Investigating the efficacy of integrated cognitive behavioral therapy for adult treatment seeking substance use disorder patients with comorbid ADHD: study protocol of a randomized controlled trial

Katelijne van Emmerik-van Oortmerssen, Ellen Vedel, Maarten W Koeter, Kim de Bruijn, Jack J M Dekker, Wim van den Brink, Robert A Schoevers, Katelijne van Emmerik-van Oortmerssen, Ellen Vedel, Maarten W Koeter, Kim de Bruijn, Jack J M Dekker, Wim van den Brink, Robert A Schoevers

Abstract

Background: Attention deficit hyperactivity disorder (ADHD) frequently co-occurs with substance use disorders (SUD). The combination of ADHD and SUD is associated with a negative prognosis of both SUD and ADHD. Pharmacological treatments of comorbid ADHD in adult patients with SUD have not been very successful. Recent studies show positive effects of cognitive behavioral therapy (CBT) in ADHD patients without SUD, but CBT has not been studied in ADHD patients with comorbid SUD.

Methods/design: This paper presents the protocol of a randomized controlled trial to test the efficacy of an integrated CBT protocol aimed at reducing SUD as well as ADHD symptoms in SUD patients with a comorbid diagnosis of ADHD. The experimental group receives 15 CBT sessions directed at symptom reduction of SUD as well as ADHD. The control group receives treatment as usual, i.e. 10 CBT sessions directed at symptom reduction of SUD only. The primary outcome is the level of self-reported ADHD symptoms. Secondary outcomes include measures of substance use, depression and anxiety, quality of life, health care consumption and neuropsychological functions.

Discussion: This is the first randomized controlled trial to test the efficacy of an integrated CBT protocol for adult SUD patients with a comorbid diagnosis of ADHD. The rationale for the trial, the design, and the strengths and limitations of the study are discussed.

Trial registration: ClinicalTrials.gov NCT01431235.

Figures

Figure 1
Figure 1
Trial flowchart.

