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- Bihlar Muld, Berit, et al.
(author)
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Attention deficit/hyperactivity disorders with co-existing substance use disorder is characterized by early antisocial behaviour and poor cognitive skills
- 2013
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In: BMC Psychiatry. - 1471-244X. ; 13, s. 336-
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Journal article (peer-reviewed)abstract
- BACKGROUND: Attention Deficit/Hyperactivity Disorder (ADHD) is associated with an increased risk of co-existing substance abuse. The Swedish legislation on compulsory healthcare can be applied to persons with severe substance abuse who can be treated involuntarily during a period of six months. This context enables a reliable clinical assessment of ADHD in individuals with severe substance use disorder (SUD).METHODS: In the context of compulsory care for individuals with severe SUD, male patients were assessed for ADHD, co-morbid psychiatric symptoms, psychosocial background, treatment history, and cognition. The data from the ADHD/SUD group (n = 60) was compared with data from (1) a group of individuals with severe substance abuse without known ADHD (SUD group, n = 120), as well as (2) a group with ADHD from an outpatient psychiatric clinic (ADHD/Psych group, n = 107).RESULTS: Compared to the general SUD group in compulsory care, the ADHD/SUD group had already been significantly more often in compulsory care during childhood or adolescence, as well as imprisoned more often as adults. The most common preferred abused substance in the ADHD/SUD group was stimulant drugs, while alcohol and benzodiazepine abuse was more usual in the general SUD group. Compared to the ADHD/Psych group, the ADHD/SUD group reported more ADHD symptoms during childhood and performed poorer on all tests of general intellectual ability and executive functions.CONCLUSIONS: The clinical characteristics of the ADHD/SUD group differed from those of both the SUD group and the ADHD/Psych group in several respects, indicating that ADHD in combination with SUD is a particularly disabling condition. The combination of severe substance abuse, poor general cognitive ability, severe psychosocial problems, including indications of antisocial behaviour, and other co-existing psychiatric conditions should be considered in treatment planning for adults with ADHD and SUD.
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| 2. |
- Bihlar Muld, Berit, et al.
(author)
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Long-term outcomes of pharmacologically treated versus non-treated adults with ADHD and substance use disorder : a naturalistic study
- 2015
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In: Journal of Substance Abuse Treatment. - : Elsevier. - 0740-5472 .- 1873-6483. ; 51, s. 82-90
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIMS: The pharmacological treatment of individuals with attention deficit hyperactivity disorder (ADHD) and severe substance use disorder (SUD) is controversial, and few studies have examined the long-term psychosocial outcome of these treatments. Our aim was to investigate whether pharmacological treatment was associated with improved long-term psychosocial outcomes.METHODS: The present naturalistic study consisted of a long-term follow-up of 60 male patients with ADHD and comorbid severe SUD; all participants had received compulsory inpatient treatment due to severe substance abuse. The average interval between inpatient discharge and follow-up was 18.4months. Thirty patients had received pharmacological treatment for ADHD, and 30 patients were pharmacologically untreated. The groups were compared with respect to mortality and psychosocial outcomes operationalized as substance abuse status, ongoing voluntary rehabilitation, current housing situation and employment status.RESULTS: The groups were comparable with regard to the demographic and background characteristics. Overall, mortality was high; 8.3% of the participants had deceased at follow-up (one in the pharmacologically treated group and four in the untreated group; the between-group difference was not significant). The group that received pharmacological treatment for ADHD exhibited fewer substance abuse relapses, received more frequently voluntary treatments in accordance with a rehabilitation plan, required less frequent compulsory care, were more frequently accommodated in supportive housing or a rehabilitation center, and displayed a higher employment rate than the non-treated group.CONCLUSIONS: The recommendations for the close clinical monitoring of high-risk populations and the prevention of misuse and drug diversion were fulfilled in the structured environment of compulsory care for the treated group. Pharmacological treatment of ADHD in individuals with severe SUD may decrease the risk of relapse and increase these patients' ability to follow a non-pharmacological rehabilitation plan, thereby improving their long-term outcomes.
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| 3. |
- Bihlar Muld, Berit
(author)
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Men with ADHD in compulsory care for substance abuse : characterization and treatment
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Substance use disorder (SUD) is one of the most common comorbid conditions in adults with attention deficit-hyperactivity disorder (ADHD). There are still few studies that address combined ADHD and SUD as compared to studies on ADHD without SUD. The aims of the present thesis were (1); to conduct a clinical characterization of men with ADHD in compulsory care for severe SUD; (2) to investigate whether pharmacological treatment in ADHD/SUD cases was associated with improved long-term psychosocial outcomes; (3) to explore the feasibility of DBT (dialectic behavior therapy)-based skills training in ADHD/SUD patients in compulsory care; and (4) to explore the association between the skills training and the psychosocial outcome after six months. All studies were conducted at a compulsory care institution for men. In the clinical characterization (Study I), 60 men with ADHD and SUD were compared with (1) 120 men in compulsory care for severe substance abuse without a known ADHD regarding comorbid psychiatric symptoms, psychosocial background, treatment history, and cognition, and with (2) 107 men with ADHD but without severe SUD from an outpatient psychiatric clinic. In Study II, a comparison was made between 30 patients who had received pharmacological treatment for ADHD and 30 non-treated patients. The long-term outcome was measured as the current status regarding abuse, voluntary rehabilitation, accommodation and employment, as well as mortality. In Study III, the feasibility and acceptability of DBT- based skills training were explored; 40 patients were included. The patients were follow-up six months after discharge from compulsory care, (Study IV). The outcome measures were substance abuse status, voluntary treatment status, and accommodation and employment status. The characteristics of the ADHD/SUD found in Study I were an early onset of antisocial behavior that persisted into adulthood and poor cognitive skills. Study II showed that the overall mortality was high (8.3%) and that the pharmacologically treated group had significantly better outcomes in all measured psychosocial parameters. In Study III, it was found that the DBT-based skills training for ADHD was feasible and acceptable in a context of compulsory care for SUD. Significant symptom reduction, as well as an increased general well-being, was also found. The completers of the DBT-based skills training had fewer relapses and were more often in voluntary treatments, compared to non-completers in the six-month follow-up study (Study IV). However, no causal conclusion regarding the relationship between the DBT-based skills training and the psychosocial outcome can be drawn due to the base-line differences between completers and non-completers, as well as the lack of a control group. To sum up, ADHD in combination with SUD is a particularly disabling condition. The combination of severe substance abuse, poor general cognitive ability, severe psycho-social problems, including indications of antisocial behavior, and other co-existing psychiatric conditions should be considered in treatment planning for adults with ADHD and SUD. Pharmacological treatment of ADHD in individuals with ADHD and severe SUD may decrease the risk of relapse and increase the patients’ ability to follow a nonpharmacological rehabilitation plan and thereby improve their long-term outcomes. Use of the structured treatment setting in the compulsory care for SUD for the initiation and stabilization of the pharmacological treatment for ADHD may be beneficial for high-risk populations. Furthermore, adapted structured treatments, such as DBT-based skills training, may be feasible in compulsory care and useful for some patients in this group. Discontinuation of voluntary treatment programs during the compulsory care may indicate low motivation or ability to participate in voluntary treatment and therefore predict a negative outcome after discharge.
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