Insomnia Symptoms in Patients With Substance Use Disorders During Detoxification and Associated Clinical Features

Background: Insomnia is highly prevalent in patients with substance use disorders (SUD), and it has been related to a worse course of addiction. Insomnia during detoxification in a hospital has not been adequately studied. This study aims to compare sociodemographic, clinical, and psychopathological characteristics of SUD patients undergoing a detoxification program, by comorbidity and insomnia symptoms. Methodology: We recruited 481 patients who received pharmacological and psychotherapeutic treatment for detoxification. They were evaluated through semi-structured interviews, standardized questionnaires, and a specific sleep log. A bivariate and multivariate analysis of the data was performed. Results: Insomnia was reported by 66.5% patients, with sleep-maintenance insomnia the most frequent issue, followed by early morning awakening and sleep-onset insomnia. Patients with alcohol use disorder and cannabis use disorder had higher prevalence of sleep-onset insomnia. Patients with cocaine and heroin use disorder had higher prevalence of sleep-maintenance insomnia. Independent factors that allowed the identification of insomnia symptoms included being female (OR: 3.43), polysubstance use (OR: 2.85), comorbid anxiety disorder (OR: 2.02), and prior admission for detoxification (OR: 1.22). Conclusions: Insomnia symptoms are very prevalent in patients admitted for detoxification. The diagnosis and therapeutic strategies for the insomnia symptoms should be improved, especially in women and in patients with greater addiction severity and with anxiety disorders

Clinical differences between cocaine-induced psychotic disorder and psychotic symptoms in cocaine-dependent patients

The aim of this study is to compare the clinical characteristics of three groups of patients in treatment for cocaine dependence: patients without any psychotic symptoms (NS), patients with transient psychotic symptoms (PS) and patients with cocaine-induced psychotic disorder (CIPD). An observational and retrospective study of 150 cocaine-dependent patients undergoing treatment in the Drug Unit of the Psychiatry Department of University Hospital Vall d׳Hebron in Barcelona (Spain) using these three groups, NS, PS and CIPD, was performed. All patients were evaluated with the PRISM interview. ANOVA, χ(2) tests and multivariate multinomial regression analysis were used to perform statistical analyses. Seven patients with a primary psychotic disorder were discharged. Forty-six patients (32.1%) did not report any psychotic symptoms. Ninety-seven patients (67.9%) presented with a history of any cocaine-induced psychotic symptom and were considered as the cocaine-induced psychotic (CIP) group. Among them, 39 (27.3%) were included in the PS group and 58 (40.6%) were included in the CIPD group. A history of imprisonment was found significantly more frequently in the PS group than in the NS group. The distribution of age at onset of dependence, lifetime cannabis abuse or dependence and imprisonment were significantly different between the NS and CIPD groups. We conclude that in cocaine-dependent patients, clinicians should be advised about the risk of development of psychotic symptoms. The presence of some psychotic symptoms could increase the potential risks of disturbing behaviours

Barriers to linkage to care in hepatitis C patients with substance use disorders and dual diagnoses, despite centralized management

Hepatitis C virus; Dual diagnosis; Substance use disorderVirus de l'Hepatitis C; Diagnòstic dual; Trastorn per consum de substànciesVirus de la Hepatitis C; Diagnóstico dual; Trastorno por consumo de sustanciasBackground: Hepatitis C virus (HCV) management is a challenge in patients with substance use disorder (SUD). This study aimed to describe an HCV screening and linkage to care program in SUD patients, and analyze the characteristics of this population in relation to HCV infection, particularly the impact of psychiatric comorbidities (dual diagnosis). Methods: This study was a prospective clinical cohort study using a collaborative, multidisciplinary model to offer HCV care (screening, diagnosis, and therapy) to individuals with SUD attending a dedicated hospital clinic. The characteristics of the participants, prevalence of HCV infection, percentage who started therapy, and adherence to treatment were compared according to the patients’ consumption characteristics and presence of dual diagnosis. HCV screening, diagnosis, treatment initiation, and sustained virologic response were analyzed. Results: 528 individuals attended the center (November 2018–June 2019) and 401 (76%) accepted screening. In total, 112 (28%) were anti-HCV-positive and 42 (10%) had detectable HCV RNA, but only 20 of the latter started HCV therapy. Among the 253 (63%) patients with a dual diagnosis, there were no differences in HCV infection prevalence versus patients with SUD alone (p = 0.28). Dual diagnosis did not lead to a higher risk of HCV infection or interfere with linkage to care or treatment. Conclusion: This study found a high prevalence of dual diagnosis and HCV infection in SUD patients, but dual diagnosis was not associated with an increased risk of acquiring HCV or more complex access to care. Despite use of a multidisciplinary management approach, considerable barriers to HCV care remain in this population that would need more specific focus.This work was supported by AbbVie

