Remarkable Reduction of Cocaine Use in Dual Disorder (Adult Attention Deficit Hyperactive Disorder/Cocaine Use Disorder) Patients Treated with Medications for ADHD

Background: Cocaine use disorder (CUD) is a growing public health concern, but so far no effective pharmacotherapies have been demonstrated. Stimulant medications have proved to be promising in CUD treatment. The self-medication hypothesis (SMH) can help to explain this phenomenon better, especially in cases where CUD co-occurs with adult attention deficit hyperactivity disorder (A-ADHD). Methods: In the present retrospective study, a sample of 20 consecutive patients (aged from 18 to 65 years) with dual disorder (A-ADHD/CUD), under treatment with methylphenidate (MPH) or atomoxetine (ATM) medications, was followed to study the effects of A-ADHD treatment on cocaine use. Patients were followed for a mean period of 7 months (minimum 1, maximum 30 months). All individuals were assessed with standardized questionnaires to evaluate diagnosis, treatment efficacy, and clinical improvement. Results: the results showed that behaviors reflecting cocaine addiction were sharply reduced during the stimulant treatment of A-ADHD, and were not correlated with age, gender, familiarity, length of treatment, or medication used. CUD improvement was closely correlated with the A-ADHD improvement. This study supports the validity of the SMH in ADHD patients with co-occurring CUD

Contemporary perspective on addictive behaviors: underpinning mechanisms, assessment, and treatment

This special issue gathered contributions from authors in the scientifc community working on addictive behaviors. In particular, authors were solicited to relate about underpinning mechanisms, assessment protocols, and intervention programs that are currently proposed for substance abuse, Internet addiction, and other forms of problematic conducts in pediatric populations, adolescence, and adulthood. Most of the papers used a biopsychosocial model for the onset and maintaining of addictive behaviors and their comorbidities with other psychopathologies. Although the intent was accept contributions focused on all forms of addictive behaviors, this special issue is composed of four papers concerning problematic use of the web and two articles focusing on substance use. Of note, all papers addressed the developmental phases of childhood and adolescence

The mental status of 1090 heroin addicts at entry into treatment: should depression be considered a 'dual diagnosis'?

<p>Abstract</p> <p>Background</p> <p>Mental symptoms are common in heroin addiction and may arise from issues of addiction and withdrawal, raising doubts about the patients truly having co-morbid psychiatric diagnoses.</p> <p>Methods</p> <p>We studied the mental status of 1090 heroin addicts (831 males and 259 females aged between 16 and 51 years) at the beginning of treatment, and its relationship to relevant demographic and clinical data through the use of standardised instruments.</p> <p>Results</p> <p>A total of 506 (46.42%) heroin addicts showed depressive-anxious symptomatology, 421 (38.62%) had psychomotor excitement and 163 (14.95%) demonstrated a psychotic state. Patients with depressive-anxious symptomatology on the whole had a less severe addictive illness compared to those demonstrating excited and psychotic symptoms. The presence of depressive-anxious features was felt to not necessarily be indicative of the presence of a dual diagnosis.</p> <p>Conclusion</p> <p>The presence of depressive-anxious symptomatology in the clinical presentation in heroin addicts appears to be unrelated to 'dual diagnosis'.</p

Subtyping patients with heroin addiction at treatment entry: factor derived from the Self-Report Symptom Inventory (SCL-90)

<p>Abstract</p> <p>Background</p> <p>Addiction is a relapsing chronic condition in which psychiatric phenomena play a crucial role. Psychopathological symptoms in patients with heroin addiction are generally considered to be part of the drug addict's personality, or else to be related to the presence of psychiatric comorbidity, raising doubts about whether patients with long-term abuse of opioids actually possess specific psychopathological dimensions.</p> <p>Methods</p> <p>Using the Self-Report Symptom Inventory (SCL-90), we studied the psychopathological dimensions of 1,055 patients with heroin addiction (884 males and 171 females) aged between 16 and 59 years at the beginning of treatment, and their relationship to age, sex and duration of dependence.</p> <p>Results</p> <p>A total of 150 (14.2%) patients with heroin addiction showed depressive symptomatology characterised by feelings of worthlessness and being trapped or caught; 257 (24.4%) had somatisation symptoms, 205 (19.4%) interpersonal sensitivity and psychotic symptoms, 235 (22.3%) panic symptomatology, 208 (19.7%) violence and self-aggression. These dimensions were not correlated with sex or duration of dependence. Younger patients with heroin addiction were characterised by higher scores for violence-suicide, sensitivity and panic anxiety symptomatology. Older patients with heroin addiction showed higher scores for somatisation and worthlessness-being trapped symptomatology.</p> <p>Conclusions</p> <p>This study supports the hypothesis that mood, anxiety and impulse-control dysregulation are the core of the clinical phenomenology of addiction and should be incorporated into its nosology.</p

