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Towards Precision Addiction Treatment: New Findings in Co-morbid Substance Use and Attention-Deficit Hyperactivity Disorders

  • Substance Use and Related Disorders (F Levin and E Dakwar, Section Editors)
  • Published:
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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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References

  1. Fredriksen M, Dahl AA, Martinsen EW, Klungsoyr O, Faraone SV, Peleikis DE. Childhood and persistent ADHD symptoms associated with educational failure and long-term occupational disability in adult ADHD. Atten Defic Hyperact Disord. 2014;6:87–99.

    Article  PubMed  PubMed Central  Google Scholar 

  2. •• Dalsgaard S, Ostergaard SD, Leckman JF, Mortensen PB, Pedersen MG. Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet. 2015;385:2190–6. This study showed that ADHD is associated with increased mortality in individuals with ADHD in a large longitudinal cohort.

    Article  PubMed  Google Scholar 

  3. Clure C, Brady KT, Saladin ME, Johnson D, Waid R, Rittenbury M. Attention-deficit/hyperactivity disorder and substance use: symptom pattern and drug choice. Am J Drug Alcohol Abuse. 1999;25:441–8.

    Article  CAS  PubMed  Google Scholar 

  4. Levin FR, Evans SM, Kleber HD. Prevalence of adult attention-deficit hyperactivity disorder among cocaine abusers seeking treatment. Drug Alcohol Depend. 1998;52:15–25.

    Article  CAS  PubMed  Google Scholar 

  5. Schubiner H, Tzelepis A, Milberger S, Lockhart N, Kruger M, Kelley BJ, et al. Prevalence of attention-deficit/hyperactivity disorder and conduct disorder among substance abusers. J Clin Psychiatry. 2000;61:244–51.

    Article  CAS  PubMed  Google Scholar 

  6. van Emmerik-van Oortmerssen K, Crunelle CL, Carpentier PJ. Substance use disorders and ADHD: an overview of recent Dutch research. Tijdschr Psychiatr. 2013;55:861–6.

    Google Scholar 

  7. • van de Glind G, Konstenius M, Koeter MW, van Emmerik-van Oortmerssen K, Carpentier PJ, Kaye S, et al. Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: results from an international multi-center study exploring DSM-IV and DSM-5 criteria. Drug Alcohol Depend. 2014;134:158–66. Early results in variability of ADHD prevalence in a cross-cultural epidemiological study.

    Article  PubMed  Google Scholar 

  8. King VL, Brooner RK, Kidorf MS, Stoller KB, Mirsky AF. Attention deficit hyperactivity disorder and treatment outcome in opioid abusers entering treatment. J Nerv Ment Dis. 1999;187:487–95.

    Article  CAS  PubMed  Google Scholar 

  9. van Emmerik-van Oortmerssen K, van de Glind G, van den Brink W, Smit F, Crunelle CL, Swets M, et al. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend. 2012;122:11–9.

    Article  Google Scholar 

  10. • van Emmerik-van Oortmerssen K, van de Glind G, Koeter MW, Allsop S, Auriacombe M, Barta C, et al. Psychiatric comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study. Addiction. 2014;109:262–72. Most recent large epidemiological study for the prevalence of ADHD and co-morbidities in different populations.

    Article  PubMed  Google Scholar 

  11. Zaman T, Malowney M, Knight J, Boyd JW. Co-occurrence of substance-related and other mental health disorders among adolescent cannabis users. J Addict Med. 2015;9:317–21.

    Article  PubMed  Google Scholar 

  12. Notzon DP, Pavlicova M, Glass A, Mariani JJ, Mahony AL, Brooks DJ, Levin FR. ADHD is highly prevalent in patients seeking treatment for cannabis use disorders. J Atten Disord. 2016.

  13. Johnston LD, O’malley PM, Bachman JG, Schulenberg JE. Monitoring the future national survey results on drug use, 1975–2010. Volume II, College Students & Adults Ages 19-50. Institute for Social Research. 2011.

