Methylphenidate treatment for cocaine abusers with adult attention-deficit/hyperactivity disorder: a pilot study.
BACKGROUND
Attention-deficit/hyperactivity disorder (ADHD) is common among cocaine abusers seeking treatment. This open trial was carried out to assess the efficacy of sustained-release methylphenidate for the treatment of cocaine abuse among individuals with ADHD.


METHODS
Twelve patients who met DSM-IV diagnostic criteria for adult ADHD and cocaine dependence were entered into a 12-week trial of divided daily doses of sustained-release methylphenidate ranging from 40 to 80 mg. In addition to the pharmacotherapy, patients also received individual weekly relapse prevention therapy. Individuals were assessed weekly for ADHD symptoms; vital signs and urine toxicologies were obtained 3 times a week.


RESULTS
Of the 12 patients entered, 10 completed at least 8 weeks of the study and 8 completed the entire study. Using both a semistructured clinical interview and a self-report assessment, patients reported reductions in attention difficulties, hyperactivity, and impulsivity. Self-reported cocaine use and craving decreased significantly. More importantly, cocaine use, confirmed by urine toxicologies, also decreased significantly.


CONCLUSIONS
These preliminary data suggest that under close supervision, the combined intervention of sustained-release methylphenidate and relapse prevention therapy may be effective in treating individuals with both adult ADHD and cocaine dependence.
Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York 10032, USA.
F R
FR
Levin
S M
SM
Evans
D M
DM
McDowell
H D
HD
Kleber
D000328:Adult; D000553:Ambulatory Care; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology; D001521:Behavior Therapy; D003042:Cocaine / Q000652:urine; D019970:Cocaine-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D003131:Combined Modality Therapy; D015897:Comorbidity; D003692:Delayed-Action Preparations; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage / Q000627:therapeutic use*; D010555:Personality Inventory; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D055502:Secondary Prevention; D015813:Substance Abuse Detection
D003692:Delayed-Action Preparations; D008774:Methylphenidate; D003042:Cocaine