Current quality of life and its determinants among opiate-dependent individuals five years after starting methadone treatment

This study explores the current QoL of opiate-dependent individuals who started outpatient methadone treatment at least 5 years ago and assesses the influence of demographic, psychosocial, drug and health-related variables on individuals' QoL. Participants (n = 159) were interviewed about their current QoL, psychological distress and severity of drug-related problems, using the Lancashire Quality of Life Profile, the Brief Symptom Inventory and the Addiction Severity Index. Potential determinants of QoL were assessed in a multiple linear regression analysis. Five years after the start of methadone treatment, opiate-dependent individuals report low QoL scores on various domains. No association was found between drug-related variables and QoL, but a significant negative impact of psychological distress was identified. Severity of psychological distress, taking medication for psychological problems and the inability to change one's living situation were associated with lower QoL. Having at least one good friend and a structured daily activity had a significant, positive impact on QoL. Opiate-dependent individuals' QoL is mainly determined by their psychological well-being and a number of psychosocial variables. These findings highlight the importance of a holistic approach to treatment and support in methadone maintenance treatment, which goes beyond fixing the negative physical consequences of opiate dependence

Towards a specific psychopathology of substance use disorder: Comparison between heroin use disorder and chronic psychotic patients

Background: Addiction is a chronic relapsing condition in which psychiatric phenomena play a crucial role. Psychopathological symptoms in patients with Substance Use Disorders (SUDs) are generally considered to be part of the drug addict personality, or else to be related to the presence of a Dual Disorder (DD), raising doubts about whether patients with long-term SUD possessed psychopathological dimensions. Our research group at the University of Pisa has shed light on the possible definition of a specific psychopathy dimension in SUD. In Heroin Use Disorder (HUD) patients, by applying a PCA factor analysis to the 90 items listed in the SCL90 checklist, a 5-factor solution was identified for the first time and was then confirmed in Alcohol Use Disorder and Cocaine Use Disorder patients. The first factor reflected a depressive 'Worthlessness-Being Trapped' dimension (W/BT); the second factor picked out a ‘Somatic Symptoms’ dimension (SS); the third identified a 'Sensitivity-Psychoticism' dimension (S/P); the fourth a 'Panic Anxiety' dimension (PA); and the fifth a 'Violence-Suicide' dimension (V/S). To confirm their specificity, these dimensions must be able to discriminate patients affected by addiction from those affected by other psychiatric diseases. Methods: In this study 40 chronic psychotic patients (CHR-PSY) were matched with 33 HUD patients according to age and gender, and compared, at univariate and multivariate level, regarding the severity and typology of the SCL90 five dimensions. Results: Low-level education was more frequent in HUD patients, but it was unrelated to psychopathological typology (χ2=8.83; p=0.065) and to severity (except for the SS dimension, F=5.94; p&lt;0.05). Psychopathological typology was able to differentiate HUD from CHR-PSY patients (χ2=14.44; p=0.006). At univariate level, only PA severity was higher in CHR-PSY patients, whereas multivariate discriminant analysis was able to differentiate HUD significantly from CHR-PSY patients (Wilks’ Lambda=0.69; χ2=25.74; df=2; p&lt;0.001), showing that 79.5% of the cases, as originally grouped, had been correctly classified. Conclusions: This study, being able to differentiate HUD from CHR-PSY patients, further supports the specificity of the proposed factorial dimensions of the psychopathology of SUD

Influence of substance use disorder on treatment retention of adult-attention-deficit/hyperactive disorder patients. A 5-year follow-up study

Attention-Deficit/Hyperactivity Disorder (ADHD) is the most widespread neurodevelopmental disorder, and it still persists into adulthood in 2–6% of the population. Psychiatric comorbidities are very common in adult ADHD (A-ADHD) patients; in particular, Substance Use Disorder (SUD) is found in 40% of these patients. Co-occurrence of ADHD and SUD is described as detrimental to clinical outcome by many authors, while only a few studies describe good clinical results in A-ADHD-SUD patients when they were treated for ADHD, both for the efficacy and the compliance of patients. In this study we tested to determine whether SUD can influence the treatment outcome of A-ADHD patients by correlating lifetime, past and current substance use in A-ADHD patients with their outcome (retention rate) during a 5-year follow-up of patients treated with stimulant and non-stimulant medications, using Kaplan–Meier survival analysis with overall and pairwise comparison. The association between demographic, symptomatological and clinical aspects with retention in treatment, adjusting for potential confounding factors, was summarized using Cox regression. After 5 years of observation, the cumulative treatment retention was 49.0%, 64.3% and 41.8% for A-ADHD patients without lifetime SUD (NSUD/A-ADHD), A-ADHD with past SUD (PSUD/A-ADHD) and A-ADHD with current SUD (CSUD/A-ADHD), respectively. Overall comparisons were not significant (Wilcoxon Rank-Sum (statistical) Test = 1.48; df = 2; p = 0.477). The lack of differences was confirmed by a Cox regression demonstrating that the ADHD diagnosis according to DIVA, gender, education, civil status, presence of psychiatric comorbidity, and psychiatric and ADHD familiarity; severity of symptomatological scales as evaluated by WHODAS, BPRS, BARRAT, DERS, HSRS, and ASRS did not influence treatment drop-out (x2 22.30; df = 20 p = 0.324). Our A-ADHD-SUD patients have the same treatment retention rate as A-ADHD patients without SUD, so it seems that substance use comorbidity does not influence this clinical parameter

