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Browning L, Cannoy CN, Moses TEH, Lundahl LH, Ledgerwood DM, Greenwald MK. Attention-deficit/hyperactivity disorder combined subtype exacerbates opioid use disorder consequences: Mediation by impulsive phenotypes. Drug Alcohol Depend 2024; 259:111292. [PMID: 38640865 PMCID: PMC11111336 DOI: 10.1016/j.drugalcdep.2024.111292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/28/2024] [Accepted: 04/06/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent and associated with opioid use disorder (OUD). Yet, little is known about the mechanisms by which ADHD (which is a heterogeneous construct/diagnosis) might alter the trajectory of OUD outcomes in persons who use heroin. AIM We examined whether ADHD subtypes are related to heroin-use consequences and the extent to which the effects of ADHD on lifetime heroin-use consequences are mediated by two impulsivity factors that may be partly independent of ADHD: foreshortened time perspective and drug-use impulsivity. METHODS Individuals who reported regular heroin use (N=250) were screened using the Assessment of Hyperactivity and Attention (AHA), Impulsive Relapse Questionnaire (IRQ), Stanford Time Perception Inventory (STPI), and a comprehensive assessment of lifetime and current substance use and substance-related consequences. This secondary analysis examined whether ADHD or intermediate phenotypes predicted heroin-use consequences. RESULTS Relative to participants whose AHA scores indicated lifetime absence of ADHD (n=88), those with scores indicating persistent ADHD (childhood and adult, n=62) endorsed significantly more total lifetime heroin-use consequences despite comparable heroin-use severity. Likewise, there was a significant indirect effect of the combined ADHD subtype in childhood on lifetime heroin-use consequences. This effect was mediated by STPI scores indicating less future (and more hedonism in the present) temporal orientation and by IRQ scores indicating less capacity for delaying drug use. CONCLUSION The combined ADHD subtype is significantly associated with lifetime heroin-use consequences, and this effect is mediated through higher drug-use impulsivity (less capacity for delay) and lower future temporal orientation.
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Affiliation(s)
- Liam Browning
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ciara N Cannoy
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Tabitha E H Moses
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Leslie H Lundahl
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - David M Ledgerwood
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mark K Greenwald
- Dept. of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA.
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2
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Zhang S, Chen C, Zhou Y, Pan M, Li H, Zhao M, Dong M, Si F, Liu L, Wang Y, Qian Q. The Chinese Version of the Compensatory ADHD Behaviors Scale (CABS): A Study on Reliability, Validity, and Clinical Utility. Neuropsychiatr Dis Treat 2024; 20:1025-1040. [PMID: 38764747 PMCID: PMC11102070 DOI: 10.2147/ndt.s463974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024] Open
Abstract
Purpose With the further development of attention-deficit/hyperactivity disorder (ADHD) research, more and more assessment tools related to ADHD have been used. However, there is still no measurement instrument to evaluate the compensatory behavior of ADHD in China. This study aimed to examine the reliability and validity of the Compensatory ADHD Behaviors Scale (CABS) adapted in Chinese and explore ecological characteristics in adults with ADHD using the CABS. Patients and Methods Data were collected from a sample of 306 adults (Mage = 26.43 years, SD = 5.32; 46.08% male). The original version CABS was translated into Chinese using the forward and backward translation procedures. Participants completed the CABS and questionnaires assessing ADHD symptoms and executive function. We utilized content validity, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and criterion validity to test the validity. Internal consistency and test-retest reliability were employed to test the reliability. Analysis of variance (ANOVA) was employed to compare ADHD subgroups based on gender, ADHD subtype, comorbidities, and medication status, while controlling for demographic variables as covariates. Results CABS exhibited good construct validity (two factors: present-oriented and future-oriented), content validity (content validity index: 0.98), internal consistency reliability (Cronbach's alpha coefficient: 0.85 to 0.87) and test-retest reliability (intraclass correlation coefficient: 0.59 to 0.88). The results of CFA showed acceptable fitness for each subscale. CABS demonstrated significant associations with inattention symptoms and plan/organizational abilities. Medicated ADHD individuals scored higher on future-oriented effectiveness subscale of CABS than non-medicated (F = 6.106, p = 0.014). Conclusion The results indicate that the Chinese CABS exhibited good validity and reliability. It can be considered a valid tool for assessing compensatory behaviors in Chinese adults with ADHD. Further research is needed to explore the connection between medication and compensatory behavior.
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Affiliation(s)
- Shiyu Zhang
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China
| | - Caili Chen
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China
| | - Yi Zhou
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China
| | - Meirong Pan
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China
| | - Haimei Li
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China
| | - Mengjie Zhao
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China
| | - Min Dong
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China
| | - Feifei Si
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China
| | - Lu Liu
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China
| | - Yufeng Wang
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China
| | - Qiujin Qian
- Peking University Sixth Hospital/ Institute of Mental Health, Beijing, 100191, People’s Republic of China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People’s Republic of China
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3
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Henning CT, Summerfeldt LJ, Parker JDA. Longitudinal Associations Between Symptoms of ADHD and Life Success: From Emerging Adulthood to Early Middle Adulthood. J Atten Disord 2024; 28:1139-1151. [PMID: 38504446 PMCID: PMC11016205 DOI: 10.1177/10870547241239148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To expand on current adult ADHD literature by investigating the stability of ADHD symptomatology (i.e., inattention and hyperactivity-impulsivity) across a 15-year period (from emerging adulthood to early middle adulthood) and the relative contributions of ADHD symptomatology to life success. METHOD A sample of 320 post-secondary students was initially assessed for ADHD symptomatology using the Conners' Adult ADHD Rating Scale (CAARS). Fifteen years later, participants were re-assessed using the CAARS and several measures of life success (e.g., relationship satisfaction, career satisfaction, and stress levels). RESULTS Inattention and hyperactivity-impulsivity symptoms showed strong stability across the 15-year period. Additionally, inattention symptoms during emerging adulthood and early middle adulthood were consistently associated with poorer life success (i.e., lower relationship and career satisfaction), particularly for men. Associations for hyperactivity-impulsivity symptoms were less consistent. CONCLUSION ADHD symptomatology can be conceptualized as a stable, dimensional trait across adulthood, with important impacts on life success.
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de Bejczy A, Addolorato G, Aubin HJ, Guiraud J, Korpi ER, John Nutt D, Witkiewitz K, Söderpalm B. AUD in perspective. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:1-19. [PMID: 38555113 DOI: 10.1016/bs.irn.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Alcohol is a major cause of pre-mature death and individual suffering worldwide, and the importance of diagnosing and treating AUD cannot be overstated. Given the global burden and the high attributable factor of alcohol in a vast number of diseases, the need for additional interventions and the development of new medicines is considered a priority by the World Health Organization (WHO). As of today, AUD is severely under-treated with a treatment gap nearing 90%, strikingly higher than that for other psychiatric disorders. Patients often seek treatment late in the progress of the disease and even among those who seek treatment only a minority receive medication, mirroring the still-prevailing stigma of the disease, and a lack of access to effective treatments, as well as a reluctance to total abstinence. To increase adherence, treatment goals should focus not only on maintaining abstinence, but also on harm reduction and psychosocial functioning. A personalised approach to AUD treatment, with a holistic view, and tailored therapy has the potential to improve AUD treatment outcomes by targeting the heterogeneity in genetics and pathophysiology, as well as reason for, and reaction to drinking. Also, the psychiatric co-morbidity rates are high in AUD and dual diagnosis can worsen symptoms and influence treatment response and should be considered in the treatment strategies.
