Study Finds Stimulants, CBT Combination Effective for Treating Patients With ADHD, Cocaine Use Disorder

The Voice of theAmerican Psychiatric Associationand the Psychiatric Community

Extended-release mixed amphetamine salts in robust doses along with cognitive behavioral therapy appears to be effective for treatment of co-occurring attention-deficit/hyperactivity disorder (ADHD) and cocaine use disorder (CUD), improving ADHD symptoms and reducing cocaine use, according to areportpublished online April 18 inJAMA Psychiatry.

Frances Levin, M.D., of the New York State Psychiatric Institute and colleagues randomized 126 patients meetingDSM-IV-TRcriteria for ADHD and CUD to receive 60 mg of extended-release mixed amphetamine salts (n=40), 80 mg of the same (n=43), or placebo (n=43) daily for 13 weeks. All participants received cognitive-behavioral therapy (CBT)/relapse prevention treatment weekly from experienced M.A.- or Ph.D.-level therapists.

The main outcome for ADHD was the percentage of participants achieving at least a 30 percent reduction in ADHD symptom severity, measured by the Adult ADHD Investigator Symptom Rating Scale; for cocaine use, the main outcome was cocaine-negative weeks (by self-report of no cocaine use and weekly benzoylecgonine urine screens) and the percentage of participants achieving abstinence for the last three weeks.

More patients achieved at least a 30 percent reduction in ADHD symptom severity in the medication groups (60 mg: 30 of 40 participants; and 80 mg: 25 of 43 participants) compared with placebo (17 of 43 participants). Rates of continuous abstinence in the last three weeks were greater for the medication groups than the placebo group: 30.2 percent for the 80 mg group and 17.5 percent for the 60 mg group vs 7.0 percent for the placebo group.

“Often, stimulants are withheld from individuals with co-occurring substance use disorders because of concern of diversion and clinical worsening,” Levin and colleagues state. “Instead, this study found the opposite—patients benefited from treatment. Thus, under closely monitored conditions, pharmacotherapy should be promoted, not barred. These data emphasize the importance of screening adults with CUD for ADHD. Future research might test long-acting stimulant formulations for other substance-abusing adult populations with ADHD, such as those with alcohol or cannabis use disorders.”

For related information on the consequences of ADHD in childhood, see thePsychiatric Newsarticle, “ADHD Outcome Data in Adults Show Value of Early Treatment.”