Serum brain-derived neurotrophic factor levels and cocaine-induced transient psychotic symptoms

Background: Cocaine-induced psychosis (CIP) is among the most serious adverse effects of cocaine. Reduced serum brain-derived neurotrophic factor (BDNF) levels have been reported in schizophrenia and psychosis; however, studies assessing the involvement of BDNF in CIP are lacking. Methods: A total of 22 cocaine-dependent patients (aged 33.65 ± 6.85) who had never experienced psychotic symptoms under the influence of cocaine (non-CIP) and 18 patients (aged 34.18 ± 8.54) with a history of CIP completed a 2-week detoxification program in an inpatient facility. Two serum samples were collected from each patient at baseline and at the end of the protocol. Demographic, consumption and clinical data were recorded for all patients. A paired group of healthy controls was also included. Results: At the beginning of the detoxification treatment, serum BDNF levels were similar in both the non-CIP and the CIP groups. During early abstinence, the non-CIP group exhibited a significant increase in serum BDNF levels (p = 0.030), whereas the CIP group exhibited a decrease. Improvements in depression (Beck Depression Inventory, BDI, p = 0.003) and withdrawal symptoms (Cocaine Selective Severity Assessment, CSSA, p = 0.013) show a significant positive correlation with serum BDNF levels in the non-CIP group, whereas no correlation between the same variables was found in the CIP group. Conclusions: This study suggests that BDNF plays a role in the transient psychotic symptoms associated with cocaine consumption. In the non-CIP group, the increase in serum BDNF appears to be driven by the effects of chronic cocaine consumption and withdrawal. In contrast, patients with CIP share some of the neurotrophic deficiencies that characterize schizophrenia and psychosis

Influence of Obesity and Metabolic Disease on Carotid Atherosclerosis in Patients with Coronary Artery Disease (CordioPrev Study)

Background Recent data suggest that the presence of associated metabolic abnormalities may be important modifiers of the association of obesity with a poorer prognosis in coronary heart disease. We determined the influence of isolated overweight and obesity on carotid intima media thickness (IMT-CC), and also assessed whether this influence was determined by the presence of metabolic abnormalities. Methods 1002 participants from the CordioPrev study were studied at entry. We determined their metabolic phenotypes and performed carotid ultrasound assessment. We evaluated the influence of obesity, overweight and metabolic phenotypes on the IMT-CC. Results Metabolically sick participants (defined by the presence of two or more metabolic abnormalities) showed a greater IMT-CC than metabolically healthy individuals (p = 4 * 10−6). Overweight and normal weight patients who were metabolically healthy showed a lower IMT-CC than the metabolically abnormal groups (all p<0.05). When we evaluated only body weight (without considering metabolic phenotypes), overweight or obese patients did not differsignificantly from normal-weight patients in their IMT-CC (p = 0.077). However, obesity was a determinant of IMT-CC when compared to the composite group of normal weight and overweight patients (all not obese). Conclusions In coronary patients, a metabolically abnormal phenotype is associated with a greater IMTCC, and may be linked to a higher risk of suffering new cardiovascular events. The protection conferred in the IMT-CC by the absence of metabolic abnormality may be blunted by the presence of obesit

Allogeneic Stem Cell Transplantation in Mature T Cell and Natural Killer/T Neoplasias: A Registry Study from Spanish GETH/GELTAMO Centers