References

    1. van de Glind G, Konstenius M, Levin FR, Koeter MW, van Emmerik-van Oortmerssen K, Carpentier PJ. Do proposed DSM-5 revisions increase prevalence rates of ADHD in treatment seeking substance use disorder patients? Results Int Multi-Cent Study. submitted for publication.
    1. van Emmerik-van Oortmerssen K, van de Glind G, van den Brink W, Smit F, Crunelle CL, Swets M. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend. 2012;122:11–19. doi: 10.1016/j.drugalcdep.2011.12.007.
    1. Arias AJ, Gelernter J, Chan G, Weiss RD, Brady KT, Farrer L. Correlates of co-occurring ADHD in drug-dependent subjects: prevalence and features of substance dependence and psychiatric disorders. Addict Behav. 2008;33:1199–1207. doi: 10.1016/j.addbeh.2008.05.003.
    1. Carroll KM, Rounsaville BJ. History and significance of childhood attention deficit disorder in treatment-seeking cocaine abusers. Compr Psychiatry. 1993;34:75–82. doi: 10.1016/0010-440X(93)90050-E.
    1. Ercan ES, Coskunol H, Varan A, Toksoz K. Childhood attention deficit/hyperactivity disorder and alcohol dependence: a 1-year follow-up. Alcohol Alcohol. 2003;38:352–356. doi: 10.1093/alcalc/agg084.
    1. Castells X, Ramos-Quiroga JA, Rigau D, Bosch R, Nogueira M, Vidal X. Efficacy of methylphenidate for adults with attention-deficit hyperactivity disorder: a meta-regression analysis. CNS Drugs. 2011;25:157–169. doi: 10.2165/11539440-000000000-00000.
    1. Konstenius M, Jayaram-Lindstrom N, Beck O, Franck J. Sustained release methylphenidate for the treatment of ADHD in amphetamine abusers: a pilot study. Drug Alcohol Depend. 2010;108:130–133. doi: 10.1016/j.drugalcdep.2009.11.006.
    1. Levin FR, Evans SM, Brooks DJ, Garawi F. Treatment of cocaine dependent treatment seekers with adult ADHD: double-blind comparison of methylphenidate and placebo. Drug Alcohol Depend. 2007;87:20–29. doi: 10.1016/j.drugalcdep.2006.07.004.
    1. Levin FR, Evans SM, Brooks DJ, Kalbag AS, Garawi F, Nunes EV. Treatment of methadone-maintained patients with adult ADHD: double-blind comparison of methylphenidate, bupropion and placebo. Drug Alcohol Depend. 2006;81:137–148. doi: 10.1016/j.drugalcdep.2005.06.012.
    1. Carpentier PJ, de Jong CA, Dijkstra BA, Verbrugge CA, Krabbe PF. A controlled trial of methylphenidate in adults with attention deficit/hyperactivity disorder and substance use disorders. Addiction. 2005;100:1868–1874. doi: 10.1111/j.1360-0443.2005.01272.x.
    1. Riggs PD, Winhusen T, Davies RD, Leimberger JD, Mikulich-Gilbertson S, Klein C. Randomized controlled trial of osmotic-release methylphenidate with cognitive-behavioral therapy in adolescents with attention-deficit/hyperactivity disorder and substance use disorders. J Am Acad Child Adolesc Psychiatry. 2011;50:903–914. doi: 10.1016/j.jaac.2011.06.010.
    1. Schubiner H, Saules KK, Arfken CL, Johanson CE, Schuster CR, Lockhart N. Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence. Exp Clin Psychopharmacol. 2002;10:286–294.
    1. Thurstone C, Riggs PD, Salomonsen-Sautel S, Mikulich-Gilbertson SK. Randomized, controlled trial of atomoxetine for attention-deficit/hyperactivity disorder in adolescents with substance use disorder. J Am Acad Child Adolesc Psychiatry. 2010;49:573–582.
    1. Wilens TE, Adler LA, Weiss MD, Michelson D, Ramsey JL, Moore RJ. Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders. Drug Alcohol Depend. 2008;96:145–154. doi: 10.1016/j.drugalcdep.2008.02.009.
    1. Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M. Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA. 2010;304:875–880. doi: 10.1001/jama.2010.1192.
    1. Solanto MV, Marks DJ, Wasserstein J, Mitchell K, Abikoff H, Alvir JM. Efficacy of meta-cognitive therapy for adult ADHD. Am J Psychiatry. 2010;167:958–968. doi: 10.1176/appi.ajp.2009.09081123.
    1. Emilsson B, Gudjonsson G, Sigurdsson JF, Baldursson G, Einarsson E, Olafsdottir H. Cognitive behaviour therapy in medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. BMC Psychiatry. 2011;11:116. doi: 10.1186/1471-244X-11-116.
    1. Kadden R, Carroll KM, Donovan D, Cooney N, Monti P, Abrams D. Cognitive-Behavioral Coping Skills Therapy Manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. Project MATCH Monograph Series, Vol. 3. Rockville: National Institute on Alcohol Abuse and Alcoholism; 1994.
    1. Miller WR, Zweben A, DiClemente CC, Rychtarik RG. Motivational Enhancement Therapy Manual: a clinical research guide for therapists treating individuals with alcohol abuse and dependence. Project MATCH Monograph Series, Vol. 2. Rockville: National Institute on Alcohol Abuse and Alcoholism; 1994.
    1. de Wildt WAJM. Achilles Leefstijl 2, werkboek trainer [Lifestyle training program, therapist guide] Amsterdam: Boom; 2001.
