CBT Helpful in Comorbid ADHD/Substance Use

Major finding: Significant improvement in ADHD symptoms and a sharp reduction in substance use were observed, regardless of whether adolescents received OROS-MPH (Concerta) or placebo.

Source of data: In a randomized controlled trial, 303 adolescents with ADHD and at least one substance use disorder, received either the active (titrated) drug or placebo along with weekly, individual CBT using a standardized manual targeting drug abuse. An intent to treat analysis was conducted to determine the results.

Disclosures: The 11-center trial was sponsored by the National Institute of Drug Abuse. The lead investigator reported no conflicts of interest.

LOS ANGELES — Psychostimulant treatment failed to outperform placebo in treating adolescents with comorbid attention-deficit/hyperactivity disorder and substance use disorders when structured cognitive-behavioral therapy was integrated into a randomized, placebo-controlled trial.

However, highly significant improvement in ADHD symptoms and a sharp reduction in substance use were observed, regardless of whether adolescents received OROS-MPH (Concerta) or placebo in the 16-week trial, reported Dr. Paula Riggs at the annual meeting of the American Academy of Addiction Psychiatry.

Rather than being seen as a negative trial, the study appears to speak to the usefulness of structured, individualized weekly CBT, said Dr. Riggs, primary investigator of the 11-center trial sponsored by the National Institute of Drug Abuse and professor of psychiatry at the University of Colorado, Denver.

The trial enrolled 303 adolescents aged 13–18 who met DSM-IV criteria for ADHD and for at least one substance use disorder (other than nicotine dependence, and excluding current opiate dependence or methamphetamine abuse or dependence).

The average age of participants was 16.5 years. About 80% were male and 20% female. Whites constituted 64% of the medication arm and 55% of the placebo arm. Roughly a fourth of the subjects in each group were African American; 15% were Hispanic.

About one-third of subjects had ADHD-inattentive type; 67% had ADHD-combined type; and less than 2%, ADHD-hyperactive type.

Cannabis and alcohol use/dependence were the most commonly represented substance use disorders, although use and/or abuse of hallucinogens, opioids, cocaine, and amphetamines also were reported.

Adolescents with major depression, anxiety disorders, and/or conduct disorder were included in the trial, resulting in a high baseline level of psychopathology among participants.

Despite this severity, almost 75% of adolescents completed the trial.

In the medication arm, 80% of 151 patients were compliant with doses, which were successfully titrated to 72 mg/daily in 96% and sustained at that dose in 86%.

Participants received either the active (titrated) drug or placebo along with weekly, individual CBT using a standardized manual targeting drug abuse.

In an intent-to-treat analysis, symptoms of ADHD declined 46% in the medication group and 45% in the placebo group.

Parents reported symptom reductions of 26% and 30% in adolescents receiving active medication or placebo on a DSM-IV symptom checklist at 8 weeks, and 24% and 30.9% reductions at 16 weeks.

Past 28-day substance use reports declined by 6.1 days (43%) in the medication arm and 4.9 days (33%) in the placebo arm—a statistically insignificant between-group difference.

Slightly more negative drug screens—3.8 compared with 2.8—were found in adolescents assigned to receive active medication, and this group also showed greater improvements in problem-solving skills and focused-coping skills that had been addressed in CBT, Dr. Riggs reported.

Subjects deemed by investigators to be “medication responders” had twice as many negative drug screens as nonresponders or those receiving placebo.

Titrated OROS-MPH was “stunningly safe and well-tolerated” in the trial, with 11 serious adverse events, 7 of which occurred in the placebo group. The only event seen more frequently in the medication arm was limb injury, an event not considered to be related to the medication.

The results were inconsistent with trials pitting psychostimulants against placebo in non–substance-abusing youth. However, they were consistent with three controlled psychostimulant trials in the non–substance-abusing adolescents when concurrent CBT was included for subjects in both the medication and placebo arms.

As in this trial, significant reductions were seen in ADHD in both groups, but with no significant advantage to medication over placebo.

Trials of psychostimulants show that 20%-50% of adolescents continue to have functionally impairing symptoms despite medication.

