis showed an interplay between adult ADHD and cognitive dysfunction in worsening QoL. We documented a complex interplay between adult ADHD, cognitive dysfunction and QoL in high-dose BZD/Z-drug users. Assessing adult ADHD, neuropsychological measures and QoL may offer a full scenario of these patients, who are frequently impaired in everyday activities. Future research should explore whether pharmacological treatment might improve cognitive dysfunction and QoL in this SUD.
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Affiliation(s)
- Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy
| | - Rebecca Casari
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Anna Bertoldi
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Fabio Lugoboni
- Addiction Medicine Unit, Department of Medicine, Verona University Hospital, Piazzale Scuro 10, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale Scuro 10, 37134, Verona, Italy.
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7
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Bidirectional relationship between heroin addiction and depression: Behavioural and neural studies. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-01032-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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8
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Lugoboni F, Bertoldi A, Casari R, Mantovani E, Morbioli L, Tamburin S. Adult Attention-Deficit/Hyperactivity Disorder and Quality of Life in High-Dose Benzodiazepine and Related Z-Drug Users. Eur Addict Res 2020; 26:274-282. [PMID: 32570244 DOI: 10.1159/000507852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Problematic high-dose benzodiazepine (BZD) and related Z-drug use for a long period is a substance use disorder previously found to be associated with adult attention-deficit/hyperactivity disorder (ADHD) and worse quality of life (QoL). Whether adult ADHD impacts QoL in high-dose BZD/Z-drug users has not been explored. AIM The aim of the study was to explore the impact of adult ADHD on QoL in high-dose BZD and related Z-drug users. METHODS We recruited 393 patients (205 men and 188 women) consecutively admitted to the Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Italy, from July 2016 to July 2019 for detoxification from high-dose BZD or Z-drug dependence. Demographic and clinical variables and QoL measures were recorded. The World Health Organization ADHD Self-Report Scale version 1.1 Symptom Checklist Part A was used to detect adult ADHD. RESULTS In our sample, 39.4% of patients were positive to adult ADHD testing (ADHD+), with some clinical features differing in comparison to patients negative to ADHD testing (ADHD-). QoL was worse in high-dose BZD/Z-drug users than the general population. The ADHD+ group showed significantly worse QoL measures than the ADHD- group. Multivariate analysis, including potential covariates showed adult ADHD and age to have the most robust and consistent positive effect for age (i.e., higher QoL) and negative effect for ADHD (i.e., lower QoL) on QoL measures. CONCLUSIONS Adult ADHD is associated with worse QoL measures in high-dose BZD/Z-drug users. Future studies should explore whether appropriate BZD/Z-drug detoxification might improve QoL measures and whether the most appropriate detoxification protocol differs in ADHD+ versus ADHD- populations.
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Affiliation(s)
- Fabio Lugoboni
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Anna Bertoldi
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Rebecca Casari
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Elisa Mantovani
- 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.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy,
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9
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Wojciechowski T. Borderline personality disorder symptoms and exposure to violence as risk factors for opioid use in adulthood. Psychiatry Res 2019; 281:112549. [PMID: 31494451 DOI: 10.1016/j.psychres.2019.112549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/18/2019] [Accepted: 08/31/2019] [Indexed: 11/19/2022]
Abstract
Borderline personality disorder and exposure to violence are both risk factors for opioid use. While past research has identified these relationships, there has yet to be any study which investigates the potential that exposure to violence may help explain the relationship between borderline personality disorder symptoms and opioid use as a mediator. The present study used data from the Pathways to Desistance study to test these proposed relationships. Results indicated that greater levels of borderline personality disorder symptoms were associated with increased opioid use frequency. However, when exposure to violence variables were included in the model, the magnitude of this effect was attenuated by more than 20% and reduced to non-significance. These results indicate the importance of identifying and treating borderline personality disorder symptomatology and to provide increased oversight of the environments which juvenile offenders are exposed to upon reentry. Doing so may help to address the opioid crisis in the United States.
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Affiliation(s)
- Thomas Wojciechowski
- Michigan State University, School of Criminal Justice, 655 Auditorium Road, East Lansing, 48824.
