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McNealy KR, Weyrich L, Bevins RA. The co-use of nicotine and prescription psychostimulants: A review of their behavioral and neuropharmacological interactions. Drug Alcohol Depend 2023; 248:109906. [PMID: 37216808 PMCID: PMC10361216 DOI: 10.1016/j.drugalcdep.2023.109906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Nicotine is commonly co-used with other psychostimulants. These high co-use rates have prompted much research on interactions between nicotine and psychostimulant drugs. These studies range from examination of illicitly used psychostimulants such as cocaine and methamphetamine to prescription psychostimulants used to treat attention deficit hyperactivity disorder (ADHD) such as methylphenidate (Ritalin™) and d-amphetamine (active ingredient of Adderall™). However, previous reviews largely focus on nicotine interactions with illicitly used psychostimulants with sparse mention of prescription psychostimulants. The currently available epidemiological and laboratory research, however, suggests high co-use between nicotine and prescription psychostimulants, and that these drugs interact to modulate use liability of either drug. The present review synthesizes epidemiological and experimental human and pre-clinical research assessing the behavioral and neuropharmacological interactions between nicotine and prescription psychostimulants that may contribute to high nicotine-prescription psychostimulant co-use. METHODS We searched databases for literature investigating acute and chronic nicotine and prescription psychostimulant interactions. Inclusion criteria were that participants/subjects had to experience nicotine and a prescription psychostimulant compound at least once in the study, in addition to assessment of their interaction. RESULTS AND CONCLUSIONS Nicotine clearly interacts with d-amphetamine and methylphenidate in a variety of behavioral tasks and neurochemical assays assessing co-use liability across preclinical, clinical, and epidemiological research. The currently available research suggests research gaps examining these interactions in women/female rodents, in consideration of ADHD symptoms, and how prescription psychostimulant exposure influences later nicotine-related outcomes. Nicotine has been less widely studied with alternative ADHD pharmacotherapy bupropion, but we also discuss this research.
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Affiliation(s)
- Kathleen R McNealy
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE68588-0308, USA.
| | - Lucas Weyrich
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Ln, Boys Town, NE68010, USA; Department of Pharmacology and Neuroscience, Creighton University, 2500 California Plaza, Omaha, NE687178, USA
| | - Rick A Bevins
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE68588-0308, USA
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Idrees I, Bellato A, Cortese S, Groom MJ. The effects of stimulant and non-stimulant medications on the autonomic nervous system (ANS) functioning in people with ADHD: A systematic review and meta-analysis. Neurosci Biobehav Rev 2023; 144:104968. [PMID: 36427764 DOI: 10.1016/j.neubiorev.2022.104968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/12/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022]
Abstract
We carried out a systematic review and meta-analysis to investigate the effects of stimulant and non-stimulant medications on autonomic functioning in people with ADHD (PROSPERO: CRD42020212439). We searched (9th August 2021) PsycInfo, MEDLINE, EMBASE, Web of Science and The Cochrane Library, for randomised and non-randomised studies reporting indices of autonomic activity, (electrodermal, pupillometry and cardiac), pre- and post-medication exposure in people meeting DSM/ICD criteria for ADHD. In the narrative syntheses, we included 5 electrodermal studies, 1 pupillometry study and 57 studies investigating heart rate and blood pressure. In the meta-analyses, 29 studies were included on blood pressure and 32 on heart rate. Administration of stimulants, and to a lesser degree, non-stimulants increased heart rate and blood pressure in people with ADHD. Similarly, an upregulation of arousal, reflected in increased electrodermal activity and pupil diameter was observed following stimulant use. Yet, the methodological diversity of studies presented in this review reinforces the need for more standardised and rigorous research to fully understand the relationship between arousal, medication, and behaviour in ADHD.
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Affiliation(s)
- Iman Idrees
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK.
| | - Alessio Bellato
- School of Psychology, University of Nottingham Malaysia, Malaysia
| | - Samuele Cortese
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK; Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
| | - Madeleine J Groom
- Academic Unit of Mental Health & Clinical Neurosciences, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Néstor S, Carlos P, Cristina P, José MR, Ignacio B, Pilar S. TOBACCO USE DISORDER AND DUAL DISORDERS Joint statement by the Spanish Psychiatry Society and the Spanish Dual Disorders Society. ACTAS ESPANOLAS DE PSIQUIATRIA 2022; 50:77-138. [PMID: 35731182 PMCID: PMC11095114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
Tobacco Use Disorder (TUD) is a health problem of the first order in the world population, affecting a vulnerable population, such as people with other mental disorders, whose morbidity and mortality are increased as a result.
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Affiliation(s)
- Szerman Néstor
- Instituto de Psiquiatría y Salud Mental, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Parro Carlos
- Instituto de Psiquiatría y Salud Mental, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Pinet Cristina
- Unidad Toxicomanías, Servicio de Psiquiatría, Hospital Sant Pau, Barcelona, España. Miembro de la Sociedad Española de Psiquiatría (SEP)
| | - Martínez-Raga José
- Departamento de Psiquiatría y Psicología Médica. Hospital Universitario Doctor Peset y Universitat de Valencia. Valencia, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Basurte Ignacio
- Dirección médica de Psiquiatría y Salud Mental de la Clínica López Ibor. Madrid, España. Profesor vinculado de la Universidad Europea de Madrid. Madrid, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Saiz Pilar
- Catedrática de Psiquiatría. Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Instituto de Investigación sanitaria del Principado de Asturias (ISPA), Servicio de Salud del Principado de Asturias (SESPA). Asturias, España. Miembro de la Sociedad Española de Psiquiatría (SEP)
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van Kernebeek MW, Vorspan F, Crunelle CL, van den Brink W, Dom G, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Ramos-Quiroga JA, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F, Icick R. Consensus International sur le dépistage, le diagnostic et le traitement des patients avec troubles de l’usage de substances en cas de comorbidité avec un trouble du déficit de l’attention avec ou sans hyperactivité. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Boesen K, Paludan-Müller AS, Gøtzsche PC, Jørgensen KJ. Extended-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev 2022; 2:CD012857. [PMID: 35201607 PMCID: PMC8869321 DOI: 10.1002/14651858.cd012857.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a psychiatric diagnosis increasingly used in adults. The recommended first-line pharmacological treatment is central nervous system (CNS) stimulants, such as methylphenidate, but uncertainty remains about its benefits and harms. OBJECTIVES To assess the beneficial and harmful effects of extended-release formulations of methylphenidate in adults diagnosed with ADHD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, nine other databases and four clinical trial registries up to February 2021. We searched 12 drug regulatory databases for clinical trial data up to 13 May 2020. In addition, we cross-referenced all available trial identifiers, handsearched reference lists, searched pharmaceutical company databases, and contacted trial authors. SELECTION CRITERIA Randomised, double-blind, parallel-group trials comparing extended-release methylphenidate formulations at any dose versus placebo and other ADHD medications in adults diagnosed with ADHD. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. We assessed dichotomous outcomes as risk ratios (RRs), and rating scales and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs). We used the Cochrane risk of bias tool to assess risks of bias, and GRADE to assess the certainty of the evidence. We meta-analysed the data using a random-effects model. We assessed three design characteristics that may impair the trial results' 'generalisability'; exclusion of participants with psychiatric comorbidity; responder selection based on previous experience with CNS stimulants; and risk of withdrawal effects. Our prespecified primary outcomes were functional outcomes, self-rated ADHD symptoms, and serious adverse events. Our secondary outcomes included quality of life, ADHD symptoms rated by investigators and by peers such as family members, cardiovascular variables, severe psychiatric adverse events, and other adverse events. MAIN RESULTS We included 24 trials (5066 participants), of which 21 reported outcome data for this review. We also identified one ongoing study. We included documents from six drug regulatory agencies covering eight trials. Twenty-one trials had an outpatient setting and three were conducted in prisons. They were primarily conducted in North America and Europe. The median participant age was 36 years. Twelve trials (76% of participants) were industry-sponsored, four (14% of participants) were publicly funded with industry involvement, seven (10% of participants) were publicly funded, and one had unclear funding. The median trial duration was eight weeks. One trial was rated at overall unclear risk of bias and 20 trials were rated at overall high risk of bias, primarily due to unclear blinding of participants and investigators, attrition bias, and selective outcome reporting. All trials were impaired in at least one of the three design characteristics related to 'generalisability'; for example, they excluded participants with psychiatric comorbidity such as depression or anxiety, or included participants only with a previous positive response to methylphenidate, or similar drugs. This may limit the trials' usefulness for clinical practice, as they may overestimate the benefits and underestimate the harms. Extended-release methylphenidate versus placebo (up to 26 weeks) For the primary outcomes, we found very low-certainty evidence that methylphenidate had no effect on 'days missed at work' at 13-week follow-up (mean difference (MD) -0.15 days, 95% confidence interval (CI) -2.11 to 1.81; 1 trial, 409 participants) or serious adverse events (risk ratio (RR) 1.43, CI 95% CI 0.85 to 2.43; 14 trials, 4078 participants), whereas methylphenidate improved self-rated ADHD symptoms (small-to-moderate effect; SMD -0.37, 95% CI -0.43 to -0.30; 16 trials, 3799 participants). For secondary outcomes, we found very low-certainty evidence that methylphenidate improved self-rated quality of life (small effect; SMD -0.15, 95% CI -0.25 to -0.05; 6 trials, 1888 participants), investigator-rated ADHD symptoms (small-to-moderate effect; SMD -0.42, 95% CI -0.49 to -0.36; 18 trials, 4183 participants), ADHD symptoms rated by peers such as family members (small-to-moderate effect; SMD -0.31, 95% CI -0.48 to -0.14; 3 trials, 1005 participants), and increased the risk of experiencing any adverse event (RR 1.27, 95% CI 1.19 to 1.37; 14 trials, 4214 participants). We rated the certainty of the evidence as 'very low' for all outcomes, primarily due to high risk of bias and 'indirectness of the evidence'. One trial (419 participants) had follow-up at 52 weeks and two trials (314 participants) included active comparators, hence long-term and comparative evidence is limited. AUTHORS' CONCLUSIONS We found very low-certainty evidence that extended-release methylphenidate compared to placebo improved ADHD symptoms (small-to-moderate effects) measured on rating scales reported by participants, investigators, and peers such as family members. Methylphenidate had no effect on 'days missed at work' or serious adverse events, the effect on quality of life was small, and it increased the risk of several adverse effects. We rated the certainty of the evidence as 'very low' for all outcomes, due to high risk of bias, short trial durations, and limitations to the generalisability of the results. The benefits and harms of extended-release methylphenidate therefore remain uncertain.
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Affiliation(s)
- Kim Boesen
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health at Charité, QUEST Center for Responsible Research, Berlin, Germany
- Nordic Cochrane Centre, Rigshospitalet Dept 7811, Copenhagen, Denmark
| | - Asger Sand Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | | | - Karsten Juhl Jørgensen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
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Kaplan B, Marcell AV, Kaplan T, Cohen JE. Association between e-cigarette use and parents' report of attention deficit hyperactivity disorder among US youth. Tob Induc Dis 2021; 19:44. [PMID: 34140843 PMCID: PMC8176894 DOI: 10.18332/tid/136031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/05/2021] [Accepted: 04/22/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION There is paucity of literature that evaluates e-cigarette use rates among the youth with attention deficit hyperactivity disorder (ADHD). The aim of this study is to compare the rates of cigarette only, e-cigarette only, dual use, and initiation age of regular use and trying to quit cigarettes or e-cigarettes among the youth with and without ADHD. METHODS We used Population Assessment of Tobacco and Health (PATH) study Wave 3 (2015–2016) youth data, a nationally representative cross-sectional study in the US. The main outcome was tobacco use status of youth and ADHD diagnosis was based on parent report. RESULTS The survey included 11801 youth (50%, 12–14 years; 49% female). Compared to youth without ADHD, the relative risk ratio (RRR) was 1.79 (95% CI: 1.02–3.21) for cigarette only use, 1.41 (95% CI: 1.01–2.21) for e-cigarette only use, 3.40 (95% CI: 1.69–6.84) for dual use, 1.75 (95% CI: 0.92–3.35) for cigarette and other product(s) use, 1.48 (95% CI: 0.58–3.77) for e-cigarette and other product(s) use, and 3.37 (95% CI: 1.88–6.17) for poly use among youth with ADHD, after adjusting for age group, sex, and race/ethnicity. CONCLUSIONS Cigarette only use, e-cigarette only use, dual use of cigarettes and e-cigarettes, and poly use of cigarettes, e-cigarettes, and other product(s) were significantly associated with parent report of an ADHD diagnosis. It is critical for healthcare providers to be screening youth for e-cigarette use, especially youth who are diagnosed with ADHD.