  14. King KM, Chassin L. Mediating and moderated effects of adolescent behavioral under control and parenting in the prediction of drug use disorders in emerging adulthood. Psychol Addict Behav. 2004;18:239–49.

    Article  PubMed  Google Scholar 

  15. Iacono WG, Malone SM, McGue M. Behavioral disinhibition and the development of early-onset addiction: common and specific influences. Annu Rev Clin Psychol. 2008;4:325–48.

    Article  PubMed  Google Scholar 

  16. Molina BS, Pelham Jr WE. Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. J Abnorm Psychol. 2003;112:497–507.

    Article  PubMed  Google Scholar 

  17. Molina BS, Pelham Jr WE. Attention-deficit/hyperactivity disorder and risk of substance use disorder: developmental considerations, potential pathways, and opportunities for research. Annu Rev Clin Psychol. 2014;10:607–39.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lee SS, Humphreys KL, Flory K, Liu R, Glass K. Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clin Psychol Rev. 2011;31:328–41.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Volkow ND, Fowler JS, Wang GJ, Goldstein RZ. Role of dopamine, the frontal cortex and memory circuits in drug addiction: insight from imaging studies. Neurobiol Learn Mem. 2002;78:610–24.

    Article  CAS  PubMed  Google Scholar 

  20. Volkow ND, Wang GJ, Kollins SH, Wigal TL, Newcorn JH, Telang F, et al. Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA. 2009;302:1084–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Volkow ND, Wang GJ, Telang F, Fowler JS, Logan J, Jayne M, et al. Profound decreases in dopamine release in striatum in detoxified alcoholics: possible orbitofrontal involvement. J Neurosci. 2007;27:12700–6.

    Article  CAS  PubMed  Google Scholar 

  22. Wong DF, Kuwabara H, Schretlen DJ, Bonson KR, Zhou Y, Nandi A, et al. Increased occupancy of dopamine receptors in human striatum during cue-elicited cocaine craving. Neuropsychopharmacology. 2006;31:2716–27.

    Article  CAS  PubMed  Google Scholar 

  23. Nutt DJ, Lingford-Hughes A, Erritzoe D, Stokes PR. The dopamine theory of addiction: 40 years of highs and lows. Nat Rev Neurosci. 2015;16:305–12.

    Article  CAS  PubMed  Google Scholar 

  24. Cortese S, Kelly C, Chabernaud C, Proal E, Di Martino A, Milham MP, et al. Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies. Am J Psychiatry. 2012;169:1038–55.

    Article  PubMed  Google Scholar 

  25. Kollins SH, Newland MC, Critchfield TS. Human sensitivity to reinforcement in operant choice: how much do consequences matter? Psychon Bull Rev. 1997;4:208–20.

    Article  CAS  PubMed  Google Scholar 

  26. Heil SH, Johnson MW, Higgins ST, Bickel WK. Delay discounting in currently using and currently abstinent cocaine-dependent outpatients and non-drug-using matched controls. Addict Behav. 2006;31:1290–4.

    Article  PubMed  Google Scholar 

  27. Plichta MM, Vasic N, Wolf RC, Lesch KP, Brummer D, Jacob C, et al. Neural hyporesponsiveness and hyperresponsiveness during immediate and delayed reward processing in adult attention-deficit/hyperactivity disorder. Biol Psychiatry. 2009;65:7–14.

    Article  PubMed  Google Scholar 

  28. Strohle A, Stoy M, Wrase J, Schwarzer S, Schlagenhauf F, Huss M, et al. Reward anticipation and outcomes in adult males with attention-deficit/hyperactivity disorder. Neuroimage. 2008;39:966–72.

    Article  PubMed  Google Scholar 

  29. Rubia K, Halari R, Cubillo A, Smith AB, Mohammad AM, Brammer M, et al. Methylphenidate normalizes fronto-striatal underactivation during interference inhibition in medication-naive boys with attention-deficit hyperactivity disorder. Neuropsychopharmacology. 2011;36:1575–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Konova AB, Moeller SJ, Tomasi D, Volkow ND, Goldstein RZ. Effects of methylphenidate on resting-state functional connectivity of the mesocorticolimbic dopamine pathways in cocaine addiction. JAMA Psychiat. 2013;70:857–68.

