The purpose of this double-blind 14-week trial was to compare the efficacy of sustained-release methylphenidate (MPH) to placebo (PBO) in treating adult attention deficit hyperactivity disorder (ADHD) symptoms in current cocaine dependent (CD) treatment seekers. The randomized sample consisted of 106 participants who were predominately male (83%) and 60% Caucasian, 14% Hispanic, 20% African-American and 6% other. All participants met DSM-IV criteria for ADHD and CD. There were no significant demographic differences between the two treatment groups. All participants received weekly individual cognitive behavioral therapy. There was no difference in retention rate based on treatment group (p=.91). The majority of the PBO group and the MPH group reported >30% improvement in their ADHD symptoms (55% versus 47%), with no significant difference between the two groups (p=.44). Using a combined outcome measure (>30% reduction in ADHD symptoms and CGI <3), the response rates were similar for both groups (28% PBO versus 30% MPH; p=.83). Longitudinal analyses of the urine toxicology data using generalized estimating equations, revealed a decrease in the probability of cocaine positive urine samples during the trial for the MPH group compared to the PBO group (p=.001). Further analysis suggested that for the MPH group, ADHD treatment responders, based on a semi structured clinical interview, were more likely to have a reduction in cocaine use compared to the non-ADHD responders. Although sustained-release MPH did not show superiority over PBO in treating ADHD symptoms, this trial provides some evidence that improvement in ADHD symptoms (clinician rated) among those patients receiving MPH, but not placebo, was associated with a reduction in cocaine use.
"Some case reports and open trials suggest that stimulants may reduce both ADHD symptoms and alcohol/drug use in adult outpatients. A recent longitudinal, double-blind, placebo-controlled study revealed that cocaine users seeking treatment who take MPH have a decreased probability to have cocaine positive urine samples when compared to those who take placebo . MPH is generally well tolerated; most of its adverse effects are mild and/or temporary . "
[Show abstract][Hide abstract] ABSTRACT: Objective:
The objective was to report a case of experienced psychosis during the treatment with methylphenidate (MPH) in a cocaine-dependent adult treated for attention-deficit/hyperactivity disorder (ADHD) with comorbid cocaine dependence.
ADHD is a frequent comorbidity in substance use disorder (SUD) patients. MPH may be effective in treating ADHD symptoms in SUD patients, thus preventing possible adverse outcomes. Cocaine-induced psychosis may be a risk factor for development of psychosis in the presence of a concurrent treatment with MPH.
General hospital psychiatry 07/2013; 35(4):451.e7-451.e9. DOI:10.1016/j.genhosppsych.2012.05.010 · 2.61 Impact Factor
"For example, although a small study showed no reduction in cocaine use with IR-methylphenidate (Schubiner et al., 2002), an open label study in cocaine-dependent adults with ADHD showed that those treated with IR-methylphenidate (20 mg three times a day) had decreased cocaine use and improved ADHD symptoms (Somoza et al., 2004). Similarly, Levin et al. (2007) showed in a double-blind placebo controlled clinical trial in cocaine-dependent individuals with ADHD that SRmethylphenidate improved ADHD symptoms compared to placebo and reduced cocaine use (Levin et al., 2007). Maintenance therapy with SR-methylphenidate (40 and 60 mg) in cocaine-dependent individuals with ADHD reduced the subjective " high " and " good drug effect " of cocaine (16 and 48 mg/kg, IV) and decreased choice for cocaine over a monetary alternative (Collins et al., 2006). "
[Show abstract][Hide abstract] ABSTRACT: Much effort has been devoted to research focused on pharmacotherapies for cocaine dependence yet there are no FDA-approved medications for this brain disease. Preclinical models have been essential to defining the central and peripheral effects produced by cocaine. Recent evidence suggests that cocaine exerts its reinforcing effects by acting on multiple neurotransmitter systems within mesocorticolimibic circuitry. Imaging studies in cocaine-dependent individuals have identified deficiencies in dopaminergic signaling primarily localized to corticolimbic areas. In addition to dysregulated striatal dopamine, norepinephrine and glutamate are also altered in cocaine dependence. In this review, we present these brain abnormalities as therapeutic targets for the treatment of cocaine dependence. We then survey promising medications that exert their therapeutic effects by presumably ameliorating these brain deficiencies. Correcting neurochemical deficits in cocaine-dependent individuals improves memory and impulse control, and reduces drug craving that may decrease cocaine use. We hypothesize that using medications aimed at reversing known neurochemical imbalances is likely to be more productive than current approaches. This view is also consistent with treatment paradigms used in neuropsychiatry and general medicine.
"Other studies have reported positive results with stimulant replacement in cocaine dependence. In a double-blind controlled trial of methylphenidate in treatment-seeking cocaine-dependent subjects with comorbid ADHD, no significant treatment effect was observed in the overall sample, but subjects whose ADHD symptoms improved with methylphenidate reduced cocaine use significantly relative to placebo-treated subjects (Levin et al., 2007). More recently, Mooney et al., (2009) reported significantly greater reduction of cocaine use in subjects treated with methamphetamine as compared to placebo (n=82). "
[Show abstract][Hide abstract] ABSTRACT: Attenuation of drug reward has been the major focus of medication development in the addiction area to date. With the growth of research in the area of cognitive neuroscience, the importance of executive function and inhibitory cognitive control in addictive disorders is becoming increasingly apparent. An emerging strategy in the pharmacotherapy of addictions and other psychiatric disorders involves the use of medications that improve cognitive function. In particular, agents that facilitate inhibitory and attentional control, improve abstraction, planning and mental flexibility could be beneficial in the treatment of substance use disorders. Because there are multiple neurotransmitter systems involved in the regulation of cognitive function, agents from a number of drug classes have been tested. In particular, agents acting through the cholinergic, adrenergic and glutamatergic systems have shown potential for improving cognitive function in a number of psychiatric and neurologic disorders, but most of these agents have not been tested in the treatment of individuals with substance use disorders. This manuscript provides a review of clinical data supporting the use of the major classes of cognitive enhancing agents in substance use disorders. Agents that have shown promise in cognitive enhancement in other disorders, and have a theoretical or mechanistic rationale for application to substance use disorders are also highlighted.
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