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Affiliation(s)
- Bekir Kaplan
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Arik V Marcell
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, United States.,Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Tugba Kaplan
- Department of Medicine, Anne Arundel Medical Center, Annapolis, United States
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
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Fluyau D, Revadigar N, Pierre CG. Systematic Review and Meta-Analysis: Treatment of Substance Use Disorder in Attention Deficit Hyperactivity Disorder. Am J Addict 2020; 30:110-121. [PMID: 33289928 DOI: 10.1111/ajad.13133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/20/2020] [Accepted: 11/22/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Treating substance use disorder (SUD) in patients with co-occurring attention deficit hyperactivity disorder (ADHD) and SUD may lower medical, psychiatric, and social complications. We conducted a systematic review with meta-analysis to investigate the clinical benefits of pharmacological interventions to treat SUD in patients with ADHD. METHODS Articles were searched on Cochrane Central Register of Controlled Trials, PubMed, EBSCO, Google Scholar, Embase, Web of Science, and Ovid MEDLINE from 1971 to 2020. Data for SUD treatment as primary study endpoints and ADHD symptoms management as secondary outcomes were synthesized using random-effects model meta-analysis. Studies (N = 17) were included. The principal measure of effect size was the standardized mean difference (SMD). PROSPERO registration: CRD42020171646. RESULTS The pooled effect of pharmacological interventions compared with placebo was small for the reduction in substance use (SMD = 0.405, 95% confidence interval [CI]: [0.252, 0.557], P < .001), abstinence (SMD = 0.328, 95% CI: [0.149, 0.507], P < .001), craving (SMD = 0.274, 95% CI: [0.103, 0.446], P = .002), and the reduction in the frequency of ADHD symptoms (SMD = 0.420, 95% CI: [0.259, 0.582], P < .001). The pooled effect was moderate for the management of withdrawal symptoms (SMD = 0.577, 95% CI: [0.389, 0.764], P = .001]) and the decrease in the severity of ADHD symptoms (SMD = 0.533, 95% CI: [0.393, 0.672], P < .001). CONCLUSION AND SCIENTIFIC SIGNIFICANCE The magnitude of benefits for pharmacological interventions varies. Despite some limitations, it was positive. This meta-analysis is the first to appraise the benefits of medications to treat SUD in ADHD. It is the groundwork for treatment and risk mitigation. (Am J Addict 2020;00:00-00).
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Affiliation(s)
- Dimy Fluyau
- Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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Elliott J, Johnston A, Husereau D, Kelly SE, Eagles C, Charach A, Hsieh SC, Bai Z, Hossain A, Skidmore B, Tsakonas E, Chojecki D, Mamdani M, Wells GA. Pharmacologic treatment of attention deficit hyperactivity disorder in adults: A systematic review and network meta-analysis. PLoS One 2020; 15:e0240584. [PMID: 33085721 PMCID: PMC7577505 DOI: 10.1371/journal.pone.0240584] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/29/2020] [Indexed: 01/18/2023] Open
Abstract
Background Attention deficit hyperactivity disorder (ADHD) affects approximately 3% of adults globally. Many pharmacologic treatments options exist, yet the comparative benefits and harms of individual treatments are largely unknown. We performed a systematic review and network meta-analysis to assess the relative effects of individual pharmacologic treatments for adults with ADHD. Methods We searched English-language published and grey literature sources for randomized clinical trials (RCTs) involving pharmacologic treatment of ADHD in adults (December 2018). The primary outcome was clinical response; secondary outcomes were quality of life, executive function, driving behaviour, withdrawals due to adverse events, treatment discontinuation, serious adverse events, hospitalization, cardiovascular adverse events, and emergency department visits. Data were pooled via pair-wise meta-analyses and Bayesian network meta-analyses. Risk of bias was assessed by use of Cochrane’s Risk of Bias tool, and the certainty of the evidence was assessed by use of the GRADE framework. Results Eighty-one unique trials that reported at least one outcome of interest were included, most of which were at high or unclear risk of at least one important source of bias. Notably, only 5 RCTs were deemed at overall low risk of bias. Included pharmacotherapies were methylphenidate, atomoxetine, dexamfetamine, lisdexamfetamine, guanfacine, bupropion, mixed amphetamine salts, and modafinil. As a class, ADHD pharmacotherapy improved patient- and clinician-reported clinical response compared with placebo (range: 4 to 15 RCTs per outcome); however, these findings were not conserved when the analyses were restricted to studies at low risk of bias, and the certainty of the finding is very low. There were few differences among individual medications, although atomoxetine was associated with improved patient-reported clinical response and quality of life compared with placebo. There was no significant difference in the risk of serious adverse events or treatment discontinuation between ADHD pharmacotherapies and placebo; however, the proportion of participants who withdrew due to adverse events was significantly higher among participants who received any ADHD pharmacotherapy. Few RCTs reported on the occurrence of adverse events over a long treatment duration. Conclusions Overall, despite a class effect of improving clinical response relative to placebo, there were few differences among the individual ADHD pharmacotherapies, and most studies were at risk of at least one important source of bias. Furthermore, the certainty of the evidence was very low to low for all outcomes, and there was limited reporting of long-term adverse events. As such, the choice between ADHD pharmacotherapies may depend on individual patient considerations, and future studies should assess the long-term effects of individual pharmacotherapies on patient-important outcomes, including quality of life, in robust blinded RCTs. Registration PROSPERO no. CRD 42015026049
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Affiliation(s)
- Jesse Elliott
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Amy Johnston
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Heart Nexus Research Program, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Shannon E. Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Caroline Eagles
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Alice Charach
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shu-Ching Hsieh
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Zemin Bai
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Alomgir Hossain
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Eva Tsakonas
- Independent Research Consultant, Montreal, Quebec, Canada
| | | | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - George A. Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Zaso MJ, Park A, Antshel KM. Treatments for Adolescents With Comorbid ADHD and Substance Use Disorder: A Systematic Review. J Atten Disord 2020; 24:1215-1226. [PMID: 25655767 PMCID: PMC4666815 DOI: 10.1177/1087054715569280] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Comorbid ADHD and substance use disorder (SUD) presents frequently in adolescence, a developmental period that may promote the emergence of substance misuse among individuals with ADHD. Comorbid ADHD and SUD in adolescence results in significant and unique treatment challenges, necessitating examination into effective interventions. Method: This systematic review examined existing research into the treatment of comorbid adolescent ADHD and SUD. Results: Findings from a small number of pharmacological intervention studies suggest potential efficacy of extended-release stimulant and nonstimulant medications. Efficacy of psychotherapeutic interventions has not been systematically examined. Conclusion: Current research on treatments for comorbid ADHD and SUD in adolescence is limited. Future placebo-controlled clinical trials using large samples are needed to examine the efficacy of psychotherapeutic interventions, the heightened risk of prescription stimulant misuse, and the long-term maintenance of treatment gains in this population. Clinical guidelines for the treatment of comorbid ADHD and SUD are discussed.
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Affiliation(s)
- Michelle J. Zaso
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Aesoon Park
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Kevin M. Antshel
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Gendy MNS, Ibrahim C, Sloan ME, Le Foll B. Randomized Clinical Trials Investigating Innovative Interventions for Smoking Cessation in the Last Decade. Handb Exp Pharmacol 2020; 258:395-420. [PMID: 31267165 DOI: 10.1007/164_2019_253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Every year, billions of dollars are spent treating smoking and related conditions, yet smoking-related morbidity and mortality continue to rise. There are currently only three FDA-approved medications for smoking cessation: nicotine replacement therapy, bupropion, and varenicline. Although these medications increase abstinence rates, most individuals relapse following treatment. This chapter reviews clinical trials published within the past 10 years investigating novel smoking cessation pharmacotherapies. Among these pharmacotherapies, some showed promising results, such as cytisine and endocannabinoid modulators, whereas others failed to produce significant effects. More research is needed to develop drugs that produce higher rates of long-term abstinence and to determine which subgroups of patients benefit from a given treatment.
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Affiliation(s)
- Marie N S Gendy
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Christine Ibrahim
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Matthew E Sloan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
- Addictions Division, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
- Alcohol Research and Treatment Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
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Luo SX, Covey LS, Hu MC, Winhusen TM, Nunes EV. Differential Posttreatment Outcomes of Methylphenidate for Smoking Cessation for Individuals With ADHD. Am J Addict 2019; 28:497-502. [PMID: 31538372 DOI: 10.1111/ajad.12961] [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] [Received: 05/21/2019] [Revised: 08/30/2019] [Accepted: 09/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In a multisite, randomized study (CTN-0029), a 3-month course of Osmotic-Release Oral System Methylphenidate (OROS-MPH) improved smoking cessation in a group of patients with higher baseline severity in Attention-Deficit/Hyperactivity Disorder (ADHD). This treatment, however, worsened smoking cessation outcome in the group with lower baseline ADHD severity. We want to examine whether this differential treatment effect persisted after OROS-MPH was discontinued. METHODS We conducted a secondary analysis of the 1-month follow-up data from CTN-0029 after the discontinuation of OROS-MPH (N = 134). Nicotine patch was tapered during this month. We tested whether OROS-MPH had an effect on self-reported 7-day abstinence by week, as well as possible treatment by baseline ADHD severity interactions. RESULTS Abstinence diminished overall in time after the end of the treatment. In the high baseline severity group, patients who received OROS-MPH had an advantage in 7-day abstinence at week 15 (40% for OROS-MPH vs 20% for placebo, odds ratio = 2.63, P = .028). In the lower severity group (n = 121), no difference was detected (29% for OROS-MPH vs 32% for placebo, P = 1.00) between the two treatment groups. There was also a significant treatment by baseline ADHD severity interaction (P = .03). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE OROS-MPH promotes abstinence beyond the course of treatment for patients with more severe ADHD, while the paradoxical effects in the lower baseline severity group is not persistent after medication discontinuation. Targeting ADHD in smoking cessation as a comorbidity therefore can have broader impact with more precise patient selection. (Am J Addict).
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Affiliation(s)
- Sean X Luo
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University, New York, New York
| | - Lirio S Covey
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University, New York, New York
| | - Mei-Chen Hu
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University, New York, New York
| | - Theresa M Winhusen
- Division of Addiction Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Edward V Nunes
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University, New York, New York
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Perugi G, Pallucchini A, Rizzato S, De Rossi P, Sani G, Maremmani AG, Pinzone V, Maremmani I. Pharmacotherapeutic strategies for the treatment of attention-deficit hyperactivity (ADHD) disorder with comorbid substance-use disorder (SUD). Expert Opin Pharmacother 2018; 20:343-355. [PMID: 30513231 DOI: 10.1080/14656566.2018.1551878] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Substance use disorder (SUD) is very common amongst patients with attention deficit hyperactivity disorder (ADHD). The two disorders share partially overlapping features and SUD in ADHD is characterized by an early age of onset, high likelihood of poly-substance use, increased risk of suicide attempts, more hospitalizations, and scarce treatment adherence. AREAS COVERED This paper reviews randomized active comparator-controlled or placebo-controlled trials evaluating the use of pharmacotherapy in patients with ADHD and SUD. The authors include open label and observational studies. EXPERT OPINION Stimulant and non-stimulant treatments should be used to aid ADHD symptomatology in patients with SUD. SUD seems to be less responsive, suggesting a relative independence of the two conditions. For this reason, the association of ADHD-specific drugs and SUD-treatments should be recommended in a large proportion of patients suffering from both disorders. The rate and the quality of ADHD response to specific pharmacological treatments is highly variable, depending on the dose and the duration of the treatment, the age of the patient, and the severity and the chronicity of addiction. Further research is necessary to explore the divergences in treatment response of different ADHD subtypes in different subtypes of SUD.
