title: Extended-Release Mixed Amphetamine Salts vs Placebo for Comorbid Adult Attention-Deficit/Hyperactivity Disorder and Cocaine Use Disorder: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Adult attention-deficit/hyperactivity disorder (ADHD) is prevalent but often unrecognized, in part because it tends to co-occur with other disorders such as substance use disorders. Cocaine use disorder is one such disorder with high co-occurrence of ADHD.
  
  
  OBJECTIVE
  To examine whether treatment of co-occurring ADHD and cocaine use disorder with extended-release mixed amphetamine salts is effective at both improving ADHD symptoms and reducing cocaine use.
  
  
  METHODS
  Thirteen-week, randomized, double-blind, 3-arm, placebo-controlled trial of participants meeting DSM-IV-TR criteria for both ADHD and cocaine use disorder conducted between December 1, 2007, and April 15, 2013, at 2 academic health center substance abuse treatment research sites. One hundred twenty-six adults diagnosed as having comorbid ADHD and cocaine use disorder were randomized to extended-release mixed amphetamine salts or placebo. Analysis was by intent-to-treat population.
  
  
  METHODS
  Participants received extended-release mixed amphetamine salts (60 or 80 mg) or placebo daily for 13 weeks and participated in weekly individual cognitive behavioral therapy.
  
  
  METHODS
  For ADHD, percentage of participants achieving at least a 30% reduction in ADHD symptom severity, measured by the Adult ADHD Investigator Symptom Rating Scale; for cocaine use, cocaine-negative weeks (by self-report of no cocaine use and weekly benzoylecgonine urine screens) during maintenance medication (weeks 2-13) and percentage of participants achieving abstinence for the last 3 weeks.
  
  
  RESULTS
  More patients achieved at least a 30% reduction in ADHD symptom severity in the medication groups (60 mg: 30 of 40 participants [75.0%]; odds ratio [OR] = 5.23; 95% CI, 1.98-13.85; P < .001; and 80 mg: 25 of 43 participants [58.1%]; OR = 2.27; 95% CI, 0.94-5.49; P = .07) compared with placebo (17 of 43 participants [39.5%]). The odds of a cocaine-negative week were higher in the 80-mg group (OR = 5.46; 95% CI, 2.25-13.27; P < .001) and 60-mg group (OR = 2.92; 95% CI, 1.15-7.42; P = .02) compared with placebo. Rates of continuous abstinence in the last 3 weeks were greater for the medication groups than the placebo group: 30.2% for the 80-mg group (OR = 11.87; 95% CI, 2.25-62.62; P = .004) and 17.5% for the 60-mg group (OR = 5.85; 95% CI, 1.04-33.04; P = .04) vs 7.0% for placebo.
  
  
  CONCLUSIONS
  Extended-release mixed amphetamine salts in robust doses along with cognitive behavioral therapy are effective for treatment of co-occurring ADHD and cocaine use disorder, both improving ADHD symptoms and reducing cocaine use. The data suggest the importance of screening and treatment of ADHD in adults presenting with cocaine use disorder.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier:NCT00553319.
authors.affiliation: Division of Substance Abuse, New York State Psychiatric Institute, New York2Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Frances R
authors.initials: FR
authors.lastname: Levin
authors.affiliation: Division of Substance Abuse, New York State Psychiatric Institute, New York2Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: John J
authors.initials: JJ
authors.lastname: Mariani
authors.affiliation: Department of Psychiatry, Medical School, University of Minnesota, Minneapolis.
authors.forename: Sheila
authors.initials: S
authors.lastname: Specker
authors.affiliation: Department of Psychiatry, Medical School, University of Minnesota, Minneapolis.
authors.forename: Marc
authors.initials: M
authors.lastname: Mooney
authors.affiliation: Division of Substance Abuse, New York State Psychiatric Institute, New York.
authors.forename: Amy
authors.initials: A
authors.lastname: Mahony
authors.affiliation: Division of Substance Abuse, New York State Psychiatric Institute, New York.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Brooks
authors.affiliation: Department of Psychiatry, Medical School, University of Minnesota, Minneapolis.
authors.forename: David
authors.initials: D
authors.lastname: Babb
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Yun
authors.initials: Y
authors.lastname: Bai
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Eberly
authors.affiliation: Division of Substance Abuse, New York State Psychiatric Institute, New York2Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Edward V
authors.initials: EV
authors.lastname: Nunes
authors.affiliation: Department of Psychiatry, Medical School, University of Minnesota, Minneapolis.
authors.forename: John
authors.initials: J
authors.lastname: Grabowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000662:Amphetamines / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000188:drug therapy* / Q000628:therapy; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000188:drug therapy* / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D016896:Treatment Outcome
chemical_list: D000662:Amphetamines; D000697:Central Nervous System Stimulants; D003692:Delayed-Action Preparations