Despite advances in understanding the biology of mature T and natural killer (NK)/T cell neoplasia, current therapies, even the most innovative ones, are still far from ensuring its cure. The only treatment to date that has been shown to control aggressive T cell neoplasms in the long term is allogeneic stem cell transplantation (alloSCT). We aim to report the results of alloSCT for advanced mature T and NK/T neoplasias performed in centers from our national GELTAMO/GETH (Grupo Español de Linfoma y Trasplante de Médula Ósea/Grupo Español de Trasplante Hematopoyético y Terapia Celular) over the past 25 years. As a secondary objective, we analyzed the results of alloSCT from haploidentical donors. We performed a retrospective analysis of all patients who received an alloSCT in Spanish centers (n = 201) from September 1995 to August 2018. The 2-year overall survival (OS) and disease-free survival (DFS) were 65.5% and 58.2%, respectively. The univariate for OS and DFS showed statistically different hazard ratios for conditioning intensity, response pre-alloSCT, comorbidity index, donor/receptor cytomegalovirus status and Eastern Cooperative Oncology Group (ECOG) pre-alloSCT, but only a better ECOG pre-alloSCT remained significant in the multivariate analysis. There was an increased incidence of relapse in those patients who did not develop chronic graft-versus-host disease (GVHD) and an increased risk of death in those developing moderate to severe acute GVHD. The 1-year nonrelapse mortality was 21.9% and was mainly due to GVHD (30%) and bacterial infections (17%). When comparing unrelated donors with haploidentical donors, we found similar results in terms of OS and DFS. There was, however, a reduction of acute GVHD in the haploidentical group (P = .04) and trend to a reduction of chronic GVHD. In conclusion, alloSCT is the only curative option for most aggressive T cell neoplasias. Haploidentical donors offer similar results to related donors in terms of survival with a reduction of acute GVHD

The CARBA-MAP study: national mapping of carbapenemases in Spain (2014–2018)

Introduction:Infections caused by carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa, including isolates producing acquired carbapenemases, constitute a prevalent health problem worldwide. The primary objective of this study was to determine the distribution of the different carbapenemases among carbapenemase-producing Enterobacterales (CPE, specifically Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Klebsiella aerogenes) and carbapenemase-producing P. aeruginosa (CPPA) in Spain from January 2014 to December 2018.Methods: A national, retrospective, cross-sectional multicenter study was performed. The study included the first isolate per patient and year obtained from clinical samples and obtained for diagnosis of infection in hospitalized patients. A structured questionnaire was completed by the participating centers using the REDCap platform, and results were analyzed using IBM SPSS Statistics 29.0.0.Results: A total of 2,704 carbapenemase-producing microorganisms were included, for which the type of carbapenemase was determined in 2692 cases: 2280 CPE (84.7%) and 412 CPPA (15.3%), most often using molecular methods and immunochromatographic assays. Globally, the most frequent types of carbapenemase in Enterobacterales and P. aeruginosa were OXA-48-like, alone or in combination with other enzymes (1,523 cases, 66.8%) and VIM (365 cases, 88.6%), respectively. Among Enterobacterales, carbapenemase-producing K. pneumoniae was reported in 1821 cases (79.9%), followed by E. cloacae complex in 334 cases (14.6%). In Enterobacterales, KPC is mainly present in the South and South-East regions of Spain and OXA-48-like in the rest of the country. Regarding P. aeruginosa, VIM is widely distributed all over the country. Globally, an increasing percentage of OXA-48-like enzymes was observed from 2014 to 2017. KPC enzymes were more frequent in 2017–2018 compared to 2014–2016.Discussion: Data from this study help to understand the situation and evolution of the main species of CPE and CPPA in Spain, with practical implications for control and optimal treatment of infections caused by these multi-drug resistant organisms

Comorbilidad psiquiátrica y evolución de pacientes con trastorno por consumo de sustancias y trastorno por déficit de atención con hiperactividad

