Pharmacotherapy for Attention-Deficit/Hyperactivity Disorder and Retention in Outpatient Substance Use Disorder Treatment: A Retrospective Cohort Study

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Overview

How does comorbid attention-deficit/hyperactivity disorder (ADHD) affect individuals with substance use disorder (SUD)? Is treatment for ADHD associated with retention in outpatient SUD therapy?

Abstract

Objective: To assess the relationship between short- and longer-term retention in outpatient substance use disorder (SUD) treatment and pharmacotherapy for comorbid attention-deficit/hyperactivity disorder (ADHD).

Methods: In this retrospective cohort study conducted in a single addiction psychiatry clinic, electronic health record data from July 14, 2014, through January 15, 2020, were queried for clinical ADHD diagnosis (DSM-5 criteria), ADHD pharmacotherapy, treatment duration, demographic variables, comorbid psychiatric and SUD diagnoses, and buprenorphine therapy. Individuals with ADHD (n = 203) were grouped by ADHD pharmacotherapy status (171 receiving medication compared to 32 receiving none). Kaplan-Meier and Cox proportional hazards regression analyses were performed and assessed for significance.

Results: ADHD was clinically diagnosed in 9.4% of outpatients and was associated with younger age, comorbid cocaine use, and private insurance (P < .001). Individuals receiving no ADHD pharmacotherapy were younger than those receiving medication (P = .003). Compared to no ADHD medication, ADHD pharmacotherapy was associated with greater long-term retention, with apparent group half-lives of 9 months and 36 months, respectively (P < .001). Individuals receiving no ADHD medication had a 4.9-fold increased likelihood of attrition within 90 days (P = .041). Regression analysis showed only ADHD pharmacotherapy to be significantly associated with treatment retention (hazard ratio = 0.59; 95% CI, 0.40–0.86; P = .008).

Conclusions: ADHD pharmacotherapy is robustly associated with improved short- and longer-term retention in outpatient SUD treatment. The retrospective, nonrandomized naturalistic study design limits causal inference. Further studies addressing unmeasured covariates and associated risks of treatment in adults with ADHD and SUD are necessary.

To cite: Kast KA, Rao V, Wilens TE. Pharmacotherapy for attention-deficit/hyperactivity disorder and retention in outpatient substance use disorder treatment: a retrospective cohort study. J Clin Psychiatry. 2021;82(2):20m13598.

To share: https://doi.org/10.4088/JCP.20m13598


Read the whole article at psychiatrist.com here: 
Pharmacotherapy for Attention-Deficit/Hyperactivity Disorder and Retention in Outpatient Substance Use Disorder Treatment: A Retrospective Cohort Study 

© Copyright 2021 Physicians Postgraduate Press, Inc.

Target Audience

Psychiatrists

Learning Objectives

  • Refer to available evidence when weighing risks and benefits of providing medication treatment for attention-deficit/hyperactivity disorder during outpatient treatment for substance use disorder
Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
03/03/2021
Activity expires: 
04/30/2023
Cost:
$10.00
Rating: 
0

CME Background

Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.

CME Objective

After studying this article, you should be able to:

  • Refer to available evidence when weighing risks and benefits of providing medication treatment for attention-deficit/hyperactivity disorder during outpatient treatment for substance use disorder

Statement of Need and Purpose

The presence of co-occurring ADHD can have a deleterious effect on SUD treatment effectiveness and retention. Medication treatment of ADHD in patients with co-occurring SUD, despite possibly attenuated efficacy, can lead to better outcomes of SUD treatment, including improved SUD treatment retention. Because past studies have focused on short-term outcomes, clinicians need additional information on the effects of ADHD medication treatment on SUD treatment retention over the long term.

Release, Expiration, and Review Dates

This educational activity was published in March 2021 and is eligible for AMA PRA Category 1 Credit™ through April 30, 2021. The latest review of this material was February 2021.

Disclosure of Off-Label Usage

The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents or device therapies that is outside US Food and Drug Administration–approved labeling has been presented in this article.

Funding/Support

None.

Supplementary Material

Available at Psychiatrist.com.

Faculty Affiliation


Kristopher A. Kast, MD*
Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee



Vinod Rao, MD, PhD
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts



Timothy E. Wilens, MD
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts

 

*Corresponding author: Kristopher A. Kast, MD, 1601 23rd Ave South, Nashville TN, 37212 (kristopher.a.kast@vumc.org).

Financial Disclosure

All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief of The Journal of Clinical Psychiatry, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; has been a member of the Steering Committee for Educational Activities for Medscape; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships.

Dr Wilens receives or has received grant support from the National Institutes of Health (National Institute on Drug Abuse); is or has been a consultant for Arbor, Otsuka, Ironshore, KemPharm and Vallon; has published the book Straight Talk About Psychiatric Medications for Kids (Guilford Press) and coedited the books ADHD in Adults and Children (Cambridge University Press), Massachusetts General Hospital Comprehensive Clinical Psychiatry (Elsevier), and Massachusetts General Hospital Psychopharmacology and Neurotherapeutics (Elsevier); is co-owner of a copyrighted diagnostic questionnaire (Before School Functioning Questionnaire); has a licensing agreement with Ironshore (BSFQ Questionnaire); is Chief, Division of Child and Adolescent Psychiatry and (Co-) Director of the Center for Addiction Medicine at Massachusetts General Hospital; and serves as a clinical consultant to the US National Football League (ERM Associates), US Minor/Major League Baseball, Gavin Foundation, and Bay Cove Human Services. Drs Kast and Rao have no personal affiliations or financial relationships with any commercial interest to disclose relative to the article.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Price

Cost:
$10.00
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