Personality profiles and aggressive behaviour of heroin use disorder patients compared with non-substance-use peers

Background: Personality characteristics and aggressive behaviour have long been considered factors that pre-exist addiction. Cattell’s 16-Personality Factor Questionnaire and the Buss-Durkee Inventory have been used in psychosomatic medicine, and in psychiatric as well as Substance Use Disorder patients, to study psychological profiles and aggressive behaviour. Methods: In this study, we verified the existence of the factors that pre-exist heroin. Using Cattell’s 16PF Questionnaire and the Buss-Durkee Inventory, we have, at both the univariate and multivariate level, compared 73 Heroin Use Disorder (HUD) patients with a sample of 45 Substance Non-User (SNU) peers, selected after matching their respective socio-demographic data. Our expectation was, that among the characteristics that show the most evident deviance from the general population, those that differentiate HUD patients most sharply from their SNU peers should be considered as factors pre-existing heroin addiction. Results: HUD patients and SNU peers, regarding psychological profiles, differ from the general population in the same way. As to the significant univariate differences, the 8-Sensitivity and 6-Rule-Consciousness factors are the only deviants from the general population in all individuals (higher scores in 8-Sensitivity and lower values in 6-Rule-Consciousness). Conversely, the 4-Dominance factor and 2-Reasoning factors are deviant only in the HUD patients, while 10-Abstractedness was not deviant in all our subjects. Differences in the 4-Dominance factor did not enter into the multivariate analysis. Being introverted, expedient in rule consciousness, abstracted in abstractedness, but less sensitive and more concrete in reasoning, are the prominent characteristics that allow HUD patients to be differentiated from their SNU peers. Regarding aggressive behaviour, HUD patients are deviant in all factors, whereas their SNU peers are deviant in only two elements: 2-Indirect Aggression and 6-Suspiciousness. These two factors do not, however, have a high profile at the multivariate level, and HUD patients can be distinguished by the higher values recorded for the 1-Assault and 4-Negativism factors. Conclusions: Psychological profiles that show deviance from those of the general population are unable to differentiate HUD patients from their SNU peers, with the sole exceptions of rule-consciousness and sensitivity, which, in any case, show greater deviance in their SNU peers. Assault and Negativism are not deviant in SNU peers and can be considered as probable consequences of heroin use. © 2018, Pacini Editore S.p.A. All rights reserved

Substance use disorder in adult-attention deficit hyperactive disorder patients: Patterns of use and related clinical features

Background: While a large amount of medical literature has explored the association between Attention Deficit/Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUDs), less attention has been dedicated to the typologies of SUD and their relationships with ADHD-specific symptomatology and general psychopathology in dual disorder patients. Methods: We selected 72 patients (aged 18-65) with a concomitantSUDout of 120 adults withADHD(A-ADHD). Assessment instruments included the Diagnostic Interview for ADHD in adults (DIVA 2.0), Conner’s Adult ADHD Rating Scales-Observer (CAARS-O:S): Short Version, the Structured Clinical Interview for Axis I and II Disorders (SCID-I), the Barratt Impulsiveness Scale (BIS-11), the Brief Psychiatric rating scale (BPRS), the Reactivity Intensity Polarity Stability Questionnaire (RIPoSt-40), theWorld Health Organization Disability Assessment Schedule (WHODAS 2.0) and the Morningness-Eveningness Questionnaire (MEQ). A factorial analysis was performed to group our patients by clusters in different typologies of substance use and correlations between SUDs, as made evident by their typological and diagnostic features; in addition, specific ADHD symptoms, severity of general psychopathology and patients’ functionality were assessed. Results: Two patterns of substance use were identified: the first (type 1) characterized by stimulants/alcohol and the second (type 2) by the use of cannabinoids (THC). Type 1 users were significantly younger and had more legal problems. The two patterns were similar in terms of ADHD-specific symptomatology and its severity at treatment entry. No differences were found regarding the other scales assessed, except for lower scores at MEQ in type 1 users. Conclusions: At treatment entry, the presence of different comorbid SUD clusters do not affect ADHD-specific symptomatology or severity