Attention deficit hyperactivity disorder and substance misuse: an evaluation of causal hypotheses and treatment considerations

Young, Susan; Sedgwick, Ottilie

doi:10.1586/14737175.2015.1059756

Cited by 18 publications

(17 citation statements)

References 79 publications

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“…Although sensitivity to the magnitude of deck outcomes is important for IGT performance, increased sensitivity may lead to a tendency to chase large wins on the disadvantageous decks. Heightened feedback sensitivity on the IGT has been associated with impulsivity related behaviors and disorders 22 , 76 , 77 , which are more prevalent in ADHD 78 , 79 , 80 , and the current findings provide further support for a relationship between feedback sensitivity and impulsivity related disorders.…”

Section: Discussionsupporting

confidence: 68%

Frontostriatal Dysfunction During Decision Making in Attention-Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder

Norman

Carlisi

Christakou

et al. 2018

Biological Psychiatry: Cognitive Neuroscience and Neuroimaging

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BackgroundThe aim of the current paper is to provide the first comparison of computational mechanisms and neurofunctional substrates in adolescents with attention-deficit/hyperactivity disorder (ADHD) and adolescents with obsessive-compulsive disorder (OCD) during decision making under ambiguity.MethodsSixteen boys with ADHD, 20 boys with OCD, and 20 matched control subjects (12–18 years of age) completed a functional magnetic resonance imaging version of the Iowa Gambling Task. Brain activation was compared between groups using three-way analysis of covariance. Hierarchical Bayesian analysis was used to compare computational modeling parameters between groups.ResultsPatient groups shared reduced choice consistency and relied less on reinforcement learning during decision making relative to control subjects, while adolescents with ADHD alone demonstrated increased reward sensitivity. During advantageous choices, both disorders shared underactivation in ventral striatum, while OCD patients showed disorder-specific underactivation in the ventromedial orbitofrontal cortex. During outcome evaluation, shared underactivation to losses in patients relative to control subjects was found in the medial prefrontal cortex and shared underactivation to wins was found in the left putamen/caudate. ADHD boys showed disorder-specific dysfunction in the right putamen/caudate, which was activated more to losses in patients with ADHD but more to wins in control subjects.ConclusionsThe findings suggest shared deficits in using learned reward expectancies to guide decision making, as well as shared dysfunction in medio-fronto-striato-limbic brain regions. However, findings of unique dysfunction in the ventromedial orbitofrontal cortex in OCD and in the right putamen in ADHD indicate additional, disorder-specific abnormalities and extend similar findings from inhibitory control tasks in the disorders to the domain of decision making under ambiguity.

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Section: Discussionsupporting

confidence: 68%

Frontostriatal Dysfunction During Decision Making in Attention-Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder

Norman

Carlisi

Christakou

et al. 2018

Biological Psychiatry: Cognitive Neuroscience and Neuroimaging

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“…As stimulants are considered effective first-line pharmacotherapy for ADHD, illicit stimulant use among those with ADHD is often speculated to be a form of “self-medication” of undiagnosed or untreated ADHD (Wilens et al, 2007; S. Young & Sedgwick, 2015). Other studies, however, have not found a preference for stimulants among those with ADHD (van Emmerik-van Oortmerssen et al, 2012), possibly reflecting the high levels of polydrug use that are typical among illicit drug users (Darke & Hall, 1995; van Emmerik-van Oortmerssen et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…T. Young et al, 2015). As stimulants are considered effective first-line pharmacotherapy for ADHD, illicit stimulant use among those with ADHD is often speculated to be a form of “self-medication” of undiagnosed or untreated ADHD (Wilens et al, 2007; S. Young & Sedgwick, 2015).…”

Section: Discussionmentioning

confidence: 99%

Persistence and Subtype Stability of ADHD Among Substance Use Disorder Treatment Seekers

et al. 2016

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Objective To examine ADHD symptom persistence and subtype stability among substance use disorder (SUD) treatment seekers. Method In all, 1,276 adult SUD treatment seekers were assessed for childhood and adult ADHD using Conners’ Adult ADHD Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; CAADID). A total of 290 (22.7%) participants met CAADID criteria for childhood ADHD and comprise the current study sample. Results Childhood ADHD persisted into adulthood in 72.8% (n = 211) of cases. ADHD persistence was significantly associated with a family history of ADHD, and the presence of conduct disorder and antisocial personality disorder. The combined subtype was the most stable into adulthood (78.6%) and this stability was significantly associated with conduct disorder and past treatment of ADHD. Conclusion ADHD is highly prevalent and persistent among SUD treatment seekers and is associated with the more severe phenotype that is also less likely to remit. Routine screening and follow-up assessment for ADHD is indicated to enhance treatment management and outcomes.

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“…Furthermore, the continued use of alcohol and drugs may be regarded as an expression of the palliative, avoidant, and passive coping styles for coping with stress, which is found to be frequent in patients with ADHD (Kronenberg, Goossens, van Busschbach, van Achterberg, & van den Brink, 2015). Substance abuse for reduction of stress related to ADHD symptoms and to comorbid conditions is related to the self-medication hypothesis (Young & Sedgwick, 2015). A yearning for belongingness has also been identified as an important driving force underlying substance abuse in individuals with ADHD (Nehlin, Nyberg, & Öster, 2015).…”

Section: Associations Between Adhd and Sudmentioning

confidence: 99%

Skills training groups for men with ADHD in compulsory care due to substance use disorder: a feasibility study

Muld¹,

Jokinen

Bölte

et al. 2016

ADHD Atten Def Hyp Disord

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Dialectical behavior therapy (DBT)-based skills training has been developed and previously evaluated for adults with ADHD in a psychiatric outpatient context. The aim of the present study was to evaluate the feasibility of DBT-based skills training as a voluntary intervention for men with ADHD in compulsory care due to severe substance abuse. Forty sufficiently detoxified men with ADHD in compulsory care due to life-threatening substance use disorder (SUD) were included in DBT-based skills training groups. Self- and staff-rating scales were administered before and after the treatment. The refusal rate was 42.9 %. Of those who started the DBT-based skills training, 70 % completed the treatment (attendance at ≥75 % of the sessions). The treatment acceptability was good. Both ADHD and psychiatric symptoms decreased from pre- to post-intervention in self-ratings, but not in staff ratings. The patients reported improved general well-being. The correlation between self- and staff ratings was poor. Motivation for voluntary nonpharmacological treatment was low in a compulsory care context. However, the results indicate that a DBT-based skills training program for adults with ADHD may be feasible for some patients with ADHD in combination with SUD in compulsory care, provided that considerable resources are allocated with adjustments to the target group and compulsory care context.

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Attention deficit hyperactivity disorder and substance misuse: an evaluation of causal hypotheses and treatment considerations

Cited by 18 publications

References 79 publications

Frontostriatal Dysfunction During Decision Making in Attention-Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder

Frontostriatal Dysfunction During Decision Making in Attention-Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder

Persistence and Subtype Stability of ADHD Among Substance Use Disorder Treatment Seekers

Skills training groups for men with ADHD in compulsory care due to substance use disorder: a feasibility study

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