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10
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Malik E, Adelson M, Sason A, Schreiber S, Peles E. Outcome of Patients With High Depressive Symptoms on Admission to Methadone Maintenance Treatment. J Dual Diagn 2019; 15:281-290. [PMID: 31530109 DOI: 10.1080/15504263.2019.1656353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Comorbidity of depression among individuals with opioid addiction is highly prevalent, but their outcome in methadone maintenance treatment (MMT) is not well determined.Methods: Characteristics and outcomes (retention until December 2017) of newly admitted and already (5.5 ± 4 years) in MMT patients with available Hamilton Depression Rating Scale (HAM-D) scores on admission were studied.Results: During psychiatric intake on admission, 70 (21.2%) of 330 patients were diagnosed with high depressive symptoms beyond the cutoff (HAM-D scores ≥ 18). Depressed and nondepressed groups had a similar proportion of females (20% and 23.8%) and age at admission (43.0 ± 10.5 and 43.7 ± 10.4 years), but the depressed group had higher Brief Psychiatric Rating Scale (BPRS) scores (21.4 ± 8.6 vs. 7.0 ± 7.3, respectively; p < .0005), a higher proportion of minority (non-Jewish faith; 28.6% vs.15.4%; p =.02), and a higher proportion of positive urine screening results for cocaine (55.7% vs. 34.4%; p = .001) and for benzodiazepines on admission (74.3% vs. 57.5%; p = .01). Retention after 1 year was similar (79% and 80.7%), but depressed patients had higher rates of cocaine (40.8% vs. 25.5%; p = .05) and benzodiazepine use (59.2% vs. 41.8%; p = .04) and a shorter cumulative retention (5.6 years, 95% confidence interval [CI; 4.3, 7.0]) than the nondepressed patients (6.8 years, 95% CI [6.1, 7.5]; p = .05). Of the 263 evaluated while already in MMT, 23.5% were depressed, characterized with more females (43.5% vs. 23.4%) and with a history of rape (34.5% vs. 7.6%).Conclusions: Newly admitted depressed and nondepressed patients succeeded similarly in the first year retention in treatment, despite their cocaine and benzodiazepine co-abuse. The depression was characterized with females and with rape history in those who were already in MMT. Adequate intervention is recommended for both depressed groups to improve long-term retention and outcome.
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Affiliation(s)
- Elad Malik
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Adelson
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Sason
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shaul Schreiber
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Einat Peles
- Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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11
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Slobodin O, Crunelle CL. Mini Review: Socio-Cultural Influences on the Link Between ADHD and SUD. Front Public Health 2019; 7:173. [PMID: 31294015 PMCID: PMC6606733 DOI: 10.3389/fpubh.2019.00173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/10/2019] [Indexed: 11/13/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for the development and persistence of substance use disorders (SUD). The prevalence of ADHD in patients with SUD varies across countries and cultures. So far, cross-cultural variance in ADHD prevalence rates among SUD patients was mainly ascribed to methodological differences between studies, leaving the role of societal and cultural practices in the ADHD-SUD link hardly acknowledged. The aim of the present mini review is to address this gap in the literature by providing evidence for the effect of socio-cultural practices on the ADHD-SUD link and suggesting directions for future research. To achieve this goal, we map the influence of socio-cultural factors on the ADHD-SUD link along three lines of research. The first line is concerned with the role of socio-cultural factors in the recognition, diagnosis and treatment of childhood ADHD. The second line of research is concerned with socio-cultural influences on substance use (e.g., religion, ethnic identity, acculturation, and socio-economic status). Finally, we describe potential socio-cultural factors which may operate as mechanisms for reducing or increasing access to substance abuse treatment (e.g., ethnic disparities in health care utilization). Identifying socio-cultural influences on the ADHD-SUD link may provide further insight into the bidirectional association between ADHD and SUD in different contexts and encourage future research in the field.