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Affiliation(s)
- Giulio Perugi
- a Department of Experimental and Clinic Medicine, Section of Psychiatry , University of Pisa , Pisa , Italy
| | - Alessandro Pallucchini
- a Department of Experimental and Clinic Medicine, Section of Psychiatry , University of Pisa , Pisa , Italy
| | - Salvatore Rizzato
- b Psychiatry Residency Training Program, Faculty of Medicine and Psychology , Sapienza University of Rome , Rome , Italy
| | - Pietro De Rossi
- c NESMOS Department (Neurosciences, Mental Health, and Sensory Organs) , Sapienza University of Rome.,d School of Medicine and Psychology , Sant'Andrea Hospital , Rome , Italy.,e Department of Neurology and Psychiatry , Sapienza University of Rome , Rome , Italy.,f ASL Roma 5 , Rome , Italy
| | - Gabriele Sani
- c NESMOS Department (Neurosciences, Mental Health, and Sensory Organs) , Sapienza University of Rome.,d School of Medicine and Psychology , Sant'Andrea Hospital , Rome , Italy.,e Department of Neurology and Psychiatry , Sapienza University of Rome , Rome , Italy
| | - Angelo Gi Maremmani
- g Dipartimento di Psichiatria , Unità Sanitaria della Toscana nord-occidentale, Zona della Versilia , Viareggio , Italia
| | - Vito Pinzone
- b Psychiatry Residency Training Program, Faculty of Medicine and Psychology , Sapienza University of Rome , Rome , Italy
| | - Icro Maremmani
- a Department of Experimental and Clinic Medicine, Section of Psychiatry , University of Pisa , Pisa , Italy
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Gorman D, Kashner TM. Medical Graduates, Truthful and Useful Analytics With Big Data, and the Art of Persuasion. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1113-1116. [PMID: 29280752 DOI: 10.1097/acm.0000000000002109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The authors propose that the provision of state-of-the-art, effective, safe, and affordable health care requires medical school graduates not only to be competent practitioners and scientists but also to be policy makers and professional leaders. To meet this challenge in the era of big data and cloud computing, these graduates must be able to understand and critically interpret analyses of large, observational datasets from electronic health records, third-party claims files, surveys, and epidemiologic health datasets.The authors contend that medical students need to be exposed to three components. First, students should be familiar with outcome metrics that not only are scientifically valid but also are robust, useful for the medical community, understandable to patients and relevant to their preferences and health goals, and persuasive to health administrators and policy decision makers. Next, students must interact with an inclusive set of analysts including biostatisticians, mathematical and computational statisticians, econometrists, psychometricians, epidemiologists, informaticians, and qualitative researchers. Last, students should learn in environments in which data analyses are not static with a "one-size-fits-all" solution but, rather, where mathematical and computer scientists provide new, innovative, and effective ways of solving predictable and commonplace data limitations such as missing data; make causal inferences from nonrandomized studies and/or those with selection biases; and estimate effect size when patient outcomes are heterogeneous and surveys have low response rates.
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Affiliation(s)
- Des Gorman
- D. Gorman is executive chair, Health Workforce New Zealand, and professor of medicine and associate dean, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. T.M. Kashner is health science specialist, Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC, and research professor of medicine, Loma Linda University Medical School, Loma Linda, California
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Molina BS, Howard AL, Swanson JM, Stehli A, Mitchell JT, Kennedy TM, Epstein JN, Arnold LE, Hechtman L, Vitiello B, Hoza B. Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study. J Child Psychol Psychiatry 2018; 59:692-702. [PMID: 29315559 PMCID: PMC5985671 DOI: 10.1111/jcpp.12855] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The observational follow-up of the Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long-term outcomes in a large, diverse sample. METHODS Five hundred forty-seven children, mean age 8.5, diagnosed with DSM-IV combined-type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25. RESULTS In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly faster in the ADHD group in early adolescence. Early SU predicted quicker SU escalation and more SU in adulthood for both groups. CONCLUSIONS Frequent SU for young adults with childhood ADHD is accompanied by greater initial exposure at a young age and slightly faster progression. Early SU prevention and screening is critical before escalation to intractable levels.
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Affiliation(s)
- Brooke S.G. Molina
- Departments of Psychiatry, Psychology, & Pediatrics, University of Pittsburgh
| | | | | | | | - John T. Mitchell
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center
| | - Traci M. Kennedy
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | | | - Lily Hechtman
- Division of Child Psychiatry, McGill University and Montreal Children’s Hospital
| | | | - Betsy Hoza
- Department of Psychological Science, University of Vermont
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Sweitzer MM, Kollins SH, Kozink RV, Hallyburton M, English J, Addicott MA, Oliver JA, McClernon FJ. ADHD, Smoking Withdrawal, and Inhibitory Control: Results of a Neuroimaging Study with Methylphenidate Challenge. Neuropsychopharmacology 2018; 43:851-858. [PMID: 29052617 PMCID: PMC5809794 DOI: 10.1038/npp.2017.248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/30/2017] [Accepted: 10/09/2017] [Indexed: 02/03/2023]
Abstract
Smoking withdrawal negatively impacts inhibitory control, and these effects are greater for smokers with preexisting attention problems, such as attention deficit/hyperactivity disorder (ADHD). The current study preliminarily evaluated changes in inhibitory control-related behavior and brain activation during smoking withdrawal among smokers with ADHD. Moreover, we investigated the role of catecholamine transmission in these changes by examining the effects of 40 mg methylphenidate (MPH) administration. Adult daily smokers with (n=17) and without (n=20) ADHD completed fMRI scanning under each of three conditions: (a) smoking as usual+placebo; (b) 24 h smoking abstinence+placebo and (c) 24 h smoking abstinence+MPH. Scan order was randomized and counterbalanced. Participants completed a modified Go/No-Go task to assess both sustained and transient inhibitory control. Voxelwise analysis of task-related BOLD signal revealed a significant group-by-abstinence interaction in occipital/parietal cortex during sustained inhibition, with greater abstinence-induced decreases in activation observed among ADHD smokers compared with non-ADHD smokers. Changes in behavioral performance during abstinence were associated with changes in activation in regions of occipital and parietal cortex and bilateral insula during sustained inhibition in both groups. MPH administration improved behavioral performance and increased sustained inhibitory control-related activation for both groups. During transient inhibition, MPH increased prefrontal activation for both groups and increased striatal activation only among ADHD smokers. These preliminary findings suggest that abstinence-induced changes in catecholamine transmission in visual attention areas (eg, occipital and superior parietal cortex) may be associated with inhibitory control deficits and contribute to smoking vulnerability among individuals with ADHD.
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Affiliation(s)
- Maggie M Sweitzer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road., Suite 300, Durham, NC 27710, USA, Tel: +1 919 668 0094, Fax: +1 919 681 0016, E-mail:
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rachel V Kozink
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Matt Hallyburton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Joseph English
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Merideth A Addicott
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jason A Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Luo SX, Wall M, Covey L, Hu MC, Scodes JM, Levin FR, Nunes EV, Winhusen T. Exploring longitudinal course and treatment-baseline severity interactions in secondary outcomes of smoking cessation treatment in individuals with attention-deficit hyperactivity disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 44:653-659. [PMID: 29370538 DOI: 10.1080/00952990.2017.1416474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND A double blind, placebo-controlled randomized trial (NCT00253747) evaluating osmotic-release oral system methylphenidate (OROS-MPH) for smoking-cessation revealed a significant interaction effect in which participants with higher baseline ADHD severity had better abstinence outcomes with OROS-MPH while participants with lower baseline ADHD severity had worse outcomes. OBJECTIVES This current report examines secondary outcomes that might bear on the mechanism for this differential treatment effect. METHODS Longitudinal analyses were conducted to evaluate the effect of OROS-MPH on three secondary outcomes (ADHD symptom severity, nicotine craving, and withdrawal) in the total sample (N = 255, 56% Male), and in the high (N = 134) and low (N = 121) baseline ADHD severity groups. RESULTS OROS-MPH significantly improved ADHD symptoms and nicotine withdrawal symptoms in the total sample, and exploratory analyses showed that in both higher and lower baseline severity groups, OROS-MPH statistically significantly improved these two outcomes. No effect on craving overall was detected, though exploratory analyses showed statistically significantly decreased craving in the high ADHD severity participants on OROS-MPH. No treatment by ADHD baseline severity interaction was detected for the outcomes. CONCLUSIONS Methylphenidate improved secondary outcomes during smoking cessation independent of baseline ADHD severity, with no evident treatment-baseline severity interaction. Our results suggest divergent responses to smoking cessation treatment in the higher and lower severity groups cannot be explained by concordant divergence in craving, withdrawal and ADHD symptom severity, and alternative hypotheses may need to be identified.
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Affiliation(s)
- Sean X Luo
- a Department of Psychiatry , Columbia University , New York , NY, USA
| | - Melanie Wall
- a Department of Psychiatry , Columbia University , New York , NY, USA
| | - Lirio Covey
- a Department of Psychiatry , Columbia University , New York , NY, USA
| | - Mei-Chen Hu
- a Department of Psychiatry , Columbia University , New York , NY, USA
| | - Jennifer M Scodes
- a Department of Psychiatry , Columbia University , New York , NY, USA
| | - Frances R Levin
- a Department of Psychiatry , Columbia University , New York , NY, USA
| | - Edward V Nunes
- a Department of Psychiatry , Columbia University , New York , NY, USA
| | - Theresa Winhusen
- b Department of Psychiatry , University of Cincinnati , Cincinnati , OH, USA
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Crunelle CL, van den Brink W, Moggi F, Konstenius M, Franck J, Levin FR, van de Glind G, Demetrovics Z, Coetzee C, Luderer M, Schellekens A, Matthys F. International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder. Eur Addict Res 2018; 24:43-51. [PMID: 29510390 PMCID: PMC5986068 DOI: 10.1159/000487767] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/18/2018] [Indexed: 12/22/2022]
Abstract
Adult attention deficit/hyperactivity disorder (ADHD) often co-occurs with substance use disorders (SUD) and is associated with early onset and more severe development of SUD and with reduced treatment effectiveness. Screening tools allow for a good recognition of possible ADHD in adults with SUD and should be used routinely, followed by an ADHD diagnostic process initiated as soon as possible. Simultaneous and integrated treatment of ADHD and SUD, using a combination of pharmaco- and psychotherapy, is recommended. Long-acting methylphenidate, extended-release amphetamines, and atomoxetine with up-titration to higher dosages may be considered in patients unresponsive to standard doses. This paper includes evidence- and consensus-based recommendations developed to provide guidance in the screening, diagnosis and treatment of patients with ADHD-SUD comorbidity.
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Affiliation(s)
- Cleo L. Crunelle
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium,Toxicological Center, Antwerp University, Antwerp, Belgium
| | - Wim van den Brink
- Amsterdam Institute of Addiction Research (AIAR), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Franz Moggi
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | | | | | - Frances R. Levin
- Columbia University, New York State Psychiatric Institute, New York, NY, USA
| | | | | | - Corné Coetzee
- Department of Pharmacy, University of Limpopo, Sovenga, South Africa
| | - Mathias Luderer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Arnt Schellekens
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behavior, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | | | - Frieda Matthys
- Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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Jolani S, Safarkhani M. The Effect of Partly Missing Covariates on Statistical Power in Randomized Controlled Trials With Discrete-Time Survival Endpoints. METHODOLOGY-EUROPEAN JOURNAL OF RESEARCH METHODS FOR THE BEHAVIORAL AND SOCIAL SCIENCES 2017. [DOI: 10.1027/1614-2241/a000121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Abstract. In randomized controlled trials (RCTs), a common strategy to increase power to detect a treatment effect is adjustment for baseline covariates. However, adjustment with partly missing covariates, where complete cases are only used, is inefficient. We consider different alternatives in trials with discrete-time survival data, where subjects are measured in discrete-time intervals while they may experience an event at any point in time. The results of a Monte Carlo simulation study, as well as a case study of randomized trials in smokers with attention deficit hyperactivity disorder (ADHD), indicated that single and multiple imputation methods outperform the other methods and increase precision in estimating the treatment effect. Missing indicator method, which uses a dummy variable in the statistical model to indicate whether the value for that variable is missing and sets the same value to all missing values, is comparable to imputation methods. Nevertheless, the power level to detect the treatment effect based on missing indicator method is marginally lower than the imputation methods, particularly when the missingness depends on the outcome. In conclusion, it appears that imputation of partly missing (baseline) covariates should be preferred in the analysis of discrete-time survival data.
