A Retrospective Comparative Study in Patients With Cocaine Use Disorder Comorbid With Attention Deficit Hyperactivity Disorder Undergoing an rTMS Protocol Treatment

Stefano Cardullo, Luis J Gómez Pérez, Diego Cuppone, Michela Sarlo, Nicola Cellini, Alberto Terraneo, Luigi Gallimberti, Graziella Madeo, Stefano Cardullo, Luis J Gómez Pérez, Diego Cuppone, Michela Sarlo, Nicola Cellini, Alberto Terraneo, Luigi Gallimberti, Graziella Madeo

Abstract

Background: Adult attention-deficit/hyperactivity disorder (ADHD) is associated with high comorbidity with other psychiatric diseases, including cocaine use disorder (CocUD). Given the common fronto-striatal dysfunction, ADHD patients often use cocaine as self-medication for ameliorating symptoms by increasing striatal dopamine release. Yet, comorbidity with ADHD is related to poor treatment outcomes. CocUD has been treated with transcranial magnetic stimulation (TMS), but no studies investigated the outcomes in patients comorbid with ADHD. Methods: Twenty-two ADHD/CocUD and 208 CocUD-only participants received a high-frequency (15 Hz) rTMS treatment stimulating the left-DLPFC. We investigated whether both groups of patients shared similar demographic and clinical characteristics at baseline. Then, we monitored the effect of treatment testing for potential differences between groups. Results: At baseline demographic, toxicology and clinical features were not different between the two groups except for global severity index (GSI from SCL-90): patients of ADHD/CocUD group reported higher general symptomatology compared to the CocUD-only group. Concerning the effect of treatment, both groups significantly improved over time regarding cocaine use, craving, and other negative affect symptoms. No differences were observed between groups. Conclusions: To our knowledge, this is the first study comparing the demographic characterization and rTMS clinical improvements of patients with a dual diagnosis of ADHD and CocUD against CocUD-only patients. Cocaine use and common self-reported withdrawal/abstinence symptoms appear to benefit from rTMS treatment with no differences between groups. Future studies are needed to further investigate these preliminary results.

Keywords: attention deficit hyperactivity disorder; cocaine use disorder; craving; dopamine; dorsolateral prefrontal cortex; repetitive transcranial magnetic stimulation.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Cardullo, Gómez Pérez, Cuppone, Sarlo, Cellini, Terraneo, Gallimberti and Madeo.

Figures

Figure 1
Figure 1
Time to the first resumption of cocaine in ADHD/CocUD and CocUD-only groups. ADHD, attention-deficit/hyperactivity disorder; CocUD, cocaine use disorder.
Figure 2
Figure 2
Distribution of patients according to cocaine frequency level at Day 90 (A), and change in cocaine frequency level in comparison to baseline (B). ADHD, attention-deficit/hyperactivity disorder; CocUD, cocaine use disorder.

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