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Affiliation(s)
- Andrea de Bejczy
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Giovanni Addolorato
- Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy; Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Henri-Jean Aubin
- Université Paris-Saclay, Inserm, CESP, Villejuif, France; AP-HP, Université Paris Saclay, Villejuif, France
| | - Julien Guiraud
- Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Vergio, Clichy, France
| | - Esa R Korpi
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - David John Nutt
- Imperial College London and GABA Labs, London, United Kingdom
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico, United States
| | - Bo Söderpalm
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
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Levin FR, Hernandez M, Mariani JJ. Treating Attention-Deficit/Hyperactivity Disorder Matters. JAMA 2024; 331:831-833. [PMID: 38470393 PMCID: PMC11562873 DOI: 10.1001/jama.2024.1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Frances R Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Mariely Hernandez
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - John J Mariani
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
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González-Saiz F, Trujols J, Vergara-Moragues E. Cocaine Effect Expectancies among Patients with Cocaine Use Disorder with and without Adult Attention Deficit Hyperactivity Disorder: Are There Any Relevant Differences? J Psychoactive Drugs 2024; 56:76-87. [PMID: 36480506 DOI: 10.1080/02791072.2022.2151951] [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: 04/25/2022] [Revised: 09/05/2022] [Accepted: 09/23/2022] [Indexed: 12/14/2022]
Abstract
Cocaine use could be modulated by drug expectancies based on previously experienced subjective effects. Some patients perceive a paradoxical calming effect after cocaine use. This study was performed to explore cocaine effect expectancies in patients diagnosed with cocaine use disorder, with and without co-occurring adult attention deficit hyperactivity disorder (ADHD). Secondly, we sought to empirically determine the presence of this paradoxical calming effect after cocaine use in patients with co-occurring adult ADHD to identify the individuals most at risk of cocaine use and relapse. Cross-sectional study using a consecutive sampling method of patients diagnosed with cocaine use disorder (n = 221) treated at public therapeutic communities in Andalusia (Spain). Participants completed a battery of instruments to assess the following variables: cocaine effect expectancies, paradoxical calming effect, adult ADHD, and other co-occurring psychiatric disorders. A multivariate binary logistic regression analysis showed that two variables, the paradoxical calming effect and antisocial personality disorder (ASPD), were independently associated with the probability of being diagnosed with adult ADHD (OR = 3.43, 95% CI = 1.88-6.26 and OR = 3.42, 95% CI = 1.30-8.95, respectively). The presence of a paradoxical calming reaction to cocaine and/or a diagnosis of ASPD in patients with cocaine use disorder increases the diagnostic suspicion of co-occurring adult ADHD.
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Affiliation(s)
- Francisco González-Saiz
- Community Mental Health Unit of Villamartin, Hospital Universitario de Jerez, Cádiz, Spain
- Department of Neuroscience, Area of Psychiatry, University of Cadiz, Cadiz, Spain
- CIBERSAM (Network of Biomedical Research Centres for Mental Health), Madrid, Spain
| | - Joan Trujols
- CIBERSAM (Network of Biomedical Research Centres for Mental Health), Madrid, Spain
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu I Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Esperanza Vergara-Moragues
- Department of Psychobiology and Behavioural Science. Complutense University of Madrid (UCM), Madrid, Spain
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7
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Yates JR, Broderick MR, Berling KL, Gieske MG, Osborn E, Nelson MR, Wright MR. Effects of adolescent methylphenidate administration on methamphetamine conditioned place preference in an animal model of attention-deficit/hyperactivity disorder: Examination of potential sex differences. Drug Alcohol Depend 2023; 252:110970. [PMID: 37748422 PMCID: PMC10615784 DOI: 10.1016/j.drugalcdep.2023.110970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/21/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely to be diagnosed with a substance use disorder; however, the effects of long-term psychostimulant treatment on addiction are mixed. Preclinical studies are useful for further elucidating the relationship between ADHD and addiction-like behaviors, but these studies have focused on male subjects only. The goal of the current study was to determine if early-life administration of methylphenidate (MPH) augments methamphetamine (METH) conditioned place preference (CPP) and/or potentiates reinstatement of CPP in both male and female rats. METHODS Male and female spontaneously hypertensive rats (SHRs) and Wistar-Kyoto rats (WKYs) received either MPH (1.5mg/kg; p.o.) or vehicle (1.0ml/kg) during adolescence (postnatal day [PND] ~29-57). Two weeks after cessation of MPH treatment, rats were tested for METH CPP (1.0mg/kg or 2.0mg/kg; s.c.). Rats were then given extinction sessions. Once rats met extinction criteria, they were tested for reinstatement of CPP following a priming injection of METH (0.25mg/kg; s.c.). RESULTS All groups developed METH CPP, except vehicle-treated SHR males and vehicle-treated WKY females conditioned with the higher dose of METH (2.0mg/kg). Female SHRs treated with MPH showed greater reinstatement of METH CPP compared to female SHRs treated with vehicle. Adolescent MPH treatment did not augment the locomotor-stimulant effects of METH in adulthood. CONCLUSIONS These results demonstrate the importance of considering biological sex when prescribing psychostimulant medications for ADHD as long-term MPH administration may increase the risk of continued drug use in females with ADHD following a period of abstinence.
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Affiliation(s)
- Justin R Yates
- Department of Psychological Science, Northern Kentucky University, 1 Nunn Drive, Highland Heights, KY 41099, USA.
| | - Maria R Broderick
- Department of Biological Sciences, Northern Kentucky University, 1 Nunn Drive, Highland Heights, KY 41099, USA
| | - Kevin L Berling
- Department of Biological Sciences, Northern Kentucky University, 1 Nunn Drive, Highland Heights, KY 41099, USA
| | - M Grace Gieske
- Department of Biological Sciences, Northern Kentucky University, 1 Nunn Drive, Highland Heights, KY 41099, USA
| | - Ethan Osborn
- Department of Biological Sciences, Northern Kentucky University, 1 Nunn Drive, Highland Heights, KY 41099, USA
| | - M Ray Nelson
- Department of Psychological Science, Northern Kentucky University, 1 Nunn Drive, Highland Heights, KY 41099, USA
| | - Makayla R Wright
- Department of Biological Sciences, Northern Kentucky University, 1 Nunn Drive, Highland Heights, KY 41099, USA
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Barbuti M, Maiello M, Spera V, Pallucchini A, Brancati GE, Maremmani AGI, Perugi G, Maremmani I. Challenges of Treating ADHD with Comorbid Substance Use Disorder: Considerations for the Clinician. J Clin Med 2023; 12:jcm12093096. [PMID: 37176536 PMCID: PMC10179386 DOI: 10.3390/jcm12093096] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Adults with attention deficit/hyperactivity disorder (ADHD) often present psychiatric comorbidities and, in particular, substance use disorder (SUD). ADHD-SUD comorbidity is characterized by greater severity of both disorders, earlier age of onset, higher likelihood of polydrug-abuse and suicidal behaviors, more hospitalizations, and lower treatment adherence. At the present stage, research focused on the pharmacological management of ADHD with comorbid SUD in both adolescents and adults is still lacking. Furthermore, while the short-term effects of stimulants are well studied, less is known about the chronic effects of these drugs on dopamine signaling. Current available evidence is consistent in reporting that high doses of stimulant medications in ADHD-SUD subjects have a mild to moderate efficacy on ADHD symptoms. Some data suggest that pharmacological treatment with stimulants may be beneficial for both ADHD symptoms and comorbid cocaine or amphetamine use. However, in the long run, stimulant medications may have a potential risk for misuse. For the absence of potential misuse, atomoxetine is often recommended for ADHD with comorbid cocaine or amphetamine use disorder. However, its efficacy in reducing addictive behavior is not demonstrated. In subjects with other subtypes of SUD, both atomoxetine and stimulant drugs seem to have scarce impact on addictive behavior, despite the improvement in ADHD symptomatology. In this population, ADHD treatment should be combined with SUD-specific strategies.
