In spite of the availability of effective pharmacologic agents for the treatment of opiate dependence, such as methadone and naltrexone, successful treatment remains inadequate for many patients. One factor which may contribute to poor treatment outcome for patients in methadone maintenance programs is the presence of comorbid disorders, of which Attention-Deficit Hyperactivity Disorder (ADHD) has been a neglected one. Based on data we have collected, the prevalence of adult ADHD is substantially higher among substance abusers, both methadone-maintained patients and cocaine abusers seeking treatment, compared to the general population. It is our hypothesis that a comorbid diagnosis of ADHD in methadone-maintained patients may impede treatment efficacy. Medications, such as methylphenidate (MPH) and bupropion (BRP), are currently two of the most effective treatments for ADHD. In fact, we have shown that sustained-release MPH is effective in reducing both ADHD symptoms and cocaine use in cocaine abusers with adult ADHD. By treating methadone maintained patients who have adult ADHD with effective medications, we hypothesize that a reduction in ADHD symptoms will improve treatment efficacy as defined by: retention in the treatment study and in the methadone program, reduction in illicit drug use and drug craving, and improvement in functioning based on the Addiction Severity Index and Clinical Global Impression. Specifically, the effectiveness of sustained-release MPH and sustained-release BPR will be assessed using a three-armed, double-blind, placebo-controlled treatment trial in 120 methadone-maintained patients diagnosed with adult ADHD. Unfortunately, ADHD often goes undiagnosed.
The second aim of this proposal is to determine the positive predictive value of several self-report instruments used to evaluate adult ADHD. Specifically, we will determine the utility of these instruments for assessing adult ADHD in substance-abusing populations. Overall, this proposal will provide a better understanding of the relationship between ADHD and substance abuse, better diagnostic evaluation, and improved pharmacologic treatment approaches for this sub-population.
|Brooks, Daniel J; Vosburg, Suzanne K; Evans, Suzette M et al. (2006) Assessment of cognitive functioning of methadone-maintenance patients: impact of adult ADHD and current cocaine dependence. J Addict Dis 25:15-25|