    1. de Wildt WAJM. Achilles leefstijl 2, client werkboek [Lifestyle training program, client workbook] Amsterdam: Boom; 2002.
    1. Safren SA, Perlman CA, Sprich S, Otto MW. Mastering your adult ADHD: A cognitive-behavioral therapy approach. New York: Oxford University Press; 2005.
    1. Safren SA, Sprich S, Perlman CA, Otto MW. Mastering your adult ADHD: a cognitive-behavioral treatment program client workbook. New York: Oxford University Press; 2005.
    1. Khantzian EJ. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. Am J Psychiatry. 1985;142:1259–1264.
    1. Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nat Rev Neurosci. 2011;12:652–669. doi: 10.1038/nrn3119.
    1. World Health Organization. Composite International Diagnostic Interview (CIDI) (version 2.1) Amsterdam: WHO-CIDI, Training en Referentie centrum, Psychiatrisch Centrum APC; 1997.
    1. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E. The world health organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35:245–256. doi: 10.1017/S0033291704002892.
    1. Kessler RC, Adler LA, Gruber MJ, Sarawate CA, Spencer T, Van Brunt DL. Validity of the world health organization adult ADHD self-report scale (ASRS) screener in a representative sample of health plan members. Int J Methods Psychiatr Res. 2007;16:52–65. doi: 10.1002/mpr.208.
    1. Epstein JN, Johnson D, Conners CK. Conners' Adult ADHD Diagnostic Interview for DSM-IV. North Tonawanda: Multi-Health Systems, Inc.; 2000.
    1. Zanarini MC, Vujanovic AA, Parachini EA, Boulanger JL, Frankenburg FR, Hennen J. A screening measure for BPD: the McLean screening instrument for borderline personality disorder (MSI-BPD) J Pers Disord. 2003;17:568–573. doi: 10.1521/pedi.17.6.568.25355.
    1. First MB, Spitzer RL, Gibbon M, Williams JBW, Benjamin L. Structured Clinical Interview for DSM-IV Axis II Personality Disorders - Patient Edition (SCID-II, Version 2.0) Washington: American Psychiatric Press; 1995.
    1. Williams JB, Gibbon M, First MB, Spitzer RL, Davies M, Borus J. The structured clinical interview for DSM-III-R (SCID) II. Multisite test-retest reliability. Arch Gen Psychiatry. 1992;49:630–636. doi: 10.1001/archpsyc.1992.01820080038006.
    1. van de Glind G, van Emmerik-van Oortmerssen K, Carpentier PJ, Levin FR, Koeter MW, Barta C. The international ADHD in substance use disorders prevalence (IASP) study: background, methods and study population. Int J Methods Psychiatr Res. in press.
    1. Chiasson JP, Stavro K, Rizkallah E, Lapierre L, Dussault M, Legault L. Questioning the specificity of ASRS-v1.1 To accurately detect ADHD in substance abusing populations. J Atten Disord. 2012;16:661–663. doi: 10.1177/1087054711425768.
    1. Daigre Blanco C, Ramos-Quiroga JA, Valero S, Bosch R, Roncero C, Gonzalvo B. Adult ADHD self-report scale (ASRS-v1.1) Symptom checklist in patients with substance use disorders. Actas Esp Psiquiatr. 2009;37:299–305.
    1. Pedrero Perez EJ, Puerta GC. ASRS v.1.1., a tool for attention-deficit/hyperactivity disorder screening in adults treated for addictive behaviors: psychometric properties and estimated prevalence. Adicciones. 2007;19:393–407.
    1. van de Glind G, van den Brink W, Koeter MW, Carpentier PJ, van Emmerik-van Oortmerssen K, Kaye S. Validity of the adult ADHD self-report scale (ASRS) as a screener for adult ADHD in treatment seeking substance use disorder patients. Submitted for publication.
    1. Murphy P, Schachar R. Use of self-ratings in the assessment of symptoms of attention deficit hyperactivity disorder in adults. Am J Psychiatry. 2000;157:1156–1159. doi: 10.1176/appi.ajp.157.7.1156.
    1. DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD Rating Scale-IV. Checklists, norms and clinical interpretation. New York: Guilford Press; 1998.
    1. Kooij JJ, Buitelaar JK, van den Oord EJ, Furer JW, Rijnders CA, Hodiamont PP. Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychol Med. 2005;35:817–827. doi: 10.1017/S003329170400337X.
    1. Kooij JJ, Boonstra A, Swinkels SH, Bekker EM, de Noord I, Buitelaar JK. Reliability, validity, and utility of instruments for self-report and informant report concerning symptoms of ADHD in adult patients. J Atten Disord. 2008;11:445–458. doi: 10.1177/1087054707299367.
    1. Sobell LC, Sobell MB. In: Measuring alcohol consumption: psychosocial and biological methods. Allen J, Litten RZ, editor. Totowa: Humana Press; 2012. Timeline follow-back: a technique for assessing self-reported ethanol consumption; pp. 41–72.
    1. Agrawal S, Sobell MB, Sobell LC. In: Calendar and time diary methods in life course research. Belli RF, Stafford FP, Alwin DF, editor. Beverly Hills: Sage; 2008. The timeline follow-back: a scientifically and clinically useful tool for assessing substance use; pp. 57–68.
