Predictors of treatment response in adolescents with comorbid substance use disorder and attention-deficit/hyperactivity disorder.
Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occurs with substance use disorder (SUD) and is associated with poor substance-use treatment outcomes. A trial evaluating osmotic-release oral system methylphenidate (OROS-MPH) for adolescents with ADHD and SUD, concurrently receiving behavioral therapy, revealed inconsistent medication effects on ADHD or SUD. Clinical care for this population would be advanced by knowledge of treatment outcome predictors. Data from the randomized placebo-controlled trial (n = 299) were analyzed. Significant treatment predictors included: 1) Substance use severity, associated with poorer ADHD and SUD outcomes, 2) ADHD severity, associated with better ADHD and SUD outcomes, 3) comorbid conduct disorder, associated with poorer ADHD outcomes, and 4) court-mandated status, associated with better SUD outcomes but poorer treatment completion. An interaction effect showed that OROS-MPH improved SUD outcomes in adolescents with comorbid conduct disorder compared to placebo. While severe SUD may require more intensive psychosocial treatment, OROS-MPH may improve substance treatment outcomes in adolescents with co-morbid attention and conduct problems.
Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. leanne.tamm@cchmc.org
Leanne
L
Tamm
Kathlene
K
Trello-Rishel
Paula
P
Riggs
Paul A
PA
Nakonezny
Michelle
M
Acosta
Genie
G
Bailey
Theresa
T
Winhusen
D000284:Administration, Oral; D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D001521:Behavior Therapy / Q000379:methods; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000627:therapeutic use*; D019955:Conduct Disorder / Q000150:complications; D017831:Diagnosis, Dual (Psychiatry); D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D008297:Male; D037141:Mandatory Programs; D008774:Methylphenidate / Q000008:administration & dosage / Q000627:therapeutic use*; D009995:Osmosis; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D016896:Treatment Outcome
D000697:Central Nervous System Stimulants; D008774:Methylphenidate