Impulsivity in Alcohol-Dependent Patients with and without ADHD: The Role of Atomoxetine

Clinical Efficacy of Atomoxetine Hydrochloride Combined with Electroencephalogram Biofeedback in Attention-Deficit/Hyperactivity Disorder in Children

Attention-deficit/hyperactivity disorder (ADHD) adversely affects the learning, social interaction, and daily living of affected children. Atomoxetine (ATX) hydrochloride (HCI) has been widely used in clinical practice. Electroencephalogram (EEG) biofeedback, as a nonpharmacological treatment approach, has also demonstrated potential in improving symptoms in children with ADHD. We aimed to investigate the clinical efficacy of combining ATX HCI with EEG biofeedback in the treatment of ADHD in children. We hypothesized that this combined therapy would be more effective in alleviating symptoms in children with ADHD. Ninety children with ADHD were randomly separated into the control group (receiving ATX HCI treatment for 12 weeks) and study group (receiving ATX HCI treatment for 12 weeks combined with 60 sessions of EEG biofeedback treatment; n = 45). Swanson, Nolan, and Pelham-IV (SNAP-IV) rating scale scores, integrated visual and auditory continuous performance test results, Conners parent symptom questionnaire (PSQ) scores, and adverse reactions were counted. After 12 weeks of treatment, SNAP-IV scores were lower in both groups and were much lower in the study group; full-scale attention quotient and full-scale response control quotient scores were elevated in both groups and were much higher in the study group; PSQ scores were lower in both groups and were much lower in the study group (all p < 0.05). During the treatment period, there was no difference in the incidence of adverse reactions between both groups (p > 0.05). The treatment combination of ATX HCI and EEG biofeedback is effective for children with ADHD, improving their behavioral issues and psychological conditions.

Gender differences in ADHD and impulsivity among alcohol or alcohol- and cocaine-dependent patients

Background

Impulsivity plays a fundamental role in the realm of addiction as is considered a risk factor for addiction. Moreover, it influences the age of onset, severity, and therapeutic management of addictions. The aim of this study was to explore measures of impulsivity in a cohort of male and female diagnosed with Alcohol Use Disorder (AUD) and contrast these findings with those from a group with Alcohol and Cocaine Use Disorder (ACUD).

Methodology

A total of 204 patients (153 men and 51 women) underwent evaluation using Adult ADHD Self-Report Scale (ASRS), Barrat Impulsiveness Scale (BIS-11), Zuckerman-Kuhlman Personality Questionnaire (ZKPQ), Visual Analogue Scale (VAS), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI).

Results

A total of 24.6% of the sample (21.9% AUD group and 32.2% ACUD group) screened positive for ADHD. Differences were observed in Total Impulsivity (T(199) =-2.587, p=.010), with the mean score being higher in the ACUD group. Gender differences were noted with ADHD exhibiting a significant explanatory power for impulsivity (greater than 37%) in women compared to men, where its relevance is minimal. Among women, an inverse relationship was found between impulsivity and activity and sociability, in contrast to men, where the inverse relationship was with intolerance to isolation. Both men and women showed associations between ADHD and elevated levels of anxiety and depression. Study limitations and practical implications are discussed.

Conclusions

Although this is an observational study and should be develop a longitudinal study, we detected that the presence of ADHD in addicted women significantly influences impulsivity and should be systematically assessed due to the differences in the clinical approach.

ADHD and Substance Use Disorders in Young People: Considerations for Evaluation, Diagnosis, and Pharmacotherapy

Co-occurring ADHD and substance use disorder (SUD) is a common clinical presentation associated with significant impairment requiring careful evaluation, diagnosis, and treatment. Treatment with medication, along with cognitive behavioral therapy, is generally regarded as effective in addressing symptoms and impairments associated with both disorders. Options for pharmacotherapy include stimulant and nonstimulant therapies administered with careful monitoring of dosage and compliance to optimize efficacy. In high-risk groups such as college students and/or those with SUD, prescribers should address risks of stimulant misuse and diversion through patient and family education, medication monitoring, and other risk-reducing practices.

Disentangling the Association between ADHD and Alcohol Use Disorder in Individuals Suffering from Bipolar Disorder: A Systematic Review and Meta-Analysis

Attention Deficit-Hyperactivity disorder (ADHD) may influence rates of Alcohol Use Disorder (AUD) among individuals suffering from Bipolar Disorder (BD). The aim of this systematic review and meta-analysis was to estimate the strength and consistency of the potential association between ADHD and AUD in BD. We searched main electronic databases for studies indexed up to November 2020. We included observational studies investigating the association between ADHD and AUD among individuals with BD. The association between ADHD and AUD was estimated using odds ratios (ORs) with 95% Confidence Intervals (CIs). Eleven studies, involving 2734 individuals with BD (516 with ADHD), were included in the meta-analysis. Individuals with both BD and ADHD had higher rates of AUD as compared with subjects with BD only (34.0% vs. 18.3%). The estimated OR of AUD for ADHD was 2.50 (95% CI: 1.91 to 3.27; I2 = 13.0%). Study-level characteristics did not influence the effect size. No risk of publication bias was estimated. Despite some limitations, this meta-analysis estimated an association between ADHD and AUD among individuals suffering from BD. At least a portion of the high rates of AUD in BD may, thereby, be related to comorbid ADHD. Longitudinal studies are needed to clarify the nature of this relationship.