Treatments and Treatment Predictors in Patients With Substance Use Disorders and Comorbid Attention-Deficit/Hyperactivity Disorder
2 SLSO - Stockholm Health Care Services
3 Donders Institute for Brain, Cognition and Behaviour
4 Semmelweis University [Budapest]
5 De Hoop ggz - De Hoop [Dordrecht, The Netherlands]
6 De Hoop ggz, Outpatient Treatment Centre Amersfoort, Amersfoort
7 VUB - Vrije Universiteit Brussel [Bruxelles]
8 UZ Brussel - Universitair Ziekenhuis Brussel = University Hospital of Brussels
9 VHRI - Vall d'Hebron Research Institute - Institut de Recerca Vall d’Hebron
10 Vall d'Hebron University Hospital [Barcelona]
11 ELTE - Eötvös Loránd Tudományegyetem = Eötvös Loránd University [Budapest]
12 University of Gibraltar
13 Flinders University [Adelaide, Australia]
14 The Collaborative Antwerp Psychiatric Research Institute (CAPRI)
15 Universiteit Antwerpen = University of Antwerp
16 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
17 New York State Psychiatric Institute
18 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
19 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
20 FHU NOR-SUD - Network of Research in Substance Use Disorders, Paris
21 SUNY Upstate Medical University
22 Nyíro Gyula National Institute of Psychiatry, and Addictology, Budapest
23 CUIMC - Columbia University Irving Medical Center
24 Department of Psychiatry, Psychosomatic Medicine and Psychotherapy [Goethe Universität]
25 UNIBE - Universität Bern = University of Bern = Université de Berne
26 Hôpital Lariboisière-Fernand-Widal [APHP]
27 CliPsyD - Clinique, Psychanalyse, Développement
28 NYU Grossman School of Medicine - New York University School of Medicine
29 Amsterdam UMC - Amsterdam University Medical Centers
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Résumé
Background: Treatment of attention-deficit/ hyperactivity disorder (ADHD) in patients with a substance use disorder (SUD) and comorbid ADHD (SUD +ADHD) may have positive effects on the outcome of both conditions, but controversy exists regarding the preferred ADHD treatment in these patients. Little is known about the treatments that are provided for these patients in routine addiction care practice and the factors that are associated with treatment provision. Objective: To describe the treatments provided in everyday clinical practice and to explore factors associated with ADHD treatment provision in patients with SUD +ADHD. Methods: An international multicenter observational prospective cohort design was employed. Patients with moderate to severe SUD and comorbid ADHD according to DSM-5 were invited to participate at the start of a new SUD treatment episode between June 2017 and May 2021. Clinical and sociodemographic data were collected at 12 study sites in 9 countries through patient interviews, interviews with treatment providers, and patient files. Treatment variation across studies was described, and mixed-effect logistic regression was used to identify factors associated with ADHD treatment provision. Results: A total of 578 treatment-seeking patients with SUD +ADHD (274 inpatients, 303 outpatients, and 1 unknown) were recruited. About two thirds received some kind of ADHD treatment (62.8%), with 54.0% receiving pharmacologic, 34.0% receiving psychological treatment, and 25.1% receiving combined pharmacologic and psychological treatment. The treatment site explained more of the variation in ADHD treatment provision than individual patient factors. In addition, higher ADHD symptom severity and sobriety at intake were associated with receiving ADHD treatment. Conclusion: These findings suggest that treatment of SUD +ADHD patients is suboptimal even in specialized centers with substantial practice variation. Further research is needed to better understand the barriers to implement treatment guidelines for ADHD + SUD and, thus, to improve quality of care.