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Affiliation(s)
- Margherita Barbuti
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Marco Maiello
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Vincenza Spera
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Alessandro Pallucchini
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Giulio E Brancati
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Angelo G I Maremmani
- Section of Psychiatry, Department of Psychiatry and Addictions, North-Western Tuscany Local Health Unit, Tuscany NHS, Versilia Zone, Via Aurelia 335, 55041 Lido di Camaiore, Italy
| | - Giulio Perugi
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
| | - Icro Maremmani
- 2nd Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
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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: 03/14/2023] [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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10
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Rocco P. Prevalence of ADHD in a Sample of Heroin Addicts Receiving Agonist Treatment-Study Conducted in a Public Addiction Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2602. [PMID: 36767966 PMCID: PMC9915126 DOI: 10.3390/ijerph20032602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder that can persist into adulthood. The co-occurrence of ADHD and substance use disorders is very frequent and has received considerable attention in recent clinical/scientific investigations. However, few studies have investigated the prevalence of ADHD in heroin addicts. This study aimed to investigate the prevalence of attention-deficit/hyperactivity disorder (ADHD) in a sample of heroin addicts treated with opioid agonists and to report this clinical experience in a public service for addiction. Outpatients over 18 years old and being treated with opioid agonists for heroin addiction were enrolled. Each patient took part in a psychiatric examination and completed an ASRS (Adult ADHD Self-Report Scale) self-assessment. Subjects with positive results were called in for another psychiatric visit, and the Brown ADD scale was used as a second-level test for ADHD; furthermore, the Mini International Neuropsychiatric Interview (MINI) and Hypomania/Mania Checklist (HCL-32) were used for differential diagnoses and to assess comorbidities. In total, 111 patients were enrolled. All were followed up by the psychiatrist, who is also the author of this report and the person who formulated the diagnoses. The prevalence of ADHD in this sample was 18%. Among the 20 patients diagnosed with ADHD, 5 (25%) were female and 15 (75%) were male. The most frequent psychiatric comorbidity was major depression, found in 11 patients (55%), of which 4 presented with hypomania (bipolar disorder). In this sample, making diagnoses was very difficult. Frequently, multiple comorbidities further complicated these cases. In conclusion, the results of this study are consistent with the literature: There seems to be a significant prevalence of ADHD even among heroin addicts, and often, the diagnosis is difficult to make. We also do not know the exact effect of opioid agonist therapy on ADHD symptoms. Hypotheses have been put forward, but studies are needed.
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Affiliation(s)
- Pasqualina Rocco
- Addiction Treatment Center, Local Health Service N. 2, Veneto, Via dei Carpani, 16/Z, 31033 Treviso, Italy
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11
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Rohner H, Gaspar N, Philipsen A, Schulze M. Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among Substance Use Disorder (SUD) Populations: Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1275. [PMID: 36674031 PMCID: PMC9859173 DOI: 10.3390/ijerph20021275] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 06/02/2023]
Abstract
(1) Background: Attention deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of age-inappropriate levels of inattention and/or hyperactivity/impulsivity that results in functional impairment at work, education, or hobbies and affects family life, social contacts, and self-confidence. ADHD is a comorbid condition associated with a prognosis of severe substance use disorder (SUD) and the early onset of such. The aim of this meta-analysis was to obtain the best estimate of the prevalence of ADHD in SUD populations. (2) Methods: A literature research was conducted using PUBMED® and Web of Science®. The following search terms were used: [ADHD], [prevalence], and [substance use disorder]. RStudio® was used for meta-analysis methods. (3) Results: In total, 31 studies were included. We estimate the prevalence of ADHD among SUD patients at 21%.
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12
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Johnston KJ, Huckins LM. Chronic Pain and Psychiatric Conditions. Complex Psychiatry 2023; 9:24-43. [PMID: 37034825 PMCID: PMC10080192 DOI: 10.1159/000527041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/01/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Chronic pain is a common condition with high socioeconomic and public health burden. A wide range of psychiatric conditions are often comorbid with chronic pain and chronic pain conditions, negatively impacting successful treatment of either condition. The psychiatric condition receiving most attention in the past with regard to chronic pain comorbidity has been major depressive disorder, despite the fact that many other psychiatric conditions also demonstrate epidemiological and genetic overlap with chronic pain. Further understanding potential mechanisms involved in psychiatric and chronic pain comorbidity could lead to new treatment strategies both for each type of disorder in isolation and in scenarios of comorbidity. Methods This article provides an overview of relationships between DSM-5 psychiatric diagnoses and chronic pain, with particular focus on PTSD, ADHD, and BPD, disorders which are less commonly studied in conjunction with chronic pain. We also discuss potential mechanisms that may drive comorbidity, and present new findings on the genetic overlap of chronic pain and ADHD, and chronic pain and BPD using linkage disequilibrium score regression analyses. Results Almost all psychiatric conditions listed in the DSM-5 are associated with increased rates of chronic pain. ADHD and BPD are significantly genetically correlated with chronic pain. Psychiatric conditions aside from major depression are often under-researched with respect to their relationship with chronic pain. Conclusion Further understanding relationships between psychiatric conditions other than major depression (such as ADHD, BPD, and PTSD as exemplified here) and chronic pain can positively impact understanding of these disorders, and treatment of both psychiatric conditions and chronic pain.
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Affiliation(s)
- Keira J.A. Johnston
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA
| | - Laura M. Huckins
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA
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13
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Brynte C, Aeschlimann M, Barta C, Begeman AHA, Bäcker A, Crunelle CL, Daigre C, De Fuentes-Merillas L, Demetrovics Z, Dom G, López LG, Icick R, Johnson B, Joostens P, Kapitány-Fövény M, Karsinti E, Kiefer F, Konstenius M, Levin FR, Luderer M, Markus W, Matthys F, Moggi F, Palma-Alvarez RF, Paraskevopoulou M, Ramos-Quiroga JA, Schellekens A, Soravia LM, Therribout N, Thomas A, van de Glind G, van Kernebeek MW, Vollstädt-Klein S, Vorspan F, van den Brink W, Franck J. The clinical course of comorbid substance use disorder and attention deficit/hyperactivity disorder: protocol and clinical characteristics of the INCAS study. BMC Psychiatry 2022; 22:625. [PMID: 36151539 PMCID: PMC9502646 DOI: 10.1186/s12888-022-04259-6] [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: 04/16/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Substance use disorders (SUD) often co-occur with attention deficit hyperactivity disorder (ADHD). Although the short-term effects of some specific interventions have been investigated in randomized clinical trials, little is known about the long-term clinical course of treatment-seeking SUD patients with comorbid ADHD. AIMS This paper presents the protocol and baseline clinical characteristics of the International Naturalistic Cohort Study of ADHD and SUD (INCAS) designed and conducted by the International Collaboration on ADHD and Substance Abuse (ICASA) foundation. The overall aim of INCAS is to investigate the treatment modalities provided to treatment-seeking SUD patients with comorbid ADHD, and to describe the clinical course and identify predictors for treatment outcomes. This ongoing study employs a multicentre observational prospective cohort design. Treatment-seeking adult SUD patients with comorbid ADHD are recruited, at 12 study sites in nine different countries. During the follow-up period of nine months, data is collected through patient files, interviews, and self-rating scales, targeting a broad range of cognitive and clinical symptom domains, at baseline, four weeks, three months and nine months. RESULTS A clinically representative sample of 578 patients (137 females, 441 males) was enrolled during the recruitment period (June 2017-May 2021). At baseline, the sample had a mean age (SD) of 36.7 years (11.0); 47.5% were inpatients and 52.5% outpatients; The most prevalent SUDs were with alcohol 54.2%, stimulants 43.6%, cannabis 33.1%, and opioids 14.5%. Patients reported previous treatments for SUD in 71.1% and for ADHD in 56.9%. Other comorbid mental disorders were present in 61.4% of the sample: major depression 31.5%, post-traumatic stress disorder 12.1%, borderline personality disorder 10.2%. CONCLUSIONS The first baseline results of this international cohort study speak to its feasibility. Data show that many SUD patients with comorbid ADHD had never received treatment for their ADHD prior to enrolment in the study. Future reports on this study will identify the course and potential predictors for successful pharmaceutical and psychological treatment outcomes. TRIAL REGISTRATION ISRCTN15998989 20/12/2019.