La prevalencia del TDAH en pacientes con Trastorno por Consumo de Sustancias o Trastorno por Uso de Sustancias (TUS) es alta, con un promedio de 14%, que según las estimaciones con los criterios DSM-5 puede variar en 9-33% según el país y los métodos diagnósticos utilizados; cifras mucho más altas en comparación con la presencia de TDAH en la población general 1-7,3% (Crunelle, Van Den Brink, et al., 2018; van de Glind, et al., 2014; Van Emmerik-van Oortmerssen et al., 2014). El objetivo de este estudio es evaluar la diferencia de comorbilidad psiquiátrica y gravedad de la adicción entre pacientes con TUS y TDAH, así como la evolución valorada en base a la abstinencia a la sustancia motivo de consulta y el tiempo de seguimiento en el tratamiento ambulatorio. Métodos: Se han realizado dos estudios, un primer estudio de seguimiento a 6 meses con la valoración de comorbilidad psiquiátrica, gravedad del consumo, abstinencia y tiempo de seguimiento en tratamiento ambulatorio, en función de presentar TDAH o no. Un segundo estudio que valora la gravedad de la adicción y la comorbilidad psiquiátrica en pacientes con diagnóstico de TDAH y con trastorno por consumo de cannabis, cocaína o cannabis/cocaína. Se utilizaron cuestionarios y entrevistas semiestructuradas para la medición de las variables: EuropASI, CAADID, SCID-I y SCID-II, ASRS, WURS, BIS-11 y FIDI. Se realizó análisis estadístico para variables simples y múltiples, de comparación de dos o más de dos grupos (Chi cuadrado, U de Man Whitney, t-student), así como análisis multivariante de regresión lineal y el análisis de supervivencia de Kaplan-Meyer para la evolución. Resultados: El estudio 1: Un total de 406 pacientes durante 1, 3 y 6 meses. El grupo de pacientes con TDAH, fue más joven, con más prevalencia de uso de cannabis, con inicio más temprano del consumo y la dependencia. Presentaron más prevalencia de trastornos de la personalidad tanto del clúster A como B, y más trastornos de conducta en la infancia. El grupo con TDAH presentó igualmente menos tiempo de abstinencia y menos meses de retención o tiempo de seguimiento en el tratamiento ambulatorio; el TDAH se asoció a mayor impulsividad en todas las escalas, principalmente la impulsividad disfuncional. En el estudio 2 se evaluaron un total de 1538 pacientes de los cuales 239 presentaron TDAH, la edad media fue de 32,9 ± 10 años, principalmente hombres. La presentación combinada de TDAH fue más frecuente (64,2%). El trastorno de ansiedad a lo largo de la vida, las habilidades laborales, el consumo de polisustancias y la evolución del uso de sustancias a lo largo de la vida, mostraron importancia en el análisis multivariado y en la comparativa de los grupos de pacientes con consumo de cannabis, cannabis/cocaína y cocaína. Los grupos más afectados fueron aquellos con el consumo de cannabis como factor común. Se concluye que los pacientes que presentan trastorno por déficit de atención con hiperactividad asociado a un trastorno por consumo de sustancias, presentan más gravedad en cuanto al consumo, más prevalencia de comorbilidad psiquiátrica, menor tiempo de abstinencia y retención en el tratamiento ambulatorio; la droga de consumo identificada como más prevalente en este grupo es el cannabis. Todo esto posiciona al grupo de pacientes con TUS y TDAH como de alto riesgo y con peor pronóstico en general. Es importante el diagnóstico y al abordaje terapéutico integral de los pacientes TUS-TDAH así como de otras comorbilidades psiquiátricas.The prevalence of ADHD in patients with Substance Use Disorder (SUD) is high, with an average of 14%, depending on the frequencies, with the DSM-5 criteria can vary by 9-33%, depending on the country and the diagnostic methods used, much higher figures compared to the presence of ADHD in the general population 1-7.3% (Crunelle, Van Den Brink, et al., 2018; van de Glind, et al., 2014; Van Emmerik-van Oortmerssen et al., 2014). Both the SUD and ADHD, as well as other psychiatric comorbidities very prevalent in this group, are important in the diagnostic process. The objective of this study is to evaluate differences in psychiatric comorbidity and severity of addiction between patients with ADHD and TUS, as well as their evolution. The evolution assessment was based on two variables: abstinence from the substance that was the reason for consultation and the time of follow-up in the outpatient treatment center. Methods: Two studies have been carried out, a first 6-month follow-up study in which the variables of psychiatric comorbidity, severity of consumption, abstinence and follow-up time in an outpatient treatment were evaluated, depending on the presence or not of ADHD. A second study assessed the severity of addiction, ADHD and psychiatric comorbidity in patients diagnosed with ADHD and with cannabis, cocaine or cannabis / cocaine use disorder. Semi-structured questionnaires and interviews will be used to measure the variables, among these are: EuropASI, CAADID, SCID-I and SCID-II; and ASRS, WURS, BIS-11 and FIDI questionnaires were evaluated. Statistical analysis was performed for single and multiple variables, comparison of two or more of two groups (Chi square, Man Whitney U, t-student), as well as multivariate linear regression analysis; for the assessment of evolution, the Kaplan-Meyer survival analysis was considered. Results: Study 1: A total of 406 patients were evaluated in a follow up periedo on 1, 3 and 6 months. The ADHD group reported youngest age, cannabis as the most commonly used drug, earlier age for the beginning of problematic substance use, more prevalence of personality disorders of both cluster A and cluster B, as well as more presence of conduct disorder in childhood. The ADHD group presented less abstinence time and less months of retention or follow-up time in outpatient treatment. ADHD was associated with greater impulsivity at all scales, mainly those related to dysfunctional impulsivity. In study 2, a total of 1538 patients were evaluated, of which 239 fullfielld criteria for ADHD diagnosis; the mean age was 32.9 ± 10 years, mainly men. The combined presentation of ADHD was the most frequent (64.2%). Anxiety disorder throughout life, work skills, consumption of polysubstances and the evolution of substance use throughout life were variables with statistic significance in the multivariate analysis when were compared the groups of patients (cannabis, cannabis / cocaine and cocaine SUD). The most affected groups were those with cannabis use as a common factor. It is concluded that patients with ADHD and SUD, have more seriousness in terms of consumption, more prevalence of psychiatric comorbidity, less abstinence time and less retention in an outpatient treatment; the drug of consumption identified as more prevalent in this group is cannabis. The significant variables in both studies were: Earlier age at start of drug consumption or dependence, worst punctuation on the drug scale in the EuropASI, earlier relapse in consumption and in drop out for ambulatory drug treatment, more prevalence of psychiatric comorbidity; all of these variables inferred high risk for present more severity and worse prognosis in patients with SUD and ADHD. The diagnosis and comprehensive therapeutic approach of SUD and ADHD patients as well as other psychiatric comorbidities is important