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Affiliation(s)
- Shahab Jolani
- Department of Methodology and Statistics, CAPHRI, Maastricht University, The Netherlands
| | - Maryam Safarkhani
- Department of Methodology and Statistics, FSW, Utrecht University, The Netherlands
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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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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Evaluate pharmacologic treatment of attention deficit/hyperactivity disorder (ADHD) in patients with substance use disorder (SUD) • Assess the causes of the diminished efficacy of ADHD medication in patients with comorbid SUD OBJECTIVE: Substance use disorder (SUD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, and the presence of ADHD complicates the treatment of the addiction. Pharmacotherapy is a potent intervention in childhood and adult ADHD, but findings have been mixed in adolescent and adult ADHD patients with SUDs. This review focuses on several contributing factors and possible explanations, with implications both for future research and for clinical practice. METHOD This systematic review examined all randomized, placebo-controlled trials of pharmacotherapy for ADHD in adult and adolescent SUD patients. RESULTS The number of studies is limited, and several studies are hampered by qualitative flaws. The results, in general, are inconclusive for most medications studied, but more recent trials using psychostimulants in robust dosing have demonstrated significantly positive results. CONCLUSION In reviewing these trials, possible explanations relating to the particular characteristics and problems of this complex patient group are discussed. Several factors, including ADHD symptom severity, psychiatric comorbidity, persistent drug use, choice of medication, and concomitant psychosocial intervention, influence study results. Taking these factors into account may improve the likelihood of detecting significant effects in future research, as the recent positive trials have indicated, and may help in the appropriate selection of pharmacotherapy in clinical practice.
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Rhodes JD, Pelham WE, Gnagy EM, Shiffman S, Derefinko KJ, Molina BSG. Cigarette smoking and ADHD: An examination of prognostically relevant smoking behaviors among adolescents and young adults. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2016; 30:588-600. [PMID: 27824233 PMCID: PMC5117481 DOI: 10.1037/adb0000188] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is associated with health risks in adolescence which includes the potential for smoking cigarettes, early smoking initiation, and rapid progression to daily smoking. Much less is known, however, about prognostically relevant smoking behaviors among individuals with childhood ADHD. Further research in this area is important for identifying individuals at pronounced risk for nicotine addiction, and for developing effective interventions for this population. This study examined initiation of cigarette smoking, progression to regular smoking, quantity of use, indicators of tobacco dependence, and quit rates among adolescents and young adults with (n = 364) and without (n = 240) childhood ADHD. Individuals with, versus without, ADHD histories were significantly more likely to become daily smokers independent of conduct disorder (CD). They were also more likely to initiate smoking at younger ages and to progress to regular smoking more quickly. There were no significant group differences in cigarettes smoked per day, Fagerström Test of Nicotine Dependence (FTND), or Nicotine Dependence Syndrome Scale (NDSS) scores or in smoking within 30 min of waking. However, smokers with ADHD reported more intense withdrawal and craving during periods of abstinence than non-ADHD smokers. There were no significant group differences in number of quit attempts. Lastly, there were no significant differences among symptom persisters and desisters in daily smoking and amount. Individuals with ADHD histories are at high risk for persistent smoking given their early onset, rapid course, and abstinence characteristics. Smoking cessation programs may need to be adapted or otherwise intensified for those with ADHD. (PsycINFO Database Record
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Affiliation(s)
| | - William E Pelham
- Center for Children and Families, Florida International University
| | | | | | - Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center
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Bushe C, Day K, Reed V, Karlsdotter K, Berggren L, Pitcher A, Televantou F, Haynes V. A network meta-analysis of atomoxetine and osmotic release oral system methylphenidate in the treatment of attention-deficit/hyperactivity disorder in adult patients. J Psychopharmacol 2016; 30:444-58. [PMID: 27005307 DOI: 10.1177/0269881116636105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The lack of head-to-head clinical studies powered to compare atomoxetine and osmotic release oral system (OROS) methylphenidate necessitates treatment comparison by methods that include indirect evidence such as network meta-analysis (NMA). A NMA assessing the relative treatment effects of atomoxetine and OROS methylphenidate in adults with attention-deficit/hyperactivity disorder (ADHD) was conducted. Studies were identified by systematic literature review. Analyses summarised improvements in efficacy, measured by ADHD-specific scales, using Cohen'sdto calculate the standardised mean difference (SMD), and all cause discontinuations. Results showed effect sizes (SMD, 95% credible interval (CrI)) relative to placebo that did not differ significantly between atomoxetine (0.46, 0.36-0.56) and OROS methylphenidate (0.51, 0.40-0.63) in clinical studies of up to 12 weeks' duration (SMD, 95% CrI for atomoxetine versus OROS methylphenidate: -0.05, -0.18-0.08). Patients treated with these medications responded better than those given placebo across all analyses. There was also no significant difference in discontinuation rates between atomoxetine and OROS methylphenidate (odds ratio, 95% CrI: 0.85, 0.53-1.35). Between-study heterogeneity was low overall. Results of this NMA suggest that the efficacy of atomoxetine and OROS methylphenidate in adults does not differ significantly. Clinical guidelines may require amendment to reflect these recent data.
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Affiliation(s)
| | - Kathleen Day
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, USA
| | | | | | | | | | | | - Virginia Haynes
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, USA
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Mamey MR, Barbosa-Leiker C, McPherson S, Burns GL, Parks C, Roll J. An application of analyzing the trajectories of two disorders: A parallel piecewise growth model of substance use and attention-deficit/hyperactivity disorder. Exp Clin Psychopharmacol 2015; 23:422-7. [PMID: 26389639 PMCID: PMC4658254 DOI: 10.1037/pha0000047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Researchers often want to examine 2 comorbid conditions simultaneously. One strategy to do so is through the use of parallel latent growth curve modeling (LGCM). This statistical technique allows for the simultaneous evaluation of 2 disorders to determine the explanations and predictors of change over time. Additionally, a piecewise model can help identify whether there are more than 2 growth processes within each disorder (e.g., during a clinical trial). A parallel piecewise LGCM was applied to self-reported attention-deficit/hyperactivity disorder (ADHD) and self-reported substance use symptoms in 303 adolescents enrolled in cognitive-behavioral therapy treatment for a substance use disorder and receiving either oral-methylphenidate or placebo for ADHD across 16 weeks. Assessing these 2 disorders concurrently allowed us to determine whether elevated levels of 1 disorder predicted elevated levels or increased risk of the other disorder. First, a piecewise growth model measured ADHD and substance use separately. Next, a parallel piecewise LGCM was used to estimate the regressions across disorders to determine whether higher scores at baseline of the disorders (i.e., ADHD or substance use disorder) predicted rates of change in the related disorder. Finally, treatment was added to the model to predict change. While the analyses revealed no significant relationships across disorders, this study explains and applies a parallel piecewise growth model to examine the developmental processes of comorbid conditions over the course of a clinical trial. Strengths of piecewise and parallel LGCMs for other addictions researchers interested in examining dual processes over time are discussed.
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Affiliation(s)
- Mary Rose Mamey
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,Corresponding author: Please address all requests for reprints to Mary Rose Mamey, Department of Psychology, Johnson Tower 310, Washington State University, Pullman, WA, 99164-4820, U.S.A.; Phone: (949) 933-4700;
| | - Celestina Barbosa-Leiker
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,College of Nursing, Washington State University, Spokane, WA 99210-1495 USA,Programs of Excellence in Addictions Research, Washington State University, Pullman, WA 99164-4820, USA,Translational Addictions Research Center, Washington State University, Pullman, WA 99164-4820, USA
| | - Sterling McPherson
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,College of Nursing, Washington State University, Spokane, WA 99210-1495 USA,Programs of Excellence in Addictions Research, Washington State University, Pullman, WA 99164-4820, USA,Translational Addictions Research Center, Washington State University, Pullman, WA 99164-4820, USA
| | - G. Leonard Burns
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA
| | - Craig Parks
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA
| | - John Roll
- Department of Psychology, Washington State University, Pullman, WA 99164-4820, USA,College of Nursing, Washington State University, Spokane, WA 99210-1495 USA,Programs of Excellence in Addictions Research, Washington State University, Pullman, WA 99164-4820, USA,Translational Addictions Research Center, Washington State University, Pullman, WA 99164-4820, USA
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Gorelick DA, McPherson S. Improving the analysis and modeling of substance use. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:475-8. [PMID: 26407028 PMCID: PMC4624102 DOI: 10.3109/00952990.2015.1085264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- David A. Gorelick
- Department of Psychiatry, University of Maryland School of
Medicine, Baltimore, MD
| | - Sterling McPherson
- Program of Excellence in Addictions Research, Washington
State University, Spokane, WA
- Providence Medical Research Center, Providence Sacred Heart
Medical Center, Spokane, WA, USA
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Young S, Sedgwick O. Attention deficit hyperactivity disorder and substance misuse: an evaluation of causal hypotheses and treatment considerations. Expert Rev Neurother 2015; 15:1005-14. [DOI: 10.1586/14737175.2015.1059756] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Covey LS, Hu MC, Winhusen T, Lima J, Berlin I, Nunes E. Anxiety and Depressed Mood Decline Following Smoking Abstinence in Adult Smokers with Attention Deficit Hyperactivity Disorder. J Subst Abuse Treat 2015; 59:104-8. [PMID: 26272693 DOI: 10.1016/j.jsat.2015.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 07/11/2015] [Accepted: 07/13/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A preponderance of relevant research has indicated reduction in anxiety and depressive symptoms following smoking abstinence. This secondary analysis investigated whether the phenomenon extends to smokers with attention deficit hyperactivity disorder (ADHD). METHODS The study setting was an 11-Week double-blind placebo-controlled randomized trial of osmotic release oral system methylphenidate (OROS-MPH) as a cessation aid when added to nicotine patch and counseling. Participants were 255 adult smokers with ADHD. The study outcomes are: anxiety (Beck Anxiety Inventory (BAI)) and depressed mood (Beck Depression Inventory II (BDI)) measured one Week and six Weeks after a target quit day (TQD). The main predictor is point-prevalence abstinence measured at Weeks 1 and 6 after TQD. Covariates are treatment (OROS-MPH vs placebo), past major depression, past anxiety disorder, number of cigarettes smoked daily, demographics (age, gender, education, marital status) and baseline scores on the BAI, BDI, and the DSM-IV ADHD Rating Scale. RESULTS Abstinence was significantly associated with lower anxiety ratings throughout the post-quit period (p<0.001). Depressed mood was lower for abstainers than non-abstainers at Week 1 (p<0.05), but no longer at Week 6 (p=0.83). Treatment with OROS-MPH relative to placebo showed significant reductions at Week 6 after TQD for both anxiety (p<0.05) and depressed mood (p<0.001), but not at Week 1. Differential abstinence effects of gender were observed. Anxiety and depression ratings at baseline predicted increased ratings of corresponding measures during the post-quit period. CONCLUSION Stopping smoking yielded reductions in anxiety and depressed mood in smokers with ADHD treated with nicotine patch and counseling. Treatment with OROS-MPH yielded mood reductions in delayed manner.