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Affiliation(s)
- Christoffer Brynte
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden.
| | - Myriam Aeschlimann
- grid.5734.50000 0001 0726 5157University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Csaba Barta
- grid.11804.3c0000 0001 0942 9821Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, Budapest, Hungary
| | | | - Amanda Bäcker
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Cleo Lina Crunelle
- grid.411326.30000 0004 0626 3362Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, 1090 Jette, Belgium
| | - Constanza Daigre
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura De Fuentes-Merillas
- grid.491352.8Novadic-Kentron Addiction Care; Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, the Netherlands
| | - Zsolt Demetrovics
- grid.5591.80000 0001 2294 6276Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary ,grid.513141.30000 0004 4670 111XCentre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Geert Dom
- grid.5284.b0000 0001 0790 3681University of Antwerp, Antwerp, Belgium ,PC Multiversum, Boechout, Belgium
| | - Lara Grau López
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Romain Icick
- grid.508487.60000 0004 7885 7602Université de Paris Cité, Paris, France
| | | | | | - Máté Kapitány-Fövény
- grid.11804.3c0000 0001 0942 9821Faculty of Health Sciences, Semmelweis University, Budapest, Hungary ,National Institute of Mental Health, Neurology and Neurosurgery – Nyírő Gyula Hospital, Budapest, Hungary
| | - Emily Karsinti
- grid.414095.d0000 0004 1797 9913Université Paris-Nanterre, CliPsyD Laboratory FR and APHP, Fernand Widal Hospital, Universitary Department of Psychiatry and Addictology, Paris, France
| | - Falk Kiefer
- grid.7700.00000 0001 2190 4373Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany ,grid.7700.00000 0001 2190 4373Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maija Konstenius
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Frances R. Levin
- grid.21729.3f0000000419368729Vagelos College of Physicians and Surgeons, New York City, USA ,grid.413734.60000 0000 8499 1112New York State Psychiatric Institute, New York City, USA
| | - Mathias Luderer
- grid.411088.40000 0004 0578 8220Department of Psychiatry, Psychosomatic Medicine and Psychoterapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Wiebren Markus
- grid.491352.8Iriszorg Addiction Care, Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, the Netherlands
| | - Frieda Matthys
- grid.411326.30000 0004 0626 3362Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, 1090 Jette, Belgium
| | - Franz Moggi
- grid.5734.50000 0001 0726 5157University Hospital of Psychiatry, Translational Research Center, University of Bern, Bern, Switzerland
| | - Raul Felipe Palma-Alvarez
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Maria Paraskevopoulou
- Department of Psychiatry, RadboudumcDonders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - J. Antoni Ramos-Quiroga
- grid.411083.f0000 0001 0675 8654Department of Psychiatry, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d’Hebron, Barcelona, Spain ,grid.430994.30000 0004 1763 0287Psychiatry Group, Mental Health and Addiction, Vall d’Hebron Research Institute (VHIR), Barcelona, Spain ,grid.469673.90000 0004 5901 7501Biomedical Network Research Centre On Mental Health (CIBERSAM), Madrid, Spain ,grid.7080.f0000 0001 2296 0625Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Arnt Schellekens
- Department of Psychiatry, RadboudumcDonders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands ,grid.491352.8Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, the Netherlands
| | - Leila M. Soravia
- grid.5734.50000 0001 0726 5157University Hospital of Psychiatry, Translational Research Center, University of Bern, Bern, Switzerland ,Südhang Clinic, Kirchlindach, Switzerland
| | - Norman Therribout
- grid.414095.d0000 0004 1797 9913Université Paris-Nanterre, CliPsyD Laboratory FR and APHP, Fernand Widal Hospital, Universitary Department of Psychiatry and Addictology, Paris, France
| | - Anil Thomas
- Mt. Sinai, Icahn School of Medicine, New York City, USA ,grid.137628.90000 0004 1936 8753NYU Grossman School of Medicine, New York City, USA
| | - Geurt van de Glind
- grid.438049.20000 0001 0824 9343University of Applied Sciences-Utrecht, Utrecht, the Netherlands
| | - Michiel Willem van Kernebeek
- grid.411326.30000 0004 0626 3362Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, 1090 Jette, Belgium
| | - Sabine Vollstädt-Klein
- grid.7700.00000 0001 2190 4373Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany ,grid.7700.00000 0001 2190 4373Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Florence Vorspan
- grid.508487.60000 0004 7885 7602Université de Paris Cité, Paris, France
| | - Wim van den Brink
- grid.509540.d0000 0004 6880 3010Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Johan Franck
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
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Calub CA, Rapport MD, Irurita C, Eckrich SJ, Bohil C. Attention Control in Children With ADHD: An Investigation Using Functional Near Infrared Spectroscopy (fNIRS). Child Neuropsychol 2022; 28:1072-1096. [PMID: 35285411 DOI: 10.1080/09297049.2022.2047913] [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: 10/18/2022]
Abstract
Attention problems are a predominant contributor to near- and far-term functional outcomes in attention-deficit/hyperactivity disorder (ADHD); however, most interventions focus on improving the alerting attentional network, which has failed to translate into improved learning for a majority of children with ADHD. Comparatively less is known regarding the executive attentional network and its overarching attention control process, which governs the ability to maintain relevant information in a highly active, interference-free state, and is intrinsic to a broad range of cognitive functions. This is the first study to compare attention control abilities in children with ADHD and typically developing (TD) children using the Visual Array Task (VAT) and to simultaneously measure hemodynamic functioning (oxyHb) using functional Near-Infrared Spectroscopy (fNIRS). Nineteen children with ADHD Combined type and 18 typically developing (TD) children aged 8 to 12 years were administered the VAT task while prefrontal activity was monitored using fNIRS. Results revealed that children with ADHD evinced large magnitude deficits in attention control and that oxyHb levels in the left dorsal lateral prefrontal cortex (dlPFC) were significantly greater in children with ADHD relative to TD children. These findings suggest that poor attention control abilities in children with ADHD may be related to increased left dlPFC activation in response to an underdeveloped and/or inefficient right dlPFC. The need to design interventions that target and strengthen attention control and its corresponding neural network is discussed based on the likelihood that attention control serves as the potential quaesitum for understanding a wide array of ADHD-related deficits.
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Affiliation(s)
- Catrina A Calub
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Mark D Rapport
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Carolina Irurita
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Samuel J Eckrich
- Department of Neuropsychology, Kennedy Krieger Institute/Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Corey Bohil
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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15
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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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16
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Bassiony MM, Mahdy RS, Haggag N, Salah Eldeen G. Current attention-deficit/hyperactivity disorder and nonmedical prescription opioid use attributed to tramadol among male adolescents without conduct disorder in Egypt. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:623-629. [PMID: 34280063 DOI: 10.1080/00952990.2021.1944172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Evidence for the association between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) is common. However, little research has investigated this relationship among adolescents using nonmedical prescription opioids, particularly tramadol.Objective: To estimate the prevalence and correlates of ADHD among adolescents with tramadol misuse and without conduct disorder (CD).Methods: This study included 122 Egyptian adolescents (100% male) with opioid use disorders attributed to tramadol. The diagnosis of SUDs, ADHD, and CD (to exclude) was based on the SCID-I criteria of the DSM-IV-TR. Drug-related problems were assessed using the Drug Use Disorders Identification Test (DUDIT). All adolescents were screened for drugs by urinalysis.Results: Thirty-eight percent of adolescents with tramadol misuse had ADHD. Adolescents with tramadol misuse and ADHD were more likely to have a younger age of onset of smoking, substance use, and tramadol misuse than adolescents without ADHD.Conclusions: ADHD is common among adolescents with tramadol misuse. There is an association between ADHD and young age of onset of tramadol misuse and drug-related problems.
