A Treatment Algorithm for Attention Deficit Hyperactivity Disorder in Cocaine-Dependent Adults

Subst Abus. 1999 Mar;20(1):59-71. Related Articles, Links


A Treatment Algorithm for Attention Deficit Hyperactivity Disorder in
Cocaine-Dependent Adults: A One-Year Private Practice Study with Long-Acting
Stimulants, Fluoxetine, and Bupropion.

Castaneda R, Sussman N, Levy R, Trujillo M.

Department of Psychiatry, Bellevue Hospital/New York University School of
Medicine. New York University Medical Center, New York, New York 10016.

A subgroup of adults in private treatment for cocaine dependence in
remission reported a therapeutic effect from cocaine during the initial
phases of cocaine addiction and, also, met DSM-IV criteria for ADHD. We
report evidence that study subjects probably medicated their ADHD symptoms
with cocaine and describe a 1-year treatment algorithm featuring long-acting
stimulants that was effective in the management of their ADHD and cocaine
dependence. Nineteen stable patients in full remission from all substance
dependence were entered into an open label, prospective, treatment trial for
ADHD. The treatment schedule consisted of the progressive introduction-and
discontinuation of ineffective medication-of each of several medications in
the following order: fluoxetine, bupropion, pemoline, sustained-release
methylphenidate, dextroamphetamine spansules, and methamphetamine gradumets.
Treatment of ADHD was successful. Several treatment regimens, especially
those including long-acting stimulants, alone or in combination with other
agents, were highly effective. All but 1 of the 19 subjects had a fully
effective response for at least 1 full year. Mean UTAH scale scores were 7.4
before any medications were administered and 1.6 at the end of the study.
Treatment proved successful in suppressing ADHD symptoms, with minimal
cocaine slips or side effects.

PMID: 12511821 [PubMed - as supplied by publisher]