    Article  CAS  Google Scholar 

  31. Castellanos FX. Is adult-onset ADHD a distinct entity? Am J Psychiatry. 2015;172:929–31.

    Article  PubMed  Google Scholar 

  32. • Moffitt TE, Houts R, Asherson P, Belsky DW, Corcoran DL, Hammerle M, et al. Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study. Am J Psychiatry. 2015;172:967–77. This is the recent study showing that adult onset ADHD may be a distinct clinical entity.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Agnew-Blais JC, Polanczyk GV, Danese A, Wertz J, Moffitt TE, Arseneault L. Evaluation of the persistence, remission, and emergence of attention-deficit/hyperactivity disorder in young adulthood. JAMA Psychiat. 2016;73:713–20.

    Article  Google Scholar 

  34. Caye A, Rocha TB, Anselmi L, Murray J, Menezes AM, Barros FC, et al. Attention-deficit/hyperactivity disorder trajectories from childhood to young adulthood: evidence from a birth cohort supporting a late-onset syndrome. JAMA Psychiat. 2016;73:705–12.

    Article  Google Scholar 

  35. Proal E, Reiss PT, Klein RG, Mannuzza S, Gotimer K, Ramos-Olazagasti MA, et al. Brain gray matter deficits at 33-year follow-up in adults with attention-deficit/hyperactivity disorder established in childhood. Arch Gen Psychiatry. 2011;68:1122–34.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wilens TE, Kwon A, Tanguay S, Chase R, Moore H, Faraone SV, et al. Characteristics of adults with attention deficit hyperactivity disorder plus substance use disorder: the role of psychiatric comorbidity. Am J Addict. 2005;14:319–27.

    Article  PubMed  Google Scholar 

  37. Kaye S, Ramos-Quiroga JA, van de Glind G, Levin FR, Faraone SV, Allsop S, Degenhardt L, Moggi F, Barta C, Konstenius M, Franck J, Skutle A, Bu ET, Koeter MW, Demetrovics Z, Kapitany-Foveny M, Schoevers RA, van Emmerik-van Oortmerssen K, Carpentier PJ, Dom G, Verspreet S, Crunelle CL, Young JT, Carruthers S, Cassar J, Fatseas M, Auriacombe M, Johnson B, Dunn M, Slobodin O, van den Brink W. Persistence and subtype stability of adhd among substance use disorder treatment seekers. J Atten Disord. 2016.

  38. Winhusen TM, Lewis DF, Riggs PD, Davies RD, Adler LA, Sonne S, et al. Subjective effects, misuse, and adverse effects of osmotic-release methylphenidate treatment in adolescent substance abusers with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2011;21:455–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Volkow ND, Chang L, Wang GJ, Fowler JS, Franceschi D, Sedler M, et al. Loss of dopamine transporters in methamphetamine abusers recovers with protracted abstinence. J Neurosci. 2001;21:9414–8.

    CAS  PubMed  Google Scholar 

  40. Cassidy TA, Varughese S, Russo L, Budman SH, Eaton TA, Butler SF. Nonmedical use and diversion of ADHD stimulants among U.S. adults Ages 18–49: a national internet survey. J Atten Disord. 2015;19:630–40.

    Article  PubMed  Google Scholar 

  41. Collins SL, Levin FR, Foltin RW, Kleber HD, Evans SM. Response to cocaine, alone and in combination with methylphenidate, in cocaine abusers with ADHD. Drug Alcohol Depend. 2006;82:158–67.

    Article  CAS  PubMed  Google Scholar 

  42. Cunill R, Castells X, Tobias A, Capella D. Pharmacological treatment of attention deficit hyperactivity disorder with co-morbid drug dependence. J Psychopharmacol. 2015;29:15–23.