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Affiliation(s)
- Lirio S Covey
- New York State Psychiatric Institute, Cincinnati, OH; Columbia University Medical Center, Cincinnati, OH.
| | - Mei-Chen Hu
- New York State Psychiatric Institute, Cincinnati, OH; Columbia University Medical Center, Cincinnati, OH
| | - Theresa Winhusen
- Addiction Sciences Division, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Jennifer Lima
- New York State Psychiatric Institute, Cincinnati, OH
| | - Ivan Berlin
- Hôpital Pitié-Salpêtrière- Université P and M Curie, INSERM U61178, Paris, France
| | - Edward Nunes
- New York State Psychiatric Institute, Cincinnati, OH; Columbia University Medical Center, Cincinnati, OH
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Westover AN, Kashner TM, Winhusen TM, Golden RM, Nakonezny PA, Adinoff B, Henley SS. A systematic approach to subgroup analyses in a smoking cessation trial. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:498-507. [PMID: 26065433 DOI: 10.3109/00952990.2015.1044605] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Traditional approaches to subgroup analyses that test each moderating factor as a separate hypothesis can lead to erroneous conclusions due to the problems of multiple comparisons, model misspecification, and multicollinearity. OBJECTIVE To demonstrate a novel, systematic approach to subgroup analyses that avoids these pitfalls. METHODS A Best Approximating Model (BAM) approach that identifies multiple moderators and estimates their simultaneous impact on treatment effect sizes was applied to a randomized, controlled, 11-week, double-blind efficacy trial on smoking cessation of adult smokers with attention-deficit/hyperactivity disorder (ADHD), randomized to either OROS-methylphenidate (n = 127) or placebo (n = 128), and treated with nicotine patch. Binary outcomes measures were prolonged smoking abstinence and point prevalence smoking abstinence. RESULTS Although the original clinical trial data analysis showed no treatment effect on smoking cessation, the BAM analysis showed significant subgroup effects for the primary outcome of prolonged smoking abstinence: (1) lifetime history of substance use disorders (adjusted odds ratio [AOR] 0.27; 95% confidence interval [CI] 0.10-0.74), and (2) more severe ADHD symptoms (baseline score >36; AOR 2.64; 95% CI 1.17-5.96). A significant subgroup effect was also shown for the secondary outcome of point prevalence smoking abstinence--age 18 to 29 years (AOR 0.23; 95% CI 0.07-0.76). CONCLUSIONS The BAM analysis resulted in different conclusions about subgroup effects compared to a hypothesis-driven approach. By examining moderator independence and avoiding multiple testing, BAMs have the potential to better identify and explain how treatment effects vary across subgroups in heterogeneous patient populations, thus providing better guidance to more effectively match individual patients with specific treatments.
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Affiliation(s)
- Arthur N Westover
- a Department of Psychiatry and.,b Department of Clinical Sciences , University of Texas Southwestern Medical Center , Dallas , TX
| | - T Michael Kashner
- a Department of Psychiatry and.,c Department of Medicine , Loma Linda University School of Medicine , Loma Linda , CA .,d Veterans Health Administration Office of Academic Affiliations , Washington , DC
| | - Theresa M Winhusen
- e Department of Psychiatry and Behavioral Neuroscience , University of Cincinnati College of Medicine , Cincinnati , OH
| | - Richard M Golden
- f University of Texas at Dallas, School of Behavioral and Brain Sciences , Richardson , TX
| | - Paul A Nakonezny
- a Department of Psychiatry and.,b Department of Clinical Sciences , University of Texas Southwestern Medical Center , Dallas , TX
| | - Bryon Adinoff
- a Department of Psychiatry and.,g VA North Texas Health Care System , Dallas VAMC , Dallas , TX , and
| | - Steven S Henley
- c Department of Medicine , Loma Linda University School of Medicine , Loma Linda , CA .,h Martingale Research Corporation , Plano , TX , USA
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Levin FR, Mariani JJ, Bisaga A, Nunes EV. Ling et al.'s 'Sustained-release methylphenidate in a randomized trial of treatment of methamphetamine use disorder'. Addiction 2015; 110:875-6. [PMID: 25808040 PMCID: PMC4507796 DOI: 10.1111/add.12885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Frances R. Levin
- Department of Psychiatry, College of Physicians and
Surgeons of Columbia University, New York, NY USA
| | - John J. Mariani
- Division of Substance Abuse, New York State Psychiatric
Institute, New York, NY USA
| | - Adam Bisaga
- Department of Psychiatry, College of Physicians and
Surgeons of Columbia University, New York, NY USA
| | - Edward V. Nunes
- Division of Substance Abuse, New York State Psychiatric
Institute, New York, NY USA
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Fond G, Guillaume S, Jaussent I, Beziat S, Macgregor A, Bernard P, Courtet P, Bailly D, Quantin X. Prevalence and smoking behavior characteristics of nonselected smokers with childhood and/or adult self-reported ADHD symptoms in a smoking-cessation program: a cross-sectional study. J Atten Disord 2015; 19:293-300. [PMID: 23942042 DOI: 10.1177/1087054713497396] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND ADHD involves impairing core symptoms of inattention and hyperactivity/impulsivity in children (childhood ADHD = CH) that may persist in adulthood (adult ADHD = AD). Conflicting findings have been found regarding AD prevalences among adult smokers, and it is unclear whether AD is associated with a more severe smoking behavior in adulthood. OBJECTIVE The aim of this article is (a) to determine CH and AD prevalences in a nonselected sample of adult smokers, (b) to describe the characteristics of smokers with ADHD symptoms versus those without, and (c) to determine whether CH and/or AD symptoms are risk factors for more severe smoking in adulthood. METHOD Three hundred and seventy-three participants aged 18 years and over were prospectively recruited in a smoking-cessation unit. Participants were classified as "no ADHD symptoms," "CH symptoms," or "AD symptoms" according to their baseline score on the Wender Utah Rating Scale (WURS) alone (for CH symptoms) and WURS combined to the Adult Self Report Scale (ASRS) for AD symptoms. Other clinical variables were reported at first consultation. RESULTS (a) CH symptoms were reported in 15.3% (57/373) of the total sample, 42.1% (24/57) of whom also had persistent ADHD symptoms in adulthood (prevalence of AD was 24/373 = 6.4%). (b) In comparison with participants without ADHD symptoms, smokers with ADHD symptoms consume significantly more tobacco, but ADHD symptoms were no longer significantly associated with the daily number of smoked cigarettes after adjustment for sociodemographic variables. No significant association was found between the two groups and age at the first cigarette, age at onset daily smoking, and nicotine dependence. (c) Participants were categorized into three groups: Group 1 without ADHD symptoms lifetime (NH; n = 316), Group 2 with childhood history of ADHD symptoms (CH; n = 33), and Group 3 with Adult ADHD symptoms (AD; n = 24). The association with tobacco consumption (>20 cigarettes/day) was significant for CH only (p = .02). After adjustment for gender, age, professional status, and educational level, this association was not longer significant. CONCLUSION Childhood and adult ADHD symptoms are both highly prevalent among nonselected smokers but our study failed to show more severe smoking characteristics among these participants after adjustment with sociodemographic variables.
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Affiliation(s)
- Guillaume Fond
- Inserm U955, Université Paris-Est, GHU Mondor, Pepsy, Fondation Fondamental, Créteil, France Inserm U1061, Montpellier, France
| | - Sebastien Guillaume
- Inserm U1061, Montpellier, France Service hospitalo-universitaire de psychiatrie, CHU de Montpellier, Montpellier, France
| | | | - Severine Beziat
- Inserm U1061, Montpellier, France Service hospitalo-universitaire de psychiatrie, CHU de Montpellier, Montpellier, France
| | - Alexandra Macgregor
- Inserm U1061, Montpellier, France Service hospitalo-universitaire de psychiatrie, CHU de Montpellier, Montpellier, France
| | - Paquito Bernard
- Département universitaire de pneumonologie et d'addictologie, Epsylon EA 4556, Institut régional du Cancer de Montpellier, CHU Montpellier, France Laboratory EA EPSYLON, Montpellier, France
| | - Philippe Courtet
- Inserm U1061, Montpellier, France Service hospitalo-universitaire de psychiatrie, CHU de Montpellier, Montpellier, France
| | - Daniel Bailly
- Service hospitalo-universitaire de psychiatrie, Hôpital Sainte-Marguerite, Marseille, France
| | - Xavier Quantin
- Département universitaire de pneumonologie et d'addictologie, Epsylon EA 4556, Institut régional du Cancer de Montpellier, CHU Montpellier, France
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Luo SX, Covey LS, Hu MC, Levin FR, Nunes EV, Winhusen TM. Toward personalized smoking-cessation treatment: Using a predictive modeling approach to guide decisions regarding stimulant medication treatment of attention-deficit/hyperactivity disorder (ADHD) in smokers. Am J Addict 2015; 24:348-56. [PMID: 25659348 DOI: 10.1111/ajad.12193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Osmotic-release oral system methylphenidate (OROS-MPH) did not show overall benefit as an adjunct smoking cessation treatment for adult smokers with ADHD in a randomized, placebo-controlled, multicenter clinical trial. A secondary analysis revealed a significant interaction between ADHD symptom severity and treatment-response to OROS-MPH, but did not account for other baseline covariates or estimate the magnitude of improvement in outcome if treatment were optimized. This present study addressed the gaps in how this relationship should inform clinical practice. METHODS Using data from the Adult Smokers with ADHD Trial (N = 255, six sites in five US States), we build predictive models to calculate the probability of achieving prolonged abstinence, verified by self-report, and expired carbon monoxide measurement. We evaluate the potential improvement in achieving prolonged abstinence with and without stratification on baseline ADHD severity. RESULTS Predictive modeling demonstrates that the interaction between baseline ADHD severity and treatment group is not affected by adjusting for other baseline covariates. A clinical trial simulation shows that giving OROS-MPH to patients with baseline Adult ADHD Symptom Rating Scale (ADHD-RS) >35 and placebo to those with ADHD-RS ≤35 would significantly improve the prolonged abstinence rate (52 ± 8% vs. 42 ± 5%, p < .001). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE In smokers with ADHD, utilization of a simple decision rule that stratifies patients based on baseline ADHD severity can enhance overall achievement of prolonged smoking abstinence. Similar analysis methods should be considered for future clinical trials for other substance use disorders.
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Affiliation(s)
- Sean X Luo
- Department of Psychiatry and Division of Substance Abuse, New York State Psychiatric Institute, New York, New York
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Cunill R, Castells X, Tobias A, Capellà D. Pharmacological treatment of attention deficit hyperactivity disorder with co-morbid drug dependence. J Psychopharmacol 2015; 29:15-23. [PMID: 25142405 DOI: 10.1177/0269881114544777] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Drug dependence is frequent in patients with attention deficit hyperactivity disorder (ADHD). Nevertheless, the efficacy and safety of pharmacological treatments in this population are unclear. METHODS A systematic review with meta-analysis was performed. Randomised placebo-controlled clinical trials investigating the efficacy of pharmacological treatment in patients with co-occurring ADHD and substance use disorder (SUD) were included. ADHD symptom severity, drug abstinence and all-cause treatment discontinuation were the primary study endpoints. The effects of patient-, intervention- and study-related covariates over the primary outcomes were investigated by means of meta-regression. RESULTS Thirteen studies were included, enrolling a total of 1,271 patients. A small to moderate reduction of ADHD symptoms was found. Meta-regression analysis identified the presence of a lead-in period as a covariate associated with reduced efficacy. Conversely, no beneficial effect was observed either on drug abstinence or treatment discontinuation. The efficacy on ADHD symptoms was smaller in studies with a lead-in period. A positive correlation between the efficacy for ADHD and that for SUD was found. CONCLUSIONS The efficacy of pharmacological interventions for co-occurring ADHD and SUD has been little investigated. Mixed results were obtained: while pharmacological interventions improved ADHD symptoms, no beneficial effect on drug abstinence or on treatment discontinuation was noted. The strength of the recommendation of pharmacological treatment for co-occurring ADHD and SUD is therefore modest. The study was registered with the international prospective register of systematic reviews (PROSPERO): CRD 4212003414.
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Affiliation(s)
- R Cunill
- Unitat d'Hospitalització Psiquiàtrica Penitenciaria (UHHP), Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - X Castells
- Department of Medical Sciences, Universitat de Girona, Girona, Spain TransLab Research Group, Universitat de Girona, Girona, Spain
| | - A Tobias
- Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain
| | - D Capellà
- Department of Medical Sciences, Universitat de Girona, Girona, Spain TransLab Research Group, Universitat de Girona, Girona, Spain
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Adler LA, Alperin S, Leon T, Faraone S. Clinical effects of lisdexamfetamine and mixed amphetamine salts immediate release in adult ADHD: results of a crossover design clinical trial. Postgrad Med 2014; 126:17-24. [PMID: 25295646 DOI: 10.3810/pgm.2014.09.2796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To examine the clinical effects of equivalent doses of single-blind (SB; patient-blind) lisdexamfetamine (LDX) and mixed amphetamine salts-immediate release (MAS-IR) on adult attention-deficit/hyperactivity disorder (ADHD) in a placebo (PBO)-controlled, crossover design. METHODS Twenty-four subjects were treated sequentially in a fixed order with (1) SB PBO (matching LDX) for 1 week, (2) SB LDX (up to 70 mg/day) for 5 weeks, (3) SB PBO washout for 3 weeks, and (4) open-label treatment MAS-IR (tid up to 45 mg/day) for 5 weeks. Clinical effects on ADHD and executive function were assessed weekly throughout the trial with the ADHD Rating Scale with adult prompts, the Clinical Global Impression Severity Scale (CGI-S), and the Behavior Rating Inventory of Executive Function (BRIEF). RESULTS Lisdexamfetamine and MAS-IR were generally well tolerated. Significant and equal reductions on ADHD clinician ratings were seen. Significantly greater reductions in CGI-S and selected BRIEF subsets were observed in LDX over MAS-IR treatment. However, in general, baseline scores for MAS-IR treatment did not fully return to the LDX baseline. Adherence in this structured and monitored clinical trial was good for once daily LDX and 3 times a day MAS-IR. CONCLUSIONS In this crossover study, both LDX and MAS-IR had significant effects on ADHD clinician ratings and measures of executive function (with response rates of about 80%); patients in this monitored clinical trial were adherent with once daily LDX and 3 times a day MAS-IR, which may not be the case in real-world clinical practice. The findings of some superiority of LDX over MAS-IR on the CGI-S and BRIEF ratings may be influenced by the variability in the baselines used, but nevertheless should be further investigated in larger scale, parallel-design clinical trials.