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Affiliation(s)
- Medhat M Bassiony
- Psychiatry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rehab S Mahdy
- Psychiatry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Noha Haggag
- Psychiatry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ghada Salah Eldeen
- Psychiatry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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17
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Martínez-Luna N, Daigre C, Palma-Álvarez F, Perea-Ortueta M, Grau-López L, Roncero C, Castell-Panisello E, Ramos-Quiroga JA. Psychiatric Comorbidity and Addiction Severity Differences in Patients With ADHD Seeking Treatment for Cannabis or Cocaine Use Disorders. J Atten Disord 2021; 25:978-988. [PMID: 31550967 DOI: 10.1177/1087054719875787] [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] [Indexed: 12/29/2022]
Abstract
Objective: The objective of this study was to compare psychiatric comorbidity and consumption-related variables in ADHD patients seeking treatment for cocaine, cannabis, or both. Method: Assessment was conducted using European Addiction Severity Index (EuropASI), Conners' Adult ADHD Diagnostic Interview (CAADID), Structured Clinical Interview for DSM Disorders (SCID), Adult Self-Report Scale (ASRS), Wender Utah Rating Scale (WURS), Barratt Impulsiveness Scale-11 (BIS-11), and FIDI, with statistical analyses of analysis of variance (ANOVA), Student's t test, chi-square test, and multinomial regression model. Results: In total, 1,538 patients with substance use disorder (SUD) were evaluated for ADHD; 239 (15.5%) had ADHD, with cannabis 41, cannabis/cocaine 36, and cocaine 74. Men represented 80%, with mean age of 32.9 ± 10 years. Significant variables were-in bivariate analysis-more years of cannabis use in cannabis group and younger age for cocaine use disorder in cannabis/cocaine group, and-in multivariate analysis-lifetime anxiety disorder and younger age at onset of any SUD in cannabis group and working affected scale in cannabis and polysubstance use in cannabis/cocaine group. Conclusion: Groups with cannabis use had higher severity. ADHD features were similar in all groups. The assessment of ADHD and comorbid disorders is important.
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Affiliation(s)
- Nieves Martínez-Luna
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Constanza Daigre
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Felipe Palma-Álvarez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Marta Perea-Ortueta
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Spain
| | - Lara Grau-López
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Carlos Roncero
- Psychiatry Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca , University of Salamanca, Spain
| | - Eudald Castell-Panisello
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
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18
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Vélez-Pastrana MC, González RA, Ramos-Fernández A, Ramírez Padilla RR, Levin FR, Albizu García C. Attention Deficit Hyperactivity Disorder in Prisoners: Increased Substance Use Disorder Severity and Psychiatric Comorbidity. Eur Addict Res 2020; 26:179-190. [PMID: 32615575 DOI: 10.1159/000508829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD) are overrepresented among incarcerated populations. We examined whether ADHD was associated with increased severity of comorbid SUD and with increased psychiatric comorbidity among prisoners. METHODS Cross-sectional study of 500 randomly selected Latino male prisoners in the Puerto Rico Correctional System using validated diagnostic measures to assess Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ADHD and SUD diagnosis, antisocial personality disorder (ASP) and borderline personality disorder (BPD), major depression, and generalized anxiety disorder (GAD). We defined SUD severity by symptom count and by presence of at least 2 current SUD diagnoses (polysubstance). RESULTS Participants with ADHD had increased risk for lifetime (p < 0.05) and current (p < 0.01) SUDs, all comorbid psychiatric disorders, and suicidality (p < 0.001). They had more severe SUD, both in number of symptoms and number of SUD (polysubstance) diagnoses (p < 0.01). ADHD was associated with increased psychiatric comorbidity, as participants with ADHD were more likely to have a second diagnosis, and a greater number of comorbid disorders (p < 0.001). ASP, BPD, major depression, and GAD, but not ADHD, were significant predictors of SUD severity in adjusted models. CONCLUSIONS Findings highlight the complex mental health needs of incarcerated populations, where SUD, ADHD, and other psychiatric disorders are prevalent and interrelated.
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Affiliation(s)
- María C Vélez-Pastrana
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico, .,Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA,
| | - Rafael A González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Rafael R Ramírez Padilla
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
| | - Frances R Levin
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Carmen Albizu García
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
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Regan T, Tubman J. Attention Deficit Hyperactivity Disorder (ADHD) Subtypes, Co-Occurring Psychiatric Symptoms and Sexual Risk Behaviors among Adolescents Receiving Substance Abuse Treatment. Subst Use Misuse 2020; 55:119-132. [PMID: 31502500 PMCID: PMC6917828 DOI: 10.1080/10826084.2019.1657895] [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] [Indexed: 10/26/2022]
Abstract
Background: Adolescents entering substance abuse treatment report clustered psychiatric symptoms and sexual risk behaviors representing differential levels of impairment and risk for maladaptive health outcomes. Objectives: To examine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) subtypes among adolescents receiving outpatient substance abuse treatment; To document group differences in (a) past-year psychiatric symptom scores and (b) sexual risk behaviors by ADHD subtype and gender. Methods: Self-report data were collected via structured interviews from 394 adolescents (280 males, M = 16.33 years, SD = 1.15 years), enrolled in an HIV/STI risk reduction intervention for adolescents receiving outpatient substance abuse treatment. ADHD diagnostic subtypes and other past-year psychiatric symptoms were assessed using the Brief Michigan Version of the Composite Internal Diagnostic Interview (UM-CIDI). Adolescents provided self-report data on sexual risk behaviors. Results: Multivariate analyses of variance (MANOVAs) documented that Inattentive and Hyperactive-Impulsive ADHD subtypes were significantly associated with higher scores for all past-year psychiatric symptoms. The combined ADHD subtype was significantly associated with higher scores for all psychiatric symptoms except affective disorder. Girls reported significantly higher mean symptoms than boys for alcohol abuse and dependence, anxiety, and affective disorder symptoms. Sexual risk behavior scores were not associated with ADHD status, but girls reported consistently higher scores for multiple risk behavior outcomes. Several psychiatric disorder symptoms were significant covariates of multiple sexual risk behaviors. Conclusion/Importance: Brief screenings for ADHD, other psychiatric disorders and sexual risk behaviors can provide data for tailoring substance abuse services to improve adolescent health outcomes for high-risk subgroups.
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Affiliation(s)
- Timothy Regan
- Department of Psychological & Brain Sciences, Texas A&M University College Station, College Station, Texas, USA
| | - Jonathan Tubman
- Department of Psychology, American University, Washington D.C., USA
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20
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Van de Glind G, Brynte C, Skutle A, Kaye S, Konstenius M, Levin F, Mathys F, Demetrovics Z, Moggi F, Ramos-Quiroga JA, Schellekens A, Crunelle C, Dom G, van den Brink W, Franck J. The International Collaboration on ADHD and Substance Abuse (ICASA): Mission, Results, and Future Activities. Eur Addict Res 2020; 26:173-178. [PMID: 32599579 PMCID: PMC7592924 DOI: 10.1159/000508870] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The International Collaboration on ADHD and Substance Abuse (ICASA) is a network of 28 centers from 16 countries initiated to investigate the link between attention deficit-hyperactivity disorder (ADHD) and substance use disorder (SUD). In this article, we present the mission, the results of finished studies, and the current and future research projects of ICASA. METHODS During the past 10 years, 3 cross-sectional studies were conducted: two International ADHD in Substance use disorders Prevalence (IASP-1 and IASP-2) studies, directed at the screening, diagnosis, and the prevalence of adult ADHD in treatment-seeking patients with SUD, and the Continuous performance test for ADHD in SUD Patients (CASP) study, testing a novel continuous performance test in SUD patients with and without adult ADHD. Recently, the prospective International Naturalistic Cohort Study of ADHD and Substance Use Disorders (INCAS) was initiated, directed at treatment provision and treatment outcome in SUD patients with adult ADHD. RESULTS The IASP studies have shown that approximately 1 in 6 adult treatment-seeking SUD patients also have ADHD. In addition, those SUD patients with adult ADHD compared to SUD patients without ADHD report more childhood trauma exposure, slower infant development, greater problems controlling their temperament, and lower educational attainment. Comorbid patients also reported more risk-taking behavior, and a higher rate of other psychiatric disorders compared to SUD patients without ADHD. Screening, diagnosis, and treatment of this patient group are possible even before abstinence has been achieved. The results of the CASP study are reported separately in this special issue. CONCLUSIONS The ICASA research to date has demonstrated a high prevalence of comorbid ADHD and SUD, associated with elevated rates of additional comorbidities and risk factors for adverse outcomes. More research is needed to find the best way to treat these patients, which is the main topic of the ongoing INCAS study.
