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Tesi etd-11092018-155929

Thesis type
Tesi di specializzazione (4 anni)
Dual Disorder (Cocaine Use Disorder/Adult ADHD) patients: characterizing clinical features and stimulant treatment outcomes
Corso di studi
relatore Prof. Maremmani, Icro
relatore Prof. Perugi, Giulio
Parole chiave
  • atomoxetine
  • methylphenidate
  • agonist treatment
  • cocaine
  • cocaine use disorder
  • adult adhd
Data inizio appello
Secretata d'ufficio
Data di rilascio
Riassunto analitico
Cocaine use disorder (CUD) is a public health concern and no effective pharmacotherapy has been demonstrated yet. Stimulant medications have been proven promising in CUD treatment, but they have not been widely studied and substantial barriers to clinical implementation still remain. The Self-Medication Hypothesis was developed to better explain this phenomenon, namely when CUD co-occurs with ADHD (Attention-Deficit/Hyperactivity Disorder). Many controlled clinical trials have already evidenced that the use of extended-release methylphenidate formulations or atomoxetine, are promising for ADHD individuals with CUD, although data about their short-term efficacy being inconclusive.
In the present study, a sample of 24 patients (aged from 18 to 65 years) with adult ADHD and co-occurring CUD, treated with stimulant drugs (methylphenidate and atomoxetine), have been followed for a mean period of 213 days (min 22; max 2.5 years) using an agonist replacement approach.
Both ADHD and CUD diagnosis were made with the Structured Clinical Interview for DSM-5 (SCID-5), following DSM-5 criteria. A diagnosis of ADHD was at first investigated with the screening test Adult ADHD Self-Report Scale (ASRS) and confirmed with the Structured Diagnostic Interview for Adult ADHD (DIVA). All individuals were assessed with standardized questionnaires to evaluate treatment efficacy and clinical improvement (Clinical of Global Impression, CGI) and cocaine addiction severity (Cocaine Problem severity Index, CPSI).
22 patients showed a reduction in the use of cocaine, a decrease in craving symptoms, and an improvement in social functioning, reaching higher levels of executive functions. The ADHD improvement was correlated to the CUD improvement. Our findings suggest that the pharmacological therapy for adult ADHD with CUD comorbidity is not only effective in improving inattention and hyperactivity, but could also positively impact on cocaine-use prognosis and outcome.