How treatment improvement in ADHD and cocaine dependence are related to one another: A secondary analysis

Frances R. Levin; C. Jean Choi; Martina Pavlicova; John J. Mariani; Amy Mahony; Daniel J. Brooks; Edward V. Nunes; John Grabowski

doi:10.1016/j.drugalcdep.2018.03.043

How treatment improvement in ADHD and cocaine dependence are related to one another: A secondary analysis

Frances R. Levin, C. Jean Choi, Martina Pavlicova, John J. Mariani, Amy Mahony, Daniel J. Brooks, Edward V. Nunes, John Grabowski

Psychiatry & Behavioral Sciences

Research output: Contribution to journal › Article › peer-review

20 Scopus citations

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 (60 mg or 80 mg 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.

Original language	English (US)
Pages (from-to)	135-140
Number of pages	6
Journal	Drug and alcohol dependence
Volume	188
DOIs	https://doi.org/10.1016/j.drugalcdep.2018.03.043
State	Published - Jul 1 2018

Bibliographical note

Funding Information:
Funding for this research was provided by the National Institute on Drug Abuse (NIDA) grants R01DA 023652 , K24 DA029647 , and K24 DA022412 . NIDA had no further role in study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the paper for publication.

Publisher Copyright:
© 2018

Keywords

ADHD
Adderall
Cocaine dependence
Treatment

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.drugalcdep.2018.03.043

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158788

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title = "How treatment improvement in ADHD and cocaine dependence are related to one another: A secondary analysis",

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 (60 mg or 80 mg 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.",

keywords = "ADHD, Adderall, Cocaine dependence, Treatment",

author = "Levin, {Frances R.} and Choi, {C. Jean} and Martina Pavlicova and Mariani, {John J.} and Amy Mahony and Brooks, {Daniel J.} and Nunes, {Edward V.} and John Grabowski",

note = "Funding Information: Funding for this research was provided by the National Institute on Drug Abuse (NIDA) grants R01DA 023652 , K24 DA029647 , and K24 DA022412 . NIDA had no further role in study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the paper for publication. Publisher Copyright: {\textcopyright} 2018",

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doi = "10.1016/j.drugalcdep.2018.03.043",

language = "English (US)",

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T2 - A secondary analysis

AU - Levin, Frances R.

AU - Choi, C. Jean

AU - Pavlicova, Martina

AU - Mariani, John J.

AU - Mahony, Amy

AU - Brooks, Daniel J.

AU - Nunes, Edward V.

AU - Grabowski, John

N1 - Funding Information: Funding for this research was provided by the National Institute on Drug Abuse (NIDA) grants R01DA 023652 , K24 DA029647 , and K24 DA022412 . NIDA had no further role in study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the paper for publication. Publisher Copyright: © 2018

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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 (60 mg or 80 mg 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.

AB - 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 (60 mg or 80 mg 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.

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KW - Cocaine dependence

KW - Treatment

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ER -

How treatment improvement in ADHD and cocaine dependence are related to one another: A secondary analysis

Abstract

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Keywords

UN SDGs

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