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Affiliation(s)
- Geurt Van de Glind
- Director ICASA Foundation, Radboud University Medical Hospital, Nijmegen, The Netherlands,Teacher at Bachelor School of Nursing, Institute for Nursing Studies, University of Applied Science, Utrecht, The Netherlands,*Geurt Van de Glind, Radboudumc/NISPA, Radboud University Medical Hospital, ICASA Foundation, Geert Grooteplein Zuid 10, NL–6525 Nijmegen (The Netherlands),
| | - Christoffer Brynte
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | | | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Maija Konstenius
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Frances Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute, Columbia University Medical Center, New York State Psychiatric Institute, New York, New York, USA
| | - Frieda Mathys
- Department of psychiatry University Hospital Brussels, Free University of Brussels, Brussels, Belgium
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Franz Moggi
- Clinical Psychological Service, University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain,Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain Cognition, and Behavior, Nijmegen, The Netherlands
| | - Cleo Crunelle
- Department of Psychiatry, University Hospital Brussels (UZ Jette), Toxicological Center, University of Antwerp, Antwerp, Belgium
| | - Geert Dom
- Antwerp University & Hospital, Addiction Psychiatry, Psychiatric Center Alexian Brothers, Antwerp, Belgium
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Johan Franck
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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21
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Moggi F, Schorno D, Soravia LM, Mohler-Kuo M, Estévez-Lamorte N, Studer J, Gmel G. Screened Attention Deficit/Hyperactivity Disorder as a Predictor of Substance Use Initiation and Escalation in Early Adulthood and the Role of Self-Reported Conduct Disorder and Sensation Seeking: A 5-Year Longitudinal Study with Young Adult Swiss Men. Eur Addict Res 2020; 26:233-244. [PMID: 32564034 PMCID: PMC7592926 DOI: 10.1159/000508304] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/28/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and sensation seeking (SS) have been consistently related to a higher risk of substance use (SU) and substance use disorder (SUD). OBJECTIVES To investigate the relationship between ADHD and prevalence rates in males at age 20 and age 25, the initiation of SU and SUD after age 20, and the escalation of SU from age 20 to age 25, and to explore the role of CD and SS in the relation of ADHD with SU and SUD initiation and escalation. METHOD Data were obtained as part of the Cohort Study on Substance Use Risk Factors (C-SURF), which focused on young Swiss men aged 20 years at baseline and 25 years at follow-up. RESULTS Participants who screened positive for ADHD at baseline exhibited a higher rate of SU and SUD than participants who screened negative. The presence of ADHD symptoms at age 20 predicted initiation of all SU between age 20 and age 25, except for alcohol and smoking. After controlling for self-reported CD and SS, ADHD still predicted this late initiation of use of hallucinogens, meth-/amphetamines, and ecstasy/MDMA; non-medical use of ADHD medication and sedatives, and alcohol use disorder (AUD). No escalation of weekly drinking and smoking or annual cannabis use was observed from age 20 to age 25. CONCLUSION Screened-positive ADHD is an independent predictor of late SU and AUD, along with self-reported CD and SS. From a public health perspective, identifying ADHD is not only important in childhood and adolescence but also in early adulthood to guide specific interventions to lower risks of drug use initiation and the development of AUD in early adulthood.
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Affiliation(s)
- Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,*Prof. Franz Moggi, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, CH–3000 Bern 60 (Switzerland),
| | - Deborah Schorno
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Leila Maria Soravia
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,Südhang Clinic, Research Deparment, Kirchlindach, Switzerland
| | - Meichun Mohler-Kuo
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Natialia Estévez-Lamorte
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - Joseph Studer
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,Swiss Institute for the Prevention of Alcohol and Drug Problems, Research Department, Lausanne, Switzerland,Center for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada,University of the West of England, Faculty of Health and Social Sciences, Bristol, United Kingdom
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Reyes MM, Schneekloth TD, Hitschfeld MJ, Karpyak VM. Impact of Sex and ADHD Status on Psychiatric Comorbidity in Treatment-Seeking Alcoholics. J Atten Disord 2019; 23:1505-1513. [PMID: 30394819 DOI: 10.1177/1087054718807997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: To assess for intrasex and intersex differences in psychiatric comorbidity according to ADHD status in treatment-seeking adults with alcohol use disorders (AUDs). Method: This study was a secondary analysis of data utilizing descriptive statistics from 472 treatment-seeking alcoholics who completed the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Results: The prevalence of ADHD in males and females was 6.0% and 6.4%, respectively. Males with ADHD and AUDs had higher rates of current and lifetime drug use disorders, current depressive disorders, and current and lifetime anxiety disorders than male alcoholics without ADHD. No intrasex differences in psychiatric comorbidities were identified in female alcoholics with respect to ADHD status. Males with ADHD and AUDs were more likely to have had opioid dependence than ADHD-positive females. No other intersex differences were found. Conclusion: Positive ADHD status was associated with increased psychiatric comorbidity among treatment-seeking alcoholic men.
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23
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Kuzmickaitė J, Leskauskas D, Gylytė O. ADHD-Related Mental Health Issues of Young Adult Male Prisoners in Pravieniškės Correction House-Open Colony (Lithuania). Am J Mens Health 2019; 13:1557988319870974. [PMID: 31426725 PMCID: PMC6702778 DOI: 10.1177/1557988319870974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate mental health issues related to attention-deficit/hyperactivity disorder (ADHD) in young adult male prisoners. The study was performed in the Pravieniškės Correction House-Open Prison Colony and represents the first study on adult ADHD in Lithuania. The sample consisted of 100 young males imprisoned for mild to moderate crimes. ADHD symptoms were assessed using the Adult Self-Report Scale v1.1 (ASRS v1.1) and Wender Utah Rating Scale (WURS) self-rating scales. Related mental health issues were evaluated using the DSM-5 Level 1 Cross-Cutting Symptom Measure, the Personality Inventory for DSM-5, and data from both medical files and offenses-incentives lists. Clinically significant ADHD symptoms were found in 17% of the respondents. Prisoners with ADHD were younger and had shorter incentives lists. Personality traits of negative affect, antagonism, disinhibition, and psychoticism with increased personality dysfunction were more prevalent in the respondents with ADHD. Medical files of prisoners with ADHD more frequently included data on substance abuse, psychiatric diagnoses, and psychopharmacological treatment. None of the respondents had been diagnosed or treated for this disorder. Clinically significant ADHD symptoms were highly prevalent among imprisoned males, but ADHD was not diagnosed or treated correctly. These findings show that the problem of ADHD in young male adults with increased risk for criminal behavior needs recognition by the politicians and professionals responsible for health care in Lithuania in order to better care for prisoners with this psychopathology.