Dr. Riggs reported no relevant financial conflicts of interest.

Major finding: Significant improvement in ADHD symptoms and a sharp reduction in substance use were observed, regardless of whether adolescents received OROS-MPH (Concerta) or placebo.

Source of data: In a randomized controlled trial, 303 adolescents with ADHD and at least one substance use disorder, received either the active (titrated) drug or placebo along with weekly, individual CBT using a standardized manual targeting drug abuse. An intent to treat analysis was conducted to determine the results.

Disclosures: The 11-center trial was sponsored by the National Institute of Drug Abuse. The lead investigator reported no conflicts of interest.

LOS ANGELES — Psychostimulant treatment failed to outperform placebo in treating adolescents with comorbid attention-deficit/hyperactivity disorder and substance use disorders when structured cognitive-behavioral therapy was integrated into a randomized, placebo-controlled trial.

However, highly significant improvement in ADHD symptoms and a sharp reduction in substance use were observed, regardless of whether adolescents received OROS-MPH (Concerta) or placebo in the 16-week trial, reported Dr. Paula Riggs at the annual meeting of the American Academy of Addiction Psychiatry.

Rather than being seen as a negative trial, the study appears to speak to the usefulness of structured, individualized weekly CBT, said Dr. Riggs, primary investigator of the 11-center trial sponsored by the National Institute of Drug Abuse and professor of psychiatry at the University of Colorado, Denver.

The trial enrolled 303 adolescents aged 13–18 who met DSM-IV criteria for ADHD and for at least one substance use disorder (other than nicotine dependence, and excluding current opiate dependence or methamphetamine abuse or dependence).

The average age of participants was 16.5 years. About 80% were male and 20% female. Whites constituted 64% of the medication arm and 55% of the placebo arm. Roughly a fourth of the subjects in each group were African American; 15% were Hispanic.

About one-third of subjects had ADHD-inattentive type; 67% had ADHD-combined type; and less than 2%, ADHD-hyperactive type.

Cannabis and alcohol use/dependence were the most commonly represented substance use disorders, although use and/or abuse of hallucinogens, opioids, cocaine, and amphetamines also were reported.

Adolescents with major depression, anxiety disorders, and/or conduct disorder were included in the trial, resulting in a high baseline level of psychopathology among participants.

Despite this severity, almost 75% of adolescents completed the trial.

In the medication arm, 80% of 151 patients were compliant with doses, which were successfully titrated to 72 mg/daily in 96% and sustained at that dose in 86%.

Participants received either the active (titrated) drug or placebo along with weekly, individual CBT using a standardized manual targeting drug abuse.

In an intent-to-treat analysis, symptoms of ADHD declined 46% in the medication group and 45% in the placebo group.

Parents reported symptom reductions of 26% and 30% in adolescents receiving active medication or placebo on a DSM-IV symptom checklist at 8 weeks, and 24% and 30.9% reductions at 16 weeks.

Past 28-day substance use reports declined by 6.1 days (43%) in the medication arm and 4.9 days (33%) in the placebo arm—a statistically insignificant between-group difference.

Slightly more negative drug screens—3.8 compared with 2.8—were found in adolescents assigned to receive active medication, and this group also showed greater improvements in problem-solving skills and focused-coping skills that had been addressed in CBT, Dr. Riggs reported.

Subjects deemed by investigators to be “medication responders” had twice as many negative drug screens as nonresponders or those receiving placebo.

Titrated OROS-MPH was “stunningly safe and well-tolerated” in the trial, with 11 serious adverse events, 7 of which occurred in the placebo group. The only event seen more frequently in the medication arm was limb injury, an event not considered to be related to the medication.

The results were inconsistent with trials pitting psychostimulants against placebo in non–substance-abusing youth. However, they were consistent with three controlled psychostimulant trials in the non–substance-abusing adolescents when concurrent CBT was included for subjects in both the medication and placebo arms.

As in this trial, significant reductions were seen in ADHD in both groups, but with no significant advantage to medication over placebo.

Trials of psychostimulants show that 20%-50% of adolescents continue to have functionally impairing symptoms despite medication.

Dr. Riggs reported no relevant financial conflicts of interest.

