مقاله انگلیسی رایگان در مورد ارتباط بهبود درمان در ADHD و وابستگی کوکائین – الزویر 2018

Background: Attention-deficit hyperactivity disorder (ADHD) is overrepresented among individuals seeking treatment for substance use disorders. We previously reported that treatment with extended release mixed amphetamine salts (MAS-XR) increased abstinence, compared to placebo, among patients with co-occurring ADHD and cocaine dependence. This secondary analysis investigates the temporal relationship between ADHD improvement and cocaine abstinence in the first six weeks of the trial. Methods: The study was a three-arm, randomized, double-blinded, placebo-controlled, 14-week trial comparing MAS-XR (60mg or 80mg daily) versus placebo among 126 participants with ADHD and cocaine dependence. An autoregressive cross-lagged structural equation model was fit and evaluated weekly ADHD improvement (defined as > 30% reduction in the Adult ADHD Investigator Symptom Rating Scale) and urine-confirmed abstinence over the first six weeks. Results: The proportion of patients with each of the possible overall patterns of response was: ADHD improves before cocaine abstinence: 24%; Cocaine abstinence occurs before ADHD improvement: 12%; ADHD improvement and abstinence occur during the same week: 6%; ADHD improves but abstinence never achieved: 34%; Abstinence achieved but ADHD never improves: 6%; Neither ADHD improvement nor abstinence: 18%. A significant cross-lagged association was found; subjects with ADHD improvement at week 2 had significantly higher odds of cocaine abstinence at week 3 (p = .014). Conclusion: When treating co-occurring ADHD and cocaine dependence with stimulant medication, abstinence is most likely preceded by improvement in ADHD, which tends to occur early with medication treatment. Other observed temporal patterns suggest the potential complexity of the relationship between ADHD and cocaine dependence.

Introduction

Attention deficit hyperactivity disorder, characterized by problems with executive deficits and impulsive behavior, is one of the most common childhood disorders and has prevalence rates up to 18% in children and adolescents (CDC, 2005). While some individuals have remission of their symptoms, most continue to have impairing symptoms into adulthood (Biederman et al., 2010; Sibley et al., 2016). Perhaps not surprisingly, ADHD is overrepresented among individuals with substance use disorders; a meta-analysis found an overall rate of 22% (van Emmerik-van Oortmerssen et al., 2012). Initially it was thought that individuals with cocaine use disorders would have elevated rates of ADHD compared to other substance use disorders because they would choose cocaine (or other stimulants) to self-medicate their underlying ADHD symptoms (even if the patient did not recognize it as such). Early work found elevated rates of ADHD among cocaine-dependent individuals (Levin et al., 1998a; Perez de Los Cobos et al., 2011), but the findings have been mixed regarding whether cocaine-dependent patients have higher rates of ADHD than other groups of substance dependent individuals (van de Glind et al., 2014; van Emmerik-van Oortmerssen et al., 2014). As argued by Khantzian et al. (1997) and Mariani et al. (2014), individuals with psychiatric disorders may use alcohol or drugs to lessen intolerable affect or other psychiatric symptoms, albeit often unsuccessfully. Further, individuals may initially use alcohol, nicotine or marijuana to mitigate these psychiatric symptoms, but a number of other factors, such as drug availability, positive subjective effects, the pharmacologic properties of the drug to induce tolerance or withdrawal, and the individual’s perception of harm may influence which drug or drugs an individual with ADHD initiates, consistently uses, and potentially develops a SUD from.