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Affiliation(s)
- Jūratė Kuzmickaitė
- 1 Lithuanian University of Health Sciences Hospital Kauno klinikos (Department of Psychiatry), Kaunas, Lithuania
| | - Darius Leskauskas
- 1 Lithuanian University of Health Sciences Hospital Kauno klinikos (Department of Psychiatry), Kaunas, Lithuania
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Huang YF, Chiou HY, Chung CH, Chien WC, Chang HJ. Psychiatric Disorders After Attention-Deficit/Hyperactivity Disorder: A Nationwide Population-Based Study in Taiwan. J Nurs Scholarsh 2019; 51:138-146. [PMID: 30609223 DOI: 10.1111/jnu.12457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the risk for psychiatric disorders in patients newly diagnosed with attention deficit hyperactive disorder (ADHD) from two longitudinal groups of children with and without ADHD. STUDY DESIGN In total, 1,745 children newly diagnosed with ADHD and 6,980 participants without ADHD were identified from Taiwan's National Health Insurance Research Database in 2005 and followed until 2010. Risks for psychiatric disorders in the ADHD and non-ADHD groups were compared. RESULTS The ADHD group was 3.82 times more likely to develop psychiatric disorders than their counterparts. The ADHD group showed the highest risk for oppositional defiant disorder, followed by adult ADHD and autism spectrum disorder. Moreover, the time effects of psychiatric disorders in the ADHD group were significant. Patients with ADHD subtypes had a significant risk for psychiatric disorders compared to their counterparts. CONCLUSIONS A high risk for psychiatric disorders was revealed in this study among children with ADHD. Childhood ADHD, the duration after the ADHD diagnosis, and the ADHD subtype were associated with psychiatric disorders. CLINICAL RELEVANCE Various psychiatric disorders were observed in children after they had been newly diagnosed with ADHD, indicating a need for integrated care that includes medical practitioners, family members, social workers, and early intervention workers for patients newly diagnosed with ADHD to decrease the risk for comprehensive psychiatric disorders.
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Affiliation(s)
- Ya-Fang Huang
- PhD Candidate, School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Chiou
- Distinguished Professor, School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Adjunct Assistant Professor, School of Public Health, National Defense Medical left, and Secretary General, Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan
| | - Wu-Chien Chien
- Associate Professor, School of Public Health, National Defense Medical left, and Associate Professor, Department of Medical Research, Tri-Service General Hospital, National Defense Medical left, Taipei, Taiwan
| | - Hsiu-Ju Chang
- Professor, Dean of Student Affairs, School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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25
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Valero S, Bosch R, Corominas M, Barrau V, Ramos-Quiroga JA, Casas M. Remittance or persistence of attention deficit-hyperactivity disorder (ADHD) and its impact on recidivism in risky driving behaviors. TRAFFIC INJURY PREVENTION 2018; 19:701-707. [PMID: 30485128 DOI: 10.1080/15389588.2018.1505043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/22/2018] [Accepted: 07/22/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Recent data regarding the persistence or remittance of attention deficit-hyperactivity disorder (ADHD) diagnosis into adulthood raise the question of its possible role in crucial public health issues, including road safety, especially when neurocognitive capacities are challenged. METHODS The study included 611 participants with serious traffic violations. The Spanish version of the Mini International Neuropsychiatric Interview (M.I.N.I.) was used to assess psychopathology. They were grouped into 3 diagnostic conditions: non-ADHD, persistent ADHD (ADHD-P), and remittent ADHD (ADHD-R). Several risky driving behaviors were analyzed. RESULTS Although participants with ADHD have more driving violations relative to non-ADHD, ADHD-R, and ADHD-P drivers have similar profiles. ADHD-R and ADHD-P drivers are more prone to perform risky and recidivistic behaviors relative to non-ADHD counterparts (P = .044 and P = .047, respectively); ADHD-R and ADHD-P participants are statistically comparable in this proneness (P = .772). CONCLUSION These results suggest that the underlying core deficits of ADHD-attention and other executive disabilities-persist despite the fact that some people no longer reach the threshold for clinical diagnosis.
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Affiliation(s)
- S Valero
- a Group of Psychiatry, Mental Health and Addiction , Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- c Biomedical Network Research Center on Mental Health (CIBERSAM) , Madrid , Spain
- d Instituto para el Desarrollo de Estudios y Terapias Avanzadas en Neurociencias (IDETAN)
| | - R Bosch
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- d Instituto para el Desarrollo de Estudios y Terapias Avanzadas en Neurociencias (IDETAN)
- e Department of Psychiatry and Legal Medicine , Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
| | - M Corominas
- a Group of Psychiatry, Mental Health and Addiction , Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- c Biomedical Network Research Center on Mental Health (CIBERSAM) , Madrid , Spain
- d Instituto para el Desarrollo de Estudios y Terapias Avanzadas en Neurociencias (IDETAN)
| | - V Barrau
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
| | - J A Ramos-Quiroga
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- c Biomedical Network Research Center on Mental Health (CIBERSAM) , Madrid , Spain
- e Department of Psychiatry and Legal Medicine , Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
| | - M Casas
- b Department of Psychiatry , Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
- c Biomedical Network Research Center on Mental Health (CIBERSAM) , Madrid , Spain
- d Instituto para el Desarrollo de Estudios y Terapias Avanzadas en Neurociencias (IDETAN)
- e Department of Psychiatry and Legal Medicine , Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain
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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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Cook J, Lloyd-Jones M, Arunogiri S, Ogden E, Bonomo Y. Managing attention deficit hyperactivity disorder in adults using illicit psychostimulants: A systematic review. Aust N Z J Psychiatry 2017. [PMID: 28639480 DOI: 10.1177/0004867417714878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT Attention deficit hyperactivity disorder and stimulant use disorder commonly co-exist, and appropriate treatments have not been well established. OBJECTIVE To provide guidance for treatment of co-existing attention deficit hyperactivity disorder and stimulant use disorder. DATA SOURCES A systematic review of published English articles using MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane, utilising consistent search terms. STUDY SELECTION Randomised controlled trials, comparing any treatment arm with a control group, for participants meeting Diagnostic and Statistical Manual of Mental Disorders or equivalent criteria for both attention deficit hyperactivity disorder and stimulant use disorder. RESULTS Eight trials were identified for inclusion in this review. Four of eight studies showed improvement in attention deficit hyperactivity disorder outcome measures compared with placebo. Two of six studies that reported substance use outcomes showed improvement in treatment arms compared with placebo. Studies to show effect tended to be those with the highest treatment dosage. CONCLUSION Evidence for the efficacy of treatment of patients with comorbid stimulant use disorder and attention deficit hyperactivity disorder is limited. Promising outcomes need replication in further studies utilising higher treatment dosage.
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Affiliation(s)
- Jon Cook
- 1 Drug Health Services, Western Health, Footscray, VIC, Australia.,2 Youth Support + Advocacy Service, Fitzroy, VIC, Australia
| | - Martyn Lloyd-Jones
- 3 Department of Addiction Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,4 Delmont Private Hospital, Glen Iris, VIC, Australia
| | - Shalini Arunogiri
- 5 Turning Point, Eastern Health, Fitzroy, VIC, Australia.,6 Monash University, Melbourne, VIC, Australia
| | - Edward Ogden
- 3 Department of Addiction Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,7 Swinburne University of Technology, Melbourne, VIC, Australia.,8 Youth Health and Rehabilitation Service (YHaRS), Fitzroy, VIC, Australia
| | - Yvonne Bonomo
- 3 Department of Addiction Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,9 Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
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Modesto-Lowe V, Charbonneau V, Farahmand P. Psychotherapy for Adolescents With Attention-Deficit Hyperactivity Disorder: A Pediatrician's Guide. Clin Pediatr (Phila) 2017; 56:667-674. [PMID: 27895149 DOI: 10.1177/0009922816673308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) presents with high levels of inattention, impulsiveness, and hyperactivity. ADHD starts in childhood and results in impairments that continue into adulthood. ADHD symptoms lead to decreased functionality in various life domains and result in poor academics, behavioral challenges, delayed independence, and strained relationships. Despite advances in diagnosis and treatment, persistent residual symptoms are common, highlighting the need for novel treatment strategies. This article aims to provide a review of the psychotherapeutic interventions available for teens that receive pharmacotherapy but continue to struggle with the residual symptoms of ADHD that interfere with academic function, relationship formation, and psychological development.