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Affiliation(s)
- Lenard A Adler
- Departments of Psychiatry and Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY
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Pérez de los Cobos J, Siñol N, Pérez V, Trujols J. Pharmacological and clinical dilemmas of prescribing in co-morbid adult attention-deficit/hyperactivity disorder and addiction. Br J Clin Pharmacol 2014; 77:337-56. [PMID: 23216449 DOI: 10.1111/bcp.12045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 11/20/2012] [Indexed: 12/21/2022] Open
Abstract
The present article reviews whether available efficacy and safety data support the pharmacological treatment of adult attention-deficit/hyperactivity disorder (ADHD) in patients with concurrent substance use disorders (SUD). Arguments for and against treating adult ADHD with active SUD are discussed. Findings from 19 large open studies and controlled clinical trials show that the use of atomoxetine or extended-release methylphenidate formulations, together with psychological therapy, yield promising though inconclusive results about short term efficacy of these drugs in the treatment of adult ADHD in patients with SUD and no other severe mental disorders. However, the efficacy of these drugs is scant or lacking for treating concurrent SUD. No serious safety issues have been associated with these drugs in patients with co-morbid SUD-ADHD, given their low risk of abuse and favourable side effect and drug-drug interaction profile. The decision to treat adult ADHD in the context of active SUD depends on various factors, some directly related to SUD-ADHD co-morbidity (e.g. degree of diagnostic uncertainty for ADHD) and other factors related to the clinical expertise of the medical staff and availability of adequate resources (e.g. the means to monitor compliance with pharmacological treatment). Our recommendation is that clinical decisions be individualized and based on a careful analysis of the advantages and disadvantages of pharmacological treatment for ADHD on a case-by-case basis in the context of active SUD.
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Affiliation(s)
- José Pérez de los Cobos
- Unitat de Conductes Addictives, Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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Mitchell JT, Dennis MF, English JS, Dennis PA, Brightwood A, Beckham JC, Kollins SH. Ecological momentary assessment of antecedents and consequences of smoking in adults with attention-deficit/hyperactivity disorder. Subst Use Misuse 2014; 49:1446-56. [PMID: 24827866 PMCID: PMC4116432 DOI: 10.3109/10826084.2014.912229] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The current study assessed antecedents and consequences of ad lib cigarette smoking in smokers diagnosed with attention-deficit/hyperactivity disorder (ADHD) using ecological momentary assessment (EMA). Adult smokers with ADHD (n = 17) completed 870 smoking and 622 nonsmoking electronic diary entries over a 7-day observation period of their naturalistic smoking behavior. Data collection occurred from 2011 to 2012. Generalized estimating equations indicated that ADHD smokers were more likely to smoke when urge to smoke, negative affect, boredom, stress, worry, and restlessness were elevated. In addition, participants were more likely to smoke in situations that elicited higher levels of nervousness and frustration. ADHD symptoms, in general, did not differ between smoking and nonsmoking contexts, though hyperactive-impulsive ADHD symptoms were elevated prior to smoking in frustrating situations. Additional situational antecedent variables were associated with smoking, including being in the presence of others smoking, being in a bar or restaurant, while outside, and while consuming caffeinated or alcoholic beverages. Participants also reported a significant improvement in urge to smoke, negative affect, stress, hunger, and ADHD symptoms after smoking a cigarette. Findings suggest certain contextual factors that may maintain ad lib cigarette smoking in smokers with ADHD and identify potential treatment targets in smoking cessation interventions for this at-risk group. Clinical implications and future research directions are discussed. Funding for this study was provided by the National Institute on Drug Abuse.
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Affiliation(s)
- John T Mitchell
- 1Duke University Medical Center, Durham, North Carolina, USA
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Kollins SH, Adcock RA. ADHD, altered dopamine neurotransmission, and disrupted reinforcement processes: implications for smoking and nicotine dependence. Prog Neuropsychopharmacol Biol Psychiatry 2014; 52:70-8. [PMID: 24560930 PMCID: PMC4004668 DOI: 10.1016/j.pnpbp.2014.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 02/04/2014] [Accepted: 02/06/2014] [Indexed: 11/19/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common and impairing disorder affecting millions of children, adolescents, and adults. Individuals with ADHD smoke cigarettes at rates significantly higher than their non-diagnosed peers and the disorder also confers risk for a number of related adverse smoking outcomes including earlier age of initiation, faster progression to regular use, heavier smoking/greater dependence, and more difficulty quitting. Progress in our understanding of dopamine neurotransmission and basic behavioral reinforcement processes in ADHD may help increase our understanding of the ADHD-smoking comorbidity. This review will examine how these areas have been studied and how further work may aid in the development of better prevention and treatment for smoking in those with ADHD.
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Affiliation(s)
- Scott H Kollins
- Department of Psychiatry & Behavioral Science, Duke University School of Medicine, Durham, NC, USA.
| | - R Alison Adcock
- Department of Psychiatry & Behavioral Science, Duke University School of Medicine, Durham, NC, USA; Duke Center for Cognitive Neuroscience, Duke University, Durham, NC, USA
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Schoenfelder EN, Faraone SV, Kollins SH. Stimulant treatment of ADHD and cigarette smoking: a meta-analysis. Pediatrics 2014; 133:1070-80. [PMID: 24819571 PMCID: PMC4531271 DOI: 10.1542/peds.2014-0179] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Individuals with attention-deficit/hyperactivity disorder (ADHD) have a significantly higher risk of cigarette smoking. The nature of the relationship between smoking and psychostimulant medications commonly used to treat ADHD is controversial. Our objective was to examine the relationship between stimulant treatment of ADHD and cigarette smoking by using meta-analysis, and to identify study and sample characteristics that moderate this relationship. METHODS Literature searches on PubMed and PsycInfo databases identified published studies for inclusion. Included studies compared cigarette smoking outcomes for stimulant-treated and untreated ADHD individuals. Seventeen studies met inclusion criteria, and 14 (total n = 2360) contained sufficient statistical information for inclusion in the meta-analysis. Two authors extracted odds ratios or frequencies of smokers in the treatment or nontreatment groups, and coded study characteristics including sample source, percentage of male participants, follow-up length, treatment consistency, type of smoking measure, prospective study, and controlling for comorbidities. RESULTS Meta-analysis revealed a significant association between stimulant treatment and lower smoking rates. Meta-regression indicated that effect sizes were larger for studies that used clinical samples, included more women, measured smoking in adolescence rather than adulthood, conceptualized stimulant treatment as consistent over time, and accounted for comorbid conduct disorder. CONCLUSIONS Nearly all studies were naturalistic, precluding causal inferences. Available data were insufficient to examine additional influences of patient demographics, treatment effectiveness, or other comorbidities. Consistent stimulant treatment of ADHD may reduce smoking risk; the effect was larger in samples with more severe psychopathology. Implications for further research, treatment of ADHD, and smoking prevention are discussed.
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Affiliation(s)
- Erin N. Schoenfelder
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina; and
| | - Stephen V. Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York
| | - Scott H. Kollins
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina; and
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Liebrenz M, Frei A, Fisher CE, Gamma A, Buadze A, Eich D. Adult attention-deficit/hyperactivity disorder and nicotine use: a qualitative study of patient perceptions. BMC Psychiatry 2014; 14:141. [PMID: 24885526 PMCID: PMC4037284 DOI: 10.1186/1471-244x-14-141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 04/21/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with high rates of comorbid substance use disorders, and cigarette smoking has a particularly high prevalence in this population. However, there is an ongoing debate as to whether this tobacco use is an attempt at "self-medication" or due to behavioral disinhibition. There is a surprising lack of qualitative studies that investigate the subjective perceptions of adults with ADHD regarding cigarette smoking. The present study was designed to fill this gap in the literature. METHODS We recruited twelve adult patients with ADHD and comorbid tobacco use from our ADHD consultation service, an outpatient facility of the Zurich University Psychiatric Hospital. Subjects were interviewed using qualitative methodology, and Mayring's qualitative content analysis was used to evaluate findings. RESULTS We identified two explanatory models linking ADHD and tobacco use: smoking as an attempt at self-medication and "smoking as a social behavior". On one hand, subjects considered tobacco a therapeutic aid, reporting positive effects on "inner tension" and cognitive function, and noted possible antidepressant properties as well. On the other hand, subjects considered smoking to enhance social functioning and to have a positive impact on interpersonal relationships. The majority believed that stimulant medications offered only a transient decrease in patterns of tobacco use because their ability to reduce nicotine cravings wore off quickly. Others believed that stimulants had no effect or even reinforced cigarette use. CONCLUSIONS Participants had different views about the link between cigarette smoking and ADHD. While the majority thought of nicotine as a sort of therapy, viewing smoking as a way to self-medicate symptoms of ADHD, motivations for nicotine use were also related to self-image, desire to belong to a peer-group, and a drive to undermine perceived social norms. Ultimately, these findings can be used by clinicians to improve treatment alliance and collaboration.
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Affiliation(s)
- Michael Liebrenz
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Anja Frei
- Institute for General Practice and Health Services Research, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Carl Erik Fisher
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Alex Gamma
- Psychiatric University Hospital, Division of ADHD Research, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Anna Buadze
- Psychiatric University Hospital, Division of ADHD Research, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Dominique Eich
- Psychiatric University Hospital, Division of ADHD Research, Lenggstrasse 31, 8032 Zurich, Switzerland
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Kollins SH, English JS, Itchon-Ramos N, Chrisman AK, Dew R, O’Brien B, McClernon FJ. A pilot study of lis-dexamfetamine dimesylate (LDX/SPD489) to facilitate smoking cessation in nicotine-dependent adults with ADHD. J Atten Disord 2014; 18:158-68. [PMID: 22508760 PMCID: PMC3421044 DOI: 10.1177/1087054712440320] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The goal of this study was to assess the efficacy and tolerability of lis-dexamfetamine dimesylate (LDX) as an adjunct to nicotine replacement therapy in adult smokers with ADHD who were undergoing a quit attempt. METHODS Thirty-two regular adult smokers with ADHD were randomized to receive LDX (n = 17) or placebo (n = 15) in addition to nicotine patch concurrent with a quit attempt. RESULTS There were no differences between smokers assigned to LDX versus placebo in any smoking outcomes. Participants treated with LDX demonstrated significant reductions in self-reported and clinician-rated ADHD symptoms. LDX was well tolerated in smokers attempting to quit. DISCUSSION In general, LDX does not facilitate smoking cessation in adults with ADHD more than does placebo, though both groups significantly reduced smoking. LDX demonstrated efficacy for reducing ADHD symptoms in adult smokers engaging in a quit attempt.
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Affiliation(s)
- Scott H. Kollins
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Joseph S. English
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Nilda Itchon-Ramos
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Allan K. Chrisman
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Rachel Dew
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - Benjamin O’Brien
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - F. Joseph McClernon
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
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Matza LS, Devine MK, Haynes VS, Davies EW, Kostelec JM, Televantou F, Jordan JB. Health state utilities associated with adult attention-deficit/hyperactivity disorder. Patient Prefer Adherence 2014; 8:997-1006. [PMID: 25114511 PMCID: PMC4109631 DOI: 10.2147/ppa.s62776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES With growing awareness of the importance of adult attention-deficit/hyperactivity disorder (ADHD) treatment, cost-effectiveness analyses, including utilities, are needed to compare the value of treatment options. Although utilities have been reported for childhood ADHD, little is known about utilities representing adult ADHD. Therefore, the purpose of this study was to estimate utilities associated with adult ADHD. METHODS Health-state descriptions of adult ADHD were drafted based on literature review, interviews with four clinicians, and clinical trial data. Health states were revised based on a pilot study with 26 participants. Final health states were rated in time trade-off interviews with general population respondents in London and Edinburgh, UK. RESULTS A total of 158 participants completed interviews (mean age =47.0 years; 49.4% female; Edinburgh =80 participants). Mean (standard deviation [SD]) utilities were 0.82 (0.17), 0.68 (0.28), and 0.67 (0.28) for health states describing treatment responders (health state A), nonresponders (health state B), and untreated patients (health state C), respectively. Most participants rated health state A as preferable to B (n=92; 58.2%) and C (n=97; 61.4%). The majority rated B and C as equal (n=125; 79.1%). Paired Student's t-tests found that A had a significantly greater mean utility than B (t=10.0; P<0.0001) and C (t=10.2; P<0.0001). CONCLUSION The current study provides utilities that may be used in cost-utility models of treatment for adult ADHD. Results reflected clear differences between health states representing treatment responders and nonresponders/untreated patients. Current utilities were comparable to those previously reported for childhood ADHD.
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Affiliation(s)
- Louis S Matza
- Outcomes Research, Evidera, Bethesda, MD, USA
- Correspondence: Louis S Matza, Evidera, 7101 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA, Tel +1 301 664 7263, Fax +1 301 654 9864, Email
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Smoking behavior characteristics of non-selected smokers with childhood attention-deficit/hyperactivity disorder (AD/HD) history: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2014; 264:379-89. [PMID: 24619241 PMCID: PMC5103035 DOI: 10.1007/s00406-014-0497-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/20/2014] [Indexed: 01/19/2023]
Abstract
It is unclear whether adult smokers with childhood attention-deficit/hyperactivity disorder history (CH) have more severe smoking behavior than non-CH smokers, while it is clearly suggested that CH adolescents have more severe smoking behavior than CH adolescents. The aim of the present comprehensive meta-analysis is to determine whether CH smokers have more severe smoking behavior characteristics than those without and the effect of age on the association between CH and smoking behavior. We included all case-control studies and first round data collection of observational studies addressing the difference in smoking behavior characteristics of CH smokers versus non-CH smokers, with validated scales or structured interviews, without any language or date restriction. Nine studies (including 365 smokers with CH and 1,708 smokers without) were included. Compared to non-CH smokers, CH smokers smoked significantly more cigarettes [standardized mean differences (SMD) = 0.15, 95 % CI 0.01-0.28, p = 0.04] and began to regularly smoke earlier (SMD = -0.28, 95 % CI -0.49; -0.07, p = 0.01) but were not significantly more nicotine dependent (SMD = 0.23, 95 % CI -0.04 to 0.48, p = 0.08). After removing the single adolescent study, the significant association between CH and number of daily smoked cigarettes disappeared, and subgroups analyses confirmed that the significant association between CH and number of daily smoked cigarettes disappeared as age increased. Our meta-analysis illustrates a clinically important link between CH and tobacco smoking in adolescence but not later in life. Further high-quality studies are needed to confirm this finding, as only two studies included participants with a mean age below 20 years.
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Kollins SH, Schoenfelder E, English JS, McClernon FJ, Dew RE, Lane SD. Methylphenidate does not influence smoking-reinforced responding or attentional performance in adult smokers with and without attention deficit hyperactivity disorder (ADHD). Exp Clin Psychopharmacol 2013; 21:375-84. [PMID: 24099358 PMCID: PMC4145471 DOI: 10.1037/a0033851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals with Attention Deficit Hyperactivity Disorder (ADHD) smoke cigarettes at rates higher than the general population and questions have been raised about how stimulant drugs-the frontline pharmacological treatment for ADHD-influence smoking risk and behavior in those with ADHD. In the present study adult regular smokers with (n = 16) and without (n = 17) ADHD participated in 3 experimental sessions in which they completed a Progressive Ratio (PR) task to measure the relative reinforcing effects of cigarette smoking and money after oral administration of placebo and 2 active doses of methylphenidate (10 mg and 40 mg). We also measured attention and inhibitory control via a Continuous Performance Test (CPT). Methylphenidate had no effect on smoking-reinforced responding, attention, or inhibitory control in either group. Attention and inhibitory control were associated with smoking-reinforced responding, but unsystematically and only in the non-ADHD group. Several design features, such as the value of the monetary response option, the PR schedule, and the potential effects of smoking on attention and inhibitory control, could have contributed to the negative findings and are discussed as such. Although inconsistent with some previous human laboratory studies of stimulant drugs and smoking, results are consistent with recent trials of stimulant drugs as adjuncts for smoking cessation in adult smokers with ADHD. In general, methylphenidate at mild and moderate doses did not influence the relative reinforcing effects of cigarette smoking in adults with and without ADHD.
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Affiliation(s)
- Scott H. Kollins
- Duke ADHD Program, Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705
| | - Erin Schoenfelder
- Duke ADHD Program, Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705
| | - Joseph S. English
- Duke ADHD Program, Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705
| | - F. Joseph McClernon
- Duke ADHD Program, Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705,The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham VAMC, 116B, 508 Fulton Street, Durham, NC 27705
| | - Rachel E. Dew
- Duke ADHD Program, Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705
| | - Scott D. Lane
- Department of Psychiatry, University of Texas Health Science Center – Houston, Center for Neurobehavioral Research on Addictions, 1941 East Road, Houston, TX 77054
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Nunes EV, Covey LS, Brigham G, Hu MC, Levin FR, Somoza E, Winhusen T. Treating nicotine dependence by targeting attention-deficit/ hyperactivity disorder (ADHD) with OROS methylphenidate: the role of baseline ADHD severity and treatment response. J Clin Psychiatry 2013; 74:983-90. [PMID: 24229749 PMCID: PMC3946795 DOI: 10.4088/jcp.12m08155] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 02/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine whether treatment of attention-deficit/hyperactivity disorder (ADHD) with osmotic-release oral system (OROS) methylphenidate promotes abstinence from smoking among smokers with ADHD who have greater severity of ADHD symptoms at baseline or greater improvement in ADHD during treatment. METHOD This is a secondary analysis of data from a randomized, double-blind, 11-week trial conducted between December 2005 and January 2008 at 6 clinical sites; the original trial was sponsored by the National Drug Abuse Clinical Trials Network. Adult cigarette smokers (aged 18-55 years) who met DSM-IV criteria for ADHD were randomly assigned to OROS methylphenidate (72 mg/d) (n = 127) or matching placebo (n = 128). All participants received nicotine patches (21 mg/d) and weekly individual smoking cessation counseling. Logistic regression was used to model prolonged abstinence from smoking (ascertained by self-report and breath carbon monoxide testing) as a function of treatment, baseline ADHD Rating Scale-IV (ADHD-RS) score, change in ADHD-RS score during treatment, and their interactions. RESULTS Treatment interacted with both ADHD-RS score at baseline (P = .01) and change in ADHD-RS score during treatment (P = .008). Among patients with higher ADHD-RS scores (> 36) at baseline and the most improvement in ADHD during treatment (ADHD-RS change score ≥ 24), 70.0% of those who took OROS methylphenidate achieved abstinence from smoking compared to 36.8% of those who took placebo (P = .02). In contrast, among patients with the lowest ADHD-RS baseline scores (≤ 30), 30.3% of those who took OROS methylphenidate achieved abstinence from smoking compared to 60.7% of those who took placebo (P = .02). CONCLUSIONS OROS methylphenidate, in combination with nicotine patch, may be an effective treatment for nicotine dependence among smokers with more severe ADHD and more robust response of ADHD symptoms to medication. OROS methylphenidate may be counterproductive among smokers with lower severity of ADHD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00253747.
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Affiliation(s)
- Edward V. Nunes
- Columbia University, Department of Psychiatry, New York, NY, New York State Psychiatric Institute, New York, NY,Corresponding Author: Edward V. Nunes, M.D. New York State Psychiatric Institute 1051 Riverside Drive, Unit 51, Room 3717 New York, NY 10032 phone: 212-543-5581 fax: 212-543-5326
| | - Lirio S. Covey
- Columbia University, Department of Psychiatry, New York, NY, New York State Psychiatric Institute, New York, NY
| | - Gregory Brigham
- Maryhaven, Inc., Columbus, OH, University of Cincinnati College of Medicine, Department of Psychiatry and Behavioral Neuroscience, Cincinnati, OH
| | - Mei-Chen Hu
- Columbia University, Department of Psychiatry, New York, NY
| | - Frances R. Levin
- Columbia University, Department of Psychiatry, New York, NY, New York State Psychiatric Institute, New York, NY
| | - Eugene Somoza
- University of Cincinnati College of Medicine, Department of Psychiatry and Behavioral Neuroscience, Cincinnati, OH, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH
| | - Theresa Winhusen
- University of Cincinnati College of Medicine, Department of Psychiatry and Behavioral Neuroscience, Cincinnati, OH
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Mitchell JT, McIntyre EM, McClernon FJ, Kollins SH. Smoking motivation in adults with attention-deficit/hyperactivity disorder using the Wisconsin inventory of smoking dependence motives. Nicotine Tob Res 2013; 16:120-5. [PMID: 24078759 DOI: 10.1093/ntr/ntt144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smokers with attention-deficit/hyperactivity disorder (ADHD) differ from smokers without ADHD across a range of smoking outcomes (e.g., higher prevalence rates of smoking, faster progression to regular smoking, and greater difficulty quitting). Moreover, ADHD as a disorder has been characterized by deficits in fundamental motivational processes. To date, few studies have examined how motivation for smoking might differ between nicotine-dependent individuals with and without ADHD. The goal of this study was to assess whether specific smoking motivation factors differentiate smokers with and without ADHD as measured by an empirically derived self-report measure of smoking motivations. METHODS Smokers with (n = 61) and without (n = 89) ADHD participated in a range of laboratory and clinical studies that included the Wisconsin Inventory of Smoking Dependence Motives (WISDM). RESULTS A series of one-way analysis of covariances statistically controlling for age and race indicated that smokers with ADHD scored higher on the following WISDM subscales than their non-ADHD peers: automaticity, loss of control, cognitive enhancement, cue exposure, and negative reinforcement. Smokers in the non-ADHD group yielded higher scores on the social- environmental goads WISDM subscale. No group by gender interactions emerged. CONCLUSIONS Cigarette smokers with ADHD report different motives for smoking than smokers without ADHD. Clarifying the role of these motivational factors has implications for smoking prevention and treatment.
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Affiliation(s)
- John T Mitchell
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
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Fond G, Guillaume S, Artero S, Bernard P, Ninot G, Courtet P, Quantin X. Self-reported major depressive symptoms at baseline impact abstinence prognosis in smoking cessation program. A one-year prospective study. J Affect Disord 2013; 149:418-21. [PMID: 23265988 DOI: 10.1016/j.jad.2012.11.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/02/2012] [Accepted: 11/29/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The association between major depressive symptoms and smoking has been extensively documented. However, previous studies report conflicting findings about the impact of depression on lapse of smoking cessation. We hypothesize that smokers with self-reported major depressive symptoms at baseline are at higher risk of a lapse. METHODS One thousand and twenty participants aged, 18 years and over, were recruited in a smoking-cessation unit. All participants were assessed for their smoking status six times during one year of follow-up. Participants were classified as "euthymic", presenting "minor depressive symptomatology" or "major depressive symptomatology" according to their baseline score on the Hospitalization Anxiety and Depression Scale. RESULTS Using Cox's proportional hazard regression modeling, adjusted for potential confounding factors (nicotine dependence, number of cigarettes/day, previous cessation attempt, alcohol misuse, socio-demographic variables), it was shown that lapse is associated with major depressive symptoms (Hazard Ratio: HR=1.23 [1.02;1.47]; p=0.03). CONCLUSION Our results suggest the importance for clinicians to deal with depression and to discriminate minor from major depressive symptoms at preliminary smoking cessation consultations.
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Bron TI, Bijlenga D, Kasander MV, Spuijbroek AT, Beekman ATF, Kooij JJS. Long-term relationship between methylphenidate and tobacco consumption and nicotine craving in adults with ADHD in a prospective cohort study. Eur Neuropsychopharmacol 2013; 23:542-54. [PMID: 22809706 DOI: 10.1016/j.euroneuro.2012.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/01/2012] [Accepted: 06/07/2012] [Indexed: 12/25/2022]
Abstract
Patients with Attention-Deficit/Hyperactivity disorder (ADHD) have higher smoking rates, a younger age of smoking onset, and increased difficulty to stop smoking as compared to controls. Methylphenidate induced acute effects of increased smoking in laboratory studies, but long-term effects are unknown. We studied the acute and long-term relationship between methylphenidate use and tobacco consumption and nicotine craving among ADHD patients naïve for methylphenidate (N=325). Patients filled out the Smoking Questionnaire (SQ) at baseline, and after two-weeks and three-months of methylphenidate use. The SQ involved questions on demographics, tobacco consumption, nicotine craving, life events, psychiatric diagnoses and use of medication. At baseline, smoking prevalence of ADHD patients was twice as high (50.2%) as the national norm (25.6%; p<.001). Tobacco consumption increased with 1.3 cigarettes per day after three-months of methylphenidate use. When translated into pack years, tobacco consumption increased by about 23 packs per year. Reports of increased nicotine craving after methylphenidate, increased with 20.3% after two weeks and 29.2% after three months. Light smokers (1-12 cigarettes/day) were especially at risk for increased tobacco consumption (p<.05). Thus although methylphenidate is the drug of choice in medical treatment for ADHD, tobacco consumption and nicotine craving increased acutely and stabilized at increased levels after three-months of methylphenidate use. Although the net effect of methylphenidate on smoking behavior and craving should be further investigated within a randomized, placebo-controlled design, the results suggest that active prevention of increased smoking is needed in patients prescribed methylphenidate.
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Affiliation(s)
- Tannetje I Bron
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands.
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Kollins SH, English JS, Roley ME, O’Brien B, Blair J, Lane SD, McClernon FJ. Effects of smoking abstinence on smoking-reinforced responding, withdrawal, and cognition in adults with and without attention deficit hyperactivity disorder. Psychopharmacology (Berl) 2013; 227:19-30. [PMID: 23247366 PMCID: PMC3624067 DOI: 10.1007/s00213-012-2937-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 11/25/2012] [Indexed: 11/24/2022]
Abstract
RATIONALE Individuals with attention deficit hyperactivity disorder (ADHD) have a more difficult time quitting smoking compared to their non-ADHD peers. Little is known about the underlying behavioral mechanisms associated with this increased risk. OBJECTIVES This study aims to assess the effects of 24-h smoking abstinence in adult smokers with and without ADHD on the following outcomes: smoking-reinforced responding, withdrawal, and cognitive function. METHODS Thirty-three (n = 16 with ADHD, 17 without ADHD) adult smokers (more than or equal to ten cigarettes/day) were enrolled. Each participant completed two experimental sessions: one following smoking as usual and one following biochemically verified 24-h smoking abstinence. Smoking-reinforced responding measured via a progressive ratio task, smoking withdrawal measured via questionnaire, and cognition measured via a continuous performance test (CPT) were assessed at each session. RESULTS Smoking abstinence robustly increased responding for cigarette puffs in both groups, and ADHD smokers responded more for puffs regardless of condition. Males in both groups worked more for cigarette puffs and made more commission errors on the CPT than females, regardless of condition. Smoking abstinence also increased ratings of withdrawal symptoms in both groups and smokers with ADHD, regardless of condition, reported greater symptoms of arousal, habit withdrawal, and somatic complaints. Across groups, smoking abstinence decreased inhibitory control and increased reaction time variability on the CPT. Abstinence-induced changes in inhibitory control and negative affect significantly predicted smoking-reinforced responding across groups. CONCLUSIONS Smokers with ADHD reported higher levels of withdrawal symptoms and worked more for cigarette puffs, regardless of condition, which could help explain higher levels of nicotine dependence and poorer cessation outcomes in this population. Abstinence-induced changes in smoking-reinforced responding are associated with changes in inhibitory control and negative affect regardless of ADHD status, a finding that may lead to novel prevention and treatment programs.
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Affiliation(s)
- Scott H. Kollins
- Duke ADHD Program, Department of Psychiatry, Duke University, School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705, USA
| | - Joseph S. English
- Duke ADHD Program, Department of Psychiatry, Duke University, School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705, USA
| | - Michelle E. Roley
- Duke ADHD Program, Department of Psychiatry, Duke University, School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705, USA
| | - Benjamin O’Brien
- Duke ADHD Program, Department of Psychiatry, Duke University, School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705, USA
| | - Justin Blair
- Duke ADHD Program, Department of Psychiatry, Duke University, School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705, USA
| | - Scott D. Lane
- Department of Psychiatry, Center for Neurobehavioral Research on Addictions, University of Texas Health Science Center–Houston, 1941 East Road, Houston, TX 77054, USA
| | - F. Joseph McClernon
- Duke ADHD Program, Department of Psychiatry, Duke University, School of Medicine, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC 27705, USA. The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham VAMC, 116B, 508 Fulton Street, Durham, NC 27705, USA
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Hammerness P, Joshi G, Doyle R, Georgiopoulos A, Geller D, Spencer T, Petty CR, Faraone SV, Biederman J. Do stimulants reduce the risk for cigarette smoking in youth with attention-deficit hyperactivity disorder? A prospective, long-term, open-label study of extended-release methylphenidate. J Pediatr 2013; 162:22-7.e2. [PMID: 22878114 DOI: 10.1016/j.jpeds.2012.06.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 05/07/2012] [Accepted: 06/22/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Although attention-deficit hyperactivity disorder (ADHD) is a well-known risk factor for cigarette smoking, prospective studies aimed at reducing smoking risk in this population are critically needed. STUDY DESIGN This was a 2-year, prospective, open-label clinical trial of extended-release methylphenidate for smoking prevention in adolescents with ADHD (n = 154). Smoking outcomes were assessed with the Fagerstrom Tolerance Questionnaire. Comparisons were made using data from a historical, naturalistic sample of ADHD (n = 103) and non-ADHD comparators (n = 188) of similar age and sex assessed with the same assessment battery as that used in subjects participating in the clinical trial. RESULTS The smoking rate at endpoint (mean, 10 months of methylphenidate treatment) was low in the clinical trial subjects and not significantly different from that in the non-ADHD comparators or the ADHD comparators receiving stimulants naturalistically (7.1% vs 8.0% vs 10.9%; P > .20). In contrast, the smoking rate was significantly lower in the clinical trial subjects than in the naturalistic sample of ADHD comparators who were not receiving stimulant treatment (7.1% vs 19.6%; P = .009 [not significant], adjusting for comorbid conduct disorder and alcohol and drug abuse). CONCLUSION Although considered preliminary until replicated in future randomized clinical trials, the findings from this single-site, open-label study suggest that stimulant treatment may contribute to a decreased risk for smoking in adolescents with ADHD. If confirmed, this finding would have significant clinical and public health impacts.
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Affiliation(s)
- Paul Hammerness
- Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02138, USA.
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Westover AN, Nakonezny PA, Winhusen T, Adinoff B, Vongpatanasin W. Risk of methylphenidate-induced prehypertension in normotensive adult smokers with attention deficit hyperactivity disorder. J Clin Hypertens (Greenwich) 2012; 15:124-32. [PMID: 23339731 DOI: 10.1111/jch.12039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The authors studied predictors of methylphenidate-induced increases in blood pressure (BP). In this secondary analysis of a randomized, double-blind, placebo-controlled smoking cessation trial, nonhypertensive adult smokers with attention deficit hyperactivity disorder randomized to osmotic-release oral system methylphenidate (OROS-MPH) (n=115) were matched one-to-one on baseline systolic BP (SBP) (±5 mm Hg) with participants randomized to placebo (n=115) and followed for 10 weeks. In adjusted mixed linear models of SBP and diastolic BP (DBP), baseline normal SBP (P<.0001) and DBP (P<.0001) were associated with significant OROS-MPH-induced increases compared with placebo, whereas significant increases were not observed in participants with baseline prehypertensive SBP (P=.27) and DBP (P=.79). Participants randomized to OROS-MPH with baseline normal BP had increased odds of developing either systolic (odds ratio [OR], 3.32; 95% confidence interval [CI], 1.41-8.37; P=.006) or diastolic prehypertension (OR, 4.32; 95% CI, 1.56-14.0; P=.004) compared with placebo using simple logistic regression. The authors demonstrated an augmented OROS-MPH-induced BP elevation and risk of prehypertension in adults with baseline normal BP. Significantly increased BP was not observed in adults with baseline prehypertension.
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Affiliation(s)
- Arthur N Westover
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-8828, USA.
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Treatment discontinuation with methylphenidate in adults with attention deficit hyperactivity disorder: a meta-analysis of randomized clinical trials. Eur J Clin Pharmacol 2012; 69:347-56. [PMID: 22983311 DOI: 10.1007/s00228-012-1390-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 08/05/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) in adulthood is increasingly diagnosed and treated. Methylphenidate is frequently advocated as a first-line pharmacological treatment. PURPOSE The aim of our study was to compare all-cause discontinuation rate of methylphenidate and its pharmaceutical presentations with placebo in adults with ADHD. METHODS This was a systematic review and meta-analysis of randomized controlled trials comparing methylphenidate with placebo in adults with ADHD. All-cause treatment discontinuation was the primary endpoint. The efficacy in reducing ADHD symptoms and safety were the secondary endpoints. RESULTS Twelve studies (2,496 patients) met the inclusion criteria. Four racemic methylphenidate and one dexmethylphenidate presentations were investigated. The rate of all-cause treatment discontinuation was greater with methylphenidate than with placebo, but this difference was not statistically significant [odds ratio (OR) 1.19, 95 % confidence interval (95 % CI) 0.82-1.74, P = 0.37, I(2) = 64 %] This finding reached the conventional threshold of statistical significance after one outlier study was excluded (OR 1.44, 95 % CI 1.14-1.82, P = 0.002, I(2) = 0). Methylphenidate was more efficacious than placebo for reducing ADHD symptoms and it was associated with a higher proportion of patients dropping out due to adverse effects. CONCLUSIONS Despite reducing ADHD symptoms, methylphenidate showed no advantage over placebo in terms of treatment discontinuation. More attention should be given in the future to the endpoint "all-cause treatment discontinuation" when making regulatory decisions and developing clinical guidelines involving the treatment of ADHD in adulthood.
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Heffner JL, Lewis DF, Winhusen TM. Osmotic release oral system methylphenidate prevents weight gain during a smoking-cessation attempt in adults with ADHD. Nicotine Tob Res 2012; 15:583-7. [PMID: 22955246 DOI: 10.1093/ntr/nts152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Adults with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for both cigarette smoking and being overweight or obese. Although smoking cessation tends to result in weight increase, potentially initiating or exacerbating weight problems, adults with ADHD who are treated with osmotic release oral system methylphenidate (OROS-MPH) tend to lose weight. It is unclear how the use of OROS-MPH during a smoking-cessation attempt might affect the typical weight gain that accompanies cessation. METHOD We examined changes in weight and hunger during a smoking-cessation attempt in 215 adults with ADHD who completed a multisite, randomized, controlled trial and were randomized to either OROS-MPH (n = 107) or placebo (n = 108) (NCT #00253747). Both groups also received open-label transdermal nicotine replacement and counseling. RESULTS Participants who received OROS-MPH lost an average of 1.6% of their body weight during the 11-week study, whereas those who received placebo gained an average of 1.3% of their weight (p < .001). Hunger ratings were lower in the OROS-MPH group (M = 1.1, SD = 0.8) than in the placebo group (M = 1.6, SD = 0.9; p < .001). CONCLUSIONS The use of OROS-MPH during a smoking-cessation attempt prevents weight gain in adults with ADHD who substantially reduce or quit smoking. The potential utility of OROS-MPH in individuals with ADHD who are attempting to quit smoking and for whom weight gain would be problematic warrants further research.
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Affiliation(s)
- Jaimee L Heffner
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA.
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