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Affiliation(s)
- Ortal Slobodin
- Department of Education, Ben-Gurion University, Be'er Sheva, Israel
| | - Cleo L. Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Toxicological Center, Antwerp University, Antwerp, Belgium
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12
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Evren C, Alniak I, Karabulut V, Cetin T, Umut G, Agachanli R, Evren B. Relationship of Probable Attention Deficit Hyperactivity Disorder with Severity of Psychopathology and Impulsivity in a Sample of Male Patients with Opioid Use Disorder. Psychiatry Investig 2018; 15:164-171. [PMID: 29475216 PMCID: PMC5900394 DOI: 10.30773/pi.2017.05.14.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/17/2017] [Accepted: 05/14/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate relationship of probable attention deficit hyperactivity disorder (ADHD) with severity of psychopathology and the effect of impulsivity on this relationship in a sample of male patients with opioid use disorder (OUD). METHODS Participants included 234 patients (115 inpatients and 119 outpatients) with OUD. Participants were evaluated with the Adult ADHD Self-Report Scale (ASRS-v1.1), the Symptom Checklist-90-R (SCL-90-R) and the Short Form of Barratt Impulsiveness Scale (BIS-11-SF). RESULTS Psychopathology and impulsivity scores were higher among those with the probable ADHD. ADHD scores were midly to moderately correlated with impulsivity and psychopathology scores. In logistic regression analyses, while severity of general psychopathology and impulsivity predicted probable ADHD in the first Model, in the second Model, among dimensions of psychopathology obsessive compulsive (OC) dimension, whereas among dimensions of impulsivity non-planning and motor impulsivity predicted probable ADHD. CONCLUSION These findings suggest that probable ADHD is related with the severity of psychopathology, particularly OC dimension, while the severity of impulsivity may have an partial mediator (particularly non-planning and motor impulsivity) effect on this relationship among patients with OUD.
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Affiliation(s)
- Cuneyt Evren
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Izgi Alniak
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Vahap Karabulut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Turan Cetin
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Gokhan Umut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Ruken Agachanli
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Bilge Evren
- Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
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Evren C, Alniak I, Karabulut V, Cetin T, Umut G, Agachanli R, Evren B. Relationship of probable ADHD with novelty seeking, severity of psychopathology and borderline personality disorder in a sample of patients with opioid use disorder. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1395312] [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: 10/18/2022] Open
Affiliation(s)
- Cuneyt Evren
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Izgi Alniak
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Vahap Karabulut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Turan Cetin
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Gokhan Umut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Ruken Agachanli
- Department of Psychiatry, Ardahan State Hospital, Ardahan, Turkey
| | - Bilge Evren
- Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
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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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Fiksdal Abel K, Ravndal E, Clausen T, Bramness JG. Attention Deficit Hyperactivity Disorder Symptoms are Common in Patients in Opioid Maintenance Treatment. Eur Addict Res 2017; 23:298-305. [PMID: 29320768 DOI: 10.1159/000484240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/13/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIMS Knowledge of attention deficit hyperactivity disorder (ADHD) symptoms among patients in opioid maintenance treatment (OMT) is important for treatment optimization and yet limited. We investigated the prevalence of ADHD symptoms, and factors associated with high ADHD symptom burden in a group of Norwegian OMT patients. METHODS We interviewed individuals entering OMT across Norway in 2 steps between 2012 and 2016. ADHD symptoms were measured by the Adult ADHD Self-Report Scale (ASRS; n = 175). We compared 2 groups of individuals who scored above or below the clinical cutoff score. Mental distress was measured with the General Symptom Index (GSI) of the Hopkin's Symptom Check-List-25. RESULTS A total of 33% of the OMT patients screened positively for ADHD on the ASRS. Participants who scored above the clinical cutoff were younger, and reported more severe substance use and mental distress. When controlling for other significant variables in a logistic regression analysis, scoring above cutoff on the ASRS was associated with higher GSI (OR 1.61; 95% CI 1.03-2.50) and use of stimulants (OR 2.55; 1.13-5.76). CONCLUSIONS ADHD symptoms were common in these OMT patients. High ADHD symptom burden was associated with higher mental distress and use of stimulants. This underlines a need of more systematic focus on ADHD in OMT to plan treatment accordingly.
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Affiliation(s)
| | - Edle Ravndal
- Norwegian Centre for Addiction Research (SERAF), Faculty of Medicine, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research (SERAF), Faculty of Medicine, Oslo, Norway
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Oslo, Norway
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