Major finding: Significant improvement in ADHD symptoms and a sharp reduction in substance use were observed, regardless of whether adolescents received OROS-MPH (Concerta) or placebo.

Source of data: In a randomized controlled trial, 303 adolescents with ADHD and at least one substance use disorder, received either the active (titrated) drug or placebo along with weekly, individual CBT using a standardized manual targeting drug abuse. An intent to treat analysis was conducted to determine the results.

Disclosures: The 11-center trial was sponsored by the National Institute of Drug Abuse. The lead investigator reported no conflicts of interest.

LOS ANGELES — Psychostimulant treatment failed to outperform placebo in treating adolescents with comorbid attention-deficit/hyperactivity disorder and substance use disorders when structured cognitive-behavioral therapy was integrated into a randomized, placebo-controlled trial.

However, highly significant improvement in ADHD symptoms and a sharp reduction in substance use were observed, regardless of whether adolescents received OROS-MPH (Concerta) or placebo in the 16-week trial, reported Dr. Paula Riggs at the annual meeting of the American Academy of Addiction Psychiatry.

Rather than being seen as a negative trial, the study appears to speak to the usefulness of structured, individualized weekly CBT, said Dr. Riggs, primary investigator of the 11-center trial sponsored by the National Institute of Drug Abuse and professor of psychiatry at the University of Colorado, Denver.

The trial enrolled 303 adolescents aged 13–18 who met DSM-IV criteria for ADHD and for at least one substance use disorder (other than nicotine dependence, and excluding current opiate dependence or methamphetamine abuse or dependence).

The average age of participants was 16.5 years. About 80% were male and 20% female. Whites constituted 64% of the medication arm and 55% of the placebo arm. Roughly a fourth of the subjects in each group were African American; 15% were Hispanic.

About one-third of subjects had ADHD-inattentive type; 67% had ADHD-combined type; and less than 2%, ADHD-hyperactive type.

Cannabis and alcohol use/dependence were the most commonly represented substance use disorders, although use and/or abuse of hallucinogens, opioids, cocaine, and amphetamines also were reported.

Adolescents with major depression, anxiety disorders, and/or conduct disorder were included in the trial, resulting in a high baseline level of psychopathology among participants.

Despite this severity, almost 75% of adolescents completed the trial.

In the medication arm, 80% of 151 patients were compliant with doses, which were successfully titrated to 72 mg/daily in 96% and sustained at that dose in 86%.

Participants received either the active (titrated) drug or placebo along with weekly, individual CBT using a standardized manual targeting drug abuse.

In an intent-to-treat analysis, symptoms of ADHD declined 46% in the medication group and 45% in the placebo group.

Parents reported symptom reductions of 26% and 30% in adolescents receiving active medication or placebo on a DSM-IV symptom checklist at 8 weeks, and 24% and 30.9% reductions at 16 weeks.

Past 28-day substance use reports declined by 6.1 days (43%) in the medication arm and 4.9 days (33%) in the placebo arm—a statistically insignificant between-group difference.

Slightly more negative drug screens—3.8 compared with 2.8—were found in adolescents assigned to receive active medication, and this group also showed greater improvements in problem-solving skills and focused-coping skills that had been addressed in CBT, Dr. Riggs reported.

Subjects deemed by investigators to be “medication responders” had twice as many negative drug screens as nonresponders or those receiving placebo.

Titrated OROS-MPH was “stunningly safe and well-tolerated” in the trial, with 11 serious adverse events, 7 of which occurred in the placebo group. The only event seen more frequently in the medication arm was limb injury, an event not considered to be related to the medication.

The results were inconsistent with trials pitting psychostimulants against placebo in non–substance-abusing youth. However, they were consistent with three controlled psychostimulant trials in the non–substance-abusing adolescents when concurrent CBT was included for subjects in both the medication and placebo arms.

As in this trial, significant reductions were seen in ADHD in both groups, but with no significant advantage to medication over placebo.

Trials of psychostimulants show that 20%-50% of adolescents continue to have functionally impairing symptoms despite medication.

Dr. Riggs reported no relevant financial conflicts of interest.