Comorbilidad psiquiátrica y evolución de pacientes con trastorno por consumo de sustancias y trastorno por déficit de atención con hiperactividad

La prevalencia del TDAH en pacientes con Trastorno por Consumo de Sustancias o Trastorno por Uso de Sustancias (TUS) es alta, con un promedio de 14%, que según las estimaciones con los criterios DSM-5 puede variar en 9-33% según el país y los métodos diagnósticos utilizados; cifras mucho más altas en comparación con la presencia de TDAH en la población general 1-7,3% (Crunelle, Van Den Brink, et al., 2018; van de Glind, et al., 2014; Van Emmerik-van Oortmerssen et al., 2014). El objetivo de este estudio es evaluar la diferencia de comorbilidad psiquiátrica y gravedad de la adicción entre pacientes con TUS y TDAH, así como la evolución valorada en base a la abstinencia a la sustancia motivo de consulta y el tiempo de seguimiento en el tratamiento ambulatorio. Métodos: Se han realizado dos estudios, un primer estudio de seguimiento a 6 meses con la valoración de comorbilidad psiquiátrica, gravedad del consumo, abstinencia y tiempo de seguimiento en tratamiento ambulatorio, en función de presentar TDAH o no. Un segundo estudio que valora la gravedad de la adicción y la comorbilidad psiquiátrica en pacientes con diagnóstico de TDAH y con trastorno por consumo de cannabis, cocaína o cannabis/cocaína. Se utilizaron cuestionarios y entrevistas semiestructuradas para la medición de las variables: EuropASI, CAADID, SCID-I y SCID-II, ASRS, WURS, BIS-11 y FIDI. Se realizó análisis estadístico para variables simples y múltiples, de comparación de dos o más de dos grupos (Chi cuadrado, U de Man Whitney, t-student), así como análisis multivariante de regresión lineal y el análisis de supervivencia de Kaplan-Meyer para la evolución. Resultados: El estudio 1: Un total de 406 pacientes durante 1, 3 y 6 meses. El grupo de pacientes con TDAH, fue más joven, con más prevalencia de uso de cannabis, con inicio más temprano del consumo y la dependencia. Presentaron más prevalencia de trastornos de la personalidad tanto del clúster A como B, y más trastornos de conducta en la infancia. El grupo con TDAH presentó igualmente menos tiempo de abstinencia y menos meses de retención o tiempo de seguimiento en el tratamiento ambulatorio; el TDAH se asoció a mayor impulsividad en todas las escalas, principalmente la impulsividad disfuncional. En el estudio 2 se evaluaron un total de 1538 pacientes de los cuales 239 presentaron TDAH, la edad media fue de 32,9 ± 10 años, principalmente hombres. La presentación combinada de TDAH fue más frecuente (64,2%). El trastorno de ansiedad a lo largo de la vida, las habilidades laborales, el consumo de polisustancias y la evolución del uso de sustancias a lo largo de la vida, mostraron importancia en el análisis multivariado y en la comparativa de los grupos de pacientes con consumo de cannabis, cannabis/cocaína y cocaína. Los grupos más afectados fueron aquellos con el consumo de cannabis como factor común. Se concluye que los pacientes que presentan trastorno por déficit de atención con hiperactividad asociado a un trastorno por consumo de sustancias, presentan más gravedad en cuanto al consumo, más prevalencia de comorbilidad psiquiátrica, menor tiempo de abstinencia y retención en el tratamiento ambulatorio; la droga de consumo identificada como más prevalente en este grupo es el cannabis. Todo esto posiciona al grupo de pacientes con TUS y TDAH como de alto riesgo y con peor pronóstico en general. Es importante el diagnóstico y al abordaje terapéutico integral de los pacientes TUS-TDAH así como de otras comorbilidades psiquiátricas.The prevalence of ADHD in patients with Substance Use Disorder (SUD) is high, with an average of 