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Affiliation(s)
- Vania Modesto-Lowe
- 1 Connecticut Valley Hospital, Middletown, CT, USA.,2 University of Connecticut School of Medicine, Farmington, CT, USA.,3 Quinnipiac University, Hamden, CT, USA
| | | | - Pantea Farahmand
- 4 New York-Presbyterian Hospital/Columbia-Cornell, Child and Adolescent Psychiatry, New York, NY, USA
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Towards Precision Addiction Treatment: New Findings in Co-morbid Substance Use and Attention-Deficit Hyperactivity Disorders. Curr Psychiatry Rep 2017; 19:14. [PMID: 28251590 PMCID: PMC5518319 DOI: 10.1007/s11920-017-0769-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) and substance use disorders (SUDs) may have common etiologies. ADHD is more prevalent in patients with substance use disorders, and this pattern is consistent across different substances of abuse. Individuals with SUDs and ADHD exhibit significant variations in their clinical presentations. The developmental trajectory of ADHD to SUDs is complex: ADHD symptoms appear first in some patients but not in others. Many patients present with a heterogeneous collection of psychiatric and substance use co-morbidities, and these symptoms change over time. ADHD symptom severity is also highly variable, and more severe ADHD symptoms worsen co-morbid SUDs and complicate treatment. New longitudinal studies with innovative methods in high-risk populations and in community-based samples may clarify issues related to patient-treatment matching. When closely monitored, psychostimulant and other adjunct medications can be safely used to treat ADHD in this population, and such treatment may also improve outcome of SUDs. In particular, emerging evidence suggests individual-level tailoring ("precision medicine") approaches may represent a key pathway to improve clinical outcome.
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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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Dahlman D, Abrahamsson T, Kral AH, Hakansson A. Nonmedical Use of Antihistaminergic Anxiolytics and Other Prescription Drugs among Persons with Opioid Dependence. JOURNAL OF ADDICTION 2016; 2016:9298571. [PMID: 28097037 PMCID: PMC5206437 DOI: 10.1155/2016/9298571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/27/2016] [Indexed: 11/25/2022]
Abstract
Background. Nonmedical prescription drug use (NMPDU) is an increasing problem, insufficiently studied among people in opioid maintenance treatment (OMT). This study investigates the prevalence of and factors associated with NMPDU for drug classes insufficiently described in opioid-dependent populations, including antihistaminergic anxiolytics and central stimulants. Methods. Study participants were recruited at two OMT clinics in Malmo, Sweden, between October 2014 and December 2015 (N = 73) and interviewed about their use, motivations for use, and acquisition and administration of prescription drugs. Results. The majority of the sample reported lifetime NMPDU: 60% for benzodiazepine-like hypnotics (z-drugs), 21% for pregabalin, 19% for stimulants, and 12%-15% for antihistaminergic anxiolytics. Lower age was associated with nonmedical benzodiazepine use (Adjusted Odds Ratio = 0.89; 95% Confidence Interval = 0.82-0.97). Illicit acquisition was reported by 61% of people using z-drugs, 46% of people using pregabalin, and 38% of people using prescription stimulants, but only by 6-10% of people using antihistaminergic anxiolytics. Conclusions. The substantial nonmedical use of pregabalin, z-drugs, and prescription stimulants found in this study suggests that clinicians should prescribe these drugs with great caution. Nonmedical use of antihistaminergic anxiolytics does not seem to be a clinical issue among people in OMT in a Swedish setting, but we propose future studies to monitor their use.
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Affiliation(s)
- Disa Dahlman
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Malmo Addiction Centre, Malmo, Sweden
| | - Tove Abrahamsson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Malmo Addiction Centre, Malmo, Sweden
| | - Alex H. Kral
- Behavioral and Urban Health Program, RTI International, San Francisco, CA, USA
| | - Anders Hakansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Malmo Addiction Centre, Malmo, Sweden
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Vogel T, Dom G, van de Glind G, Studer J, Gmel G, Strik W, Moggi F. Is attention deficit/hyperactivity disorder among men associated with initiation or escalation of substance use at 15-month follow-up? A longitudinal study involving young Swiss men. Addiction 2016; 111:1867-78. [PMID: 27061514 PMCID: PMC5215781 DOI: 10.1111/add.13422] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/20/2015] [Accepted: 04/04/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Young adults with attention deficit/hyperactivity disorder (ADHD) show higher substance use disorder (SUD) prevalence relative to non-ADHD controls; few longitudinal studies have examined the course of substance use with reference to conduct disorder (CD). We compared initiation and escalation of substance use at 15-month follow-up in men screened positive or negative for ADHD (ADHD(+) versus ADHD(-) ), controlling for CD presence in early adolescence. DESIGN Participants were recruited during August 2010 and November 2011 from the census of all young men who have to pass mandatory army conscription from three of six Swiss Army recruitment centres. A two-wave data collection was performed via questionnaires at baseline and 15-month follow-up as a part of the longitudinal Cohort Study on Substance Use Risk Factors. SETTING Recruitment centres in Lausanne, Windisch and Mels, responsible for 21 cantons in German- and French-speaking areas of Switzerland. PARTICIPANTS Consecutive sample of 5103 male Swiss Army conscripts who provided informed consent and responded to questionnaires at baseline and 15-month follow-up. Their mean age was 20.0 (standard deviation = 1.21) years at baseline. MEASUREMENTS ADHD and CD were assessed using the adult ADHD Self-Report Scale and the MINI International Neuropsychiatric Interview Plus, respectively, at baseline, and substance use was measured via self-administered substance use questionnaires at baseline and follow-up. FINDINGS Compared with the ADHD(-) group, the ADHD(+) group (n = 215, 4.2%) showed heavier baseline substance use and increased likelihood of alcohol (χ(2) = 53.96; P < 0.001), tobacco (χ(2) = 21.73; P < 0.001) and cannabis use disorders (χ(2) = 48.43; P < 0.001). The extent of alcohol, tobacco and cannabis use in the two groups remained stable from baseline to follow-up (no escalation). The ADHD(+) group was more likely to initiate substance use compared with the ADHD(-) group (higher initiation rates), particularly with amphetamines [odds ratio (OR) = 3.81; 95% confidence interval (CI) = 2.20-6.60; P < 0.001] and non-medical use of ADHD medication (OR = 4.45; 95% CI = 2.06-9.60; P < 0.001). CD was associated with initiation of substance use but did not mediate the associations between ADHD and substance use, revealing that the impact of ADHD on substance use was independent of CD. CONCLUSIONS For men in their early 20s, attention deficit/hyperactivity disorder is a risk factor for continued heavier but not escalating use of alcohol, tobacco and cannabis when already consuming these substances, compared with young men with no ADHD. It is also a risk factor for initiating the use of cannabis, stimulants, hallucinogens and sedatives, independent of conduct disorder in early adolescence.
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Affiliation(s)
- Tanja Vogel
- University Hospital of PsychiatryUniversity of BernBernSwitzerland
| | - Geert Dom
- Collaborative Antwerp Psychiatry Research Institute (CAPRI, UA)PC Alexian BrothersBoechoutBelgium
| | - Geurt van de Glind
- International Collaboration on ADHD and Substance Abuse (ICASA) FoundationUtrechtthe Netherlands,Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
| | - Joseph Studer
- Alcohol Treatment CentreLausanne University Hospital CHUVLausanneSwitzerland
| | - Gerhard Gmel
- Alcohol Treatment CentreLausanne University Hospital CHUVLausanneSwitzerland,Swiss Institute for the Prevention of Alcohol and Drug ProblemsLausanneSwitzerland,Center for Addiction and Mental HealthOntarioCanada,University of the West of EnglandBristolUK
| | - Werner Strik
- University Hospital of PsychiatryUniversity of BernBernSwitzerland
| | - Franz Moggi
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
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