    Article  CAS  PubMed  Google Scholar 

  43. Konstenius M, Jayaram-Lindstrom N, Guterstam J, Beck O, Philips B, Franck J. Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence: a 24-week randomized placebo-controlled trial. Addiction. 2014;109:440–9.

    Article  PubMed  Google Scholar 

  44. • Levin FR, Mariani JJ, Specker S, Mooney M, Mahony A, Brooks DJ, et al. Extended-release mixed amphetamine salts vs placebo for comorbid adult attention-deficit/hyperactivity disorder and cocaine use disorder: a randomized clinical trial. JAMA Psychiat. 2015;72:593–602. A two-site study showing a robust dose of psychostimulant may be effective in treating both SUD and ADHD simultaneously.

    Article  Google Scholar 

  45. Riggs PD, Winhusen T, Davies RD, Leimberger JD, Mikulich-Gilbertson S, Klein C, et al. Randomized controlled trial of osmotic-release methylphenidate with cognitive-behavioral therapy in adolescents with attention-deficit/hyperactivity disorder and substance use disorders. J Am Acad Child Adolesc Psychiatry. 2011;50:903–14.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Winhusen TM, Somoza EC, Brigham GS, Liu DS, Green CA, Covey LS, et al. Impact of attention-deficit/hyperactivity disorder (ADHD) treatment on smoking cessation intervention in ADHD smokers: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2010;71:1680–8.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Tamm L, Trello-Rishel K, Riggs P, Nakonezny PA, Acosta M, Bailey G, et al. Predictors of treatment response in adolescents with comorbid substance use disorder and attention-deficit/hyperactivity disorder. J Subst Abuse Treat. 2013;44:224–30.

    Article  PubMed  Google Scholar 

  48. Nunes EV, Covey LS, Brigham G, Hu MC, Levin FR, Somoza EC, et al. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Wilens TE, Adler LA, Weiss MD, Michelson D, Ramsey JL, Moore RJ, et al. Atomoxetine ASUDSG. Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders. Drug Alcohol Depend. 2008;96:145–54.

    Article  CAS  PubMed  Google Scholar 

  51. Kirkpatrick MG, Gunderson EW, Levin FR, Foltin RW, Hart CL. Acute and residual interactive effects of repeated administrations of oral methamphetamine and alcohol in humans. Psychopharmacology (Berl). 2012;219:191–204.

    Article  CAS  Google Scholar 

  52. Bihlar Muld B, Jokinen J, Bolte S, Hirvikoski T. Long-term outcomes of pharmacologically treated versus non-treated adults with ADHD and substance use disorder: a naturalistic study. J Subst Abuse Treat. 2015;51:82–90.

    Article  PubMed  Google Scholar 

  53. Lichtenstein P, Halldner L, Zetterqvist J, Sjolander A, Serlachius E, Fazel S, et al. Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med. 2012;367:2006–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Substance Abuse, Department of Psychiatry, Columbia University, New York, NY, USA

    Sean X. Luo & Frances R. Levin

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  1. Sean X. Luo
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  2. Frances R. Levin
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Correspondence to Sean X. Luo.

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Conflict of Interest

Sean X. Luo serves as a consultant for Click Therapeutics, LLC.

Frances R. Levin reported receiving medication from USWorldMed for an ongoing study that is sponsored by the National Institute on Drug Abuse; serving as a consultant to GWPharmaceuticals and Eli Lilly and Co. from 2005 to 2007; serving on an advisory board to Shire in 2006 to 2007; and serving as a consultant to Major League Baseball regarding the diagnosis and treatment of attention-deficit/hyperactivity disorder.

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This article is part of the Topical Collection on Substance Use and Related Disorders

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Luo, S.X., Levin, F.R. Towards Precision Addiction Treatment: New Findings in Co-morbid Substance Use and Attention-Deficit Hyperactivity Disorders. Curr Psychiatry Rep 19, 14 (2017). https://doi.org/10.1007/s11920-017-0769-7

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  • DOI: https://doi.org/10.1007/s11920-017-0769-7

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