14%, depending on the frequencies, with the DSM-5 criteria can vary by 9-33%, depending on the country and the diagnostic methods used, much higher figures compared to the presence of ADHD in the general population 1-7.3% (Crunelle, Van Den Brink, et al., 2018; van de Glind, et al., 2014; Van Emmerik-van Oortmerssen et al., 2014). Both the SUD and ADHD, as well as other psychiatric comorbidities very prevalent in this group, are important in the diagnostic process. The objective of this study is to evaluate differences in psychiatric comorbidity and severity of addiction between patients with ADHD and TUS, as well as their evolution. The evolution assessment was based on two variables: abstinence from the substance that was the reason for consultation and the time of follow-up in the outpatient treatment center. Methods: Two studies have been carried out, a first 6-month follow-up study in which the variables of psychiatric comorbidity, severity of consumption, abstinence and follow-up time in an outpatient treatment were evaluated, depending on the presence or not of ADHD. A second study assessed the severity of addiction, ADHD and psychiatric comorbidity in patients diagnosed with ADHD and with cannabis, cocaine or cannabis / cocaine use disorder. Semi-structured questionnaires and interviews will be used to measure the variables, among these are: EuropASI, CAADID, SCID-I and SCID-II; and ASRS, WURS, BIS-11 and FIDI questionnaires were evaluated. Statistical analysis was performed for single and multiple variables, comparison of two or more of two groups (Chi square, Man Whitney U, t-student), as well as multivariate linear regression analysis; for the assessment of evolution, the Kaplan-Meyer survival analysis was considered. Results: Study 1: A total of 406 patients were evaluated in a follow up periedo on 1, 3 and 6 months. The ADHD group reported youngest age, cannabis as the most commonly used drug, earlier age for the beginning of problematic substance use, more prevalence of personality disorders of both cluster A and cluster B, as well as more presence of conduct disorder in childhood. The ADHD group presented less abstinence time and less months of retention or follow-up time in outpatient treatment. ADHD was associated with greater impulsivity at all scales, mainly those related to dysfunctional impulsivity. In study 2, a total of 1538 patients were evaluated, of which 239 fullfielld criteria for ADHD diagnosis; the mean age was 32.9 ± 10 years, mainly men. The combined presentation of ADHD was the most frequent (64.2%). Anxiety disorder throughout life, work skills, consumption of polysubstances and the evolution of substance use throughout life were variables with statistic significance in the multivariate analysis when were compared the groups of patients (cannabis, cannabis / cocaine and cocaine SUD). The most affected groups were those with cannabis use as a common factor. It is concluded that patients with ADHD and SUD, have more seriousness in terms of consumption, more prevalence of psychiatric comorbidity, less abstinence time and less retention in an outpatient treatment; the drug of consumption identified as more prevalent in this group is cannabis. The significant variables in both studies were: Earlier age at start of drug consumption or dependence, worst punctuation on the drug scale in the EuropASI, earlier relapse in consumption and in drop out for ambulatory drug treatment, more prevalence of psychiatric comorbidity; all of these variables inferred high risk for present more severity and worse prognosis in patients with SUD and ADHD. The diagnosis and comprehensive therapeutic approach of SUD and ADHD patients as well as other psychiatric comorbidities is important