    1. Sobell MB, Sobell LC. In: Assessing alcohol problems. 2. Allen JP, Wilson V, editor. Rockville: National Institute on Alcohol Abuse and Alcoholism; 2003. Alcohol consumption measures; pp. 75–99.
    1. Beck AT, Steer RA. Beck Depression Inventory-Manual. New York: Harcourt Brace Jovanovich, Psychological Corporation; 1987.
    1. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–897.
    1. The EuroQol Group. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.
    1. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–343. doi: 10.3109/07853890109002087.
    1. Gunther O, Roick C, Angermeyer MC, Konig HH. The EQ-5D in alcohol dependent patients: relationships among health-related quality of life, psychopathology and social functioning. Drug Alcohol Depend. 2007;86:253–264. doi: 10.1016/j.drugalcdep.2006.07.001.
    1. van der Zanden BP, Dijkgraaf MG, Blanken P, de Borgie CA, van Ree JM, van den Brink W. Validity of the EQ-5D as a generic health outcome instrument in a heroin-dependent population. Drug Alcohol Depend. 2006;82:111–118. doi: 10.1016/j.drugalcdep.2005.08.012.
    1. Hakkaart-van Roijen L. Manual Trimbos/iMTA questionnaire for costs associated with psychiatric illness (in Dutch) Rotterdam: Institute for Medical Technology Assessment; 2002.
    1. Gilden J, Staring AB, van der Gaag M, Mulder CL. Does treatment adherence therapy reduce expense of healthcare use in patients with psychotic disorders? cost-minimization analysis in a randomized controlled trial. Schizophr Res. 2011;133:47–53. doi: 10.1016/j.schres.2011.09.025.
    1. Hakkaart-van Roijen L, Zwirs BW, Bouwmans C, Tan SS, Schulpen TW, Vlasveld L. Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD) Eur Child Adolesc Psychiatry. 2007;16:316–326. doi: 10.1007/s00787-007-0603-6.
    1. Horn EK, van Benthem TB, Hakkaart-van Roijen L, van Marwijk HW, Beekman AT, Rutten FF. Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial. BMC Health Serv Res. 2007;7:28. doi: 10.1186/1472-6963-7-28.
    1. IJff MA, Huijbregts KM, van Marwijk HW, Beekman AT, Hakkaart-van Roijen L, Rutten FF. Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomised clinical trial. BMC Health Serv Res. 2007;7:34. doi: 10.1186/1472-6963-7-34.
    1. van der Feltz-Cornelis CM, Meeuwissen JA, de Jong FJ, Hoedeman R, Elfeddali I. Randomised controlled trial of a psychiatric consultation model for treatment of common mental disorder in the occupational health setting. BMC Health Serv Res. 2007;7:29. doi: 10.1186/1472-6963-7-29.
    1. Lejuez CW, Read JP, Kahler CW, Richards JB, Ramsey SE, Stuart GL. Evaluation of a behavioral measure of risk taking: the balloon analogue risk task (BART) J Exp Psychol Appl. 2002;8:75–84.
    1. Geurts HM, Verte S, Oosterlaan J, Roeyers H, Sergeant JA. How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism? J Child Psychol Psychiatry. 2004;45:836–854. doi: 10.1111/j.1469-7610.2004.00276.x.
    1. Hammes JW. De Stroop kleur-woord test: handleiding [The Stroop color-word test: manual] Netherlands: Lisse: Swets & Zeitlinger; 1971.
    1. Stroop JR. Studies of interference in serial verbal reactions. Journal of Experimental Psychology. 1935;18:643–662.
    1. Seidman LJ. Neuropsychological functioning in people with ADHD across the lifespan. Clin Psychol Rev. 2006;26:466–485. doi: 10.1016/j.cpr.2006.01.004.
    1. Woods SP, Lovejoy DW, Ball JD. Neuropsychological characteristics of adults with ADHD: a comprehensive review of initial studies. Clin Neuropsychol. 2002;16:12–34. doi: 10.1076/clin.16.1.12.8336.
    1. Faraone SV, Biederman J, Spencer T, Michelson D, Adler L, Reimherr F. Atomoxetine and stroop task performance in adult attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2005;15:664–670. doi: 10.1089/cap.2005.15.664.
    1. Krikorian R, Bartok J, Gay N. Tower of London procedure: a standard method and developmental data. J Clin Exp Neuropsychol. 1994;16:840–850. doi: 10.1080/01688639408402697.
    1. Tucha L, Tucha O, Sontag TA, Stasik D, Laufkotter R, Lange KW. Differential effects of methylphenidate on problem solving in adults with ADHD. J Atten Disord. 2011;15:161–173. doi: 10.1177/1087054709356391.
    1. Steele M, Jensen PS, Quinn DMP. Remission versus response as the goal of therapy in ADHD: a new standard for the field? Clin Ther. 2006;28:1892–1908. doi: 10.1016/j.clinthera.2006.11.006.
    1. Zylowska L, Ackerman DL, Yang MH, Futrell JL, Horton NL, Hale TS. Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study. J Atten Disord. 2008;11:737–746.
    1. Oostenbrink JB, Bouwmans CAM, Koopmanschap MA, Rutten FFH. Handleiding voor kostenonderzoek; Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg (geactualiseerde versie 2004) Diemen: College voor Zorgverzekeringen; 2004. (Dutch manual for costing: methods and standard costs for economic evaluations in health care (actualized version 2004)).

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel