دانلود رایگان مقاله انگلیسی چگونه بهبود درمان در ADHD و وابستگی کوکائین به یکدیگر مرتبط است - الزویر 2018

Abstract

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

5. Conclusions

This paper is, to our knowledge, the first to evaluate the cross-temporal behavior of improvement in ADHD and cocaine use in participants receiving treatment for their ADHD and cocaine use disorder. This study suggests that when individuals show at least a 30% improvement in both ADHD and achieve cocaine abstinence, ADHD most commonly improves first. However, there are other pathways, such as cocaine abstinence first, ADHD improvement without cocaine abstinence, cocaine abstinence without ADHD improvement, and neither abstinence nor improvement in ADHD. Future studies might explore these pathways in more naturalistic settings and other substance use disordered ADHD adults.