Trends in Psychiatry and Psychotherapy
Trends in Psychiatry and Psychotherapy
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Craving for heroin: difference between methadone maintenance therapy patients with and without ADHD

Fissura por heroína: diferença entre pacientes em terapia de manutenção com metadona com e sem TDAH

Maurizio Coppola; Giuseppe Sacchetto; Raffaella Mondola

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Abstract Introduction Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder persisting in adulthood in 40-60% of cases. Clinical and neuroimaging studies suggest that patients affected by both drug addiction and ADHD show higher rates of craving for drug than patients without ADHD. We designed a pilot open-label study to investigate the effects of ADHD on craving for heroin in methadone maintenance therapy patients. Method Patients were recruited from outpatient facilities in an addiction treatment unit in the municipality of Alba, Italy. They were assessed using the Structured Clinical Interview for DSM-5 (SCID-5), the SCID-5 for Personality Disorders (SCID-5-PD), the Diagnostic Interview for Adult ADHD, second edition (DIVA 2.0), and the Clinical Opiate Withdrawal Scale (COWS). Categorical variables were examined using the chi-square test, and continuous variables, the t-test and Mann-Whitney’s U test for normally and non-normally distributed data, respectively. Data distribution was evaluated using Shapiro-Wilk’s test. Significance was set at p=0.05. Bonferroni correction was applied (0.0063) to avoid type I error. Results A total of 104 patients were included in the study: 14 affected by ADHD (13.5%) and 90 were not affected (86.5%). Patients with ADHD showed higher intensity of craving for heroin than patients without ADHD in the absence of withdrawal symptoms. Conclusion Drug addiction and ADHD share various neurobiological mechanisms that mutually influence the evolution of both disorders. In particular, dopamine dysfunction within various brain circuits may influence impulsivity levels, motivation, inhibitory control, executive functions, and behavior and, consequently, the intensity of craving.


Craving, addiction, ADHD, heroin


Resumo Introdução O transtorno de déficit de atenção e hiperatividade (TDAH) é um transtorno do neurodesenvolvimento que persiste na idade adulta em 40-60% dos casos. Estudos clínicos e de neuroimagem sugerem que pacientes afetados tanto por adição quanto por TDAH apresentam maiores índices de fissura (craving) por droga do que pacientes sem TDAH. Este estudo piloto aberto investigou os efeitos do TDAH sobre fissura por heroína em pacientes em terapia de manutenção com metadona. Método Os pacientes foram recrutados em serviços ambulatoriais em uma unidade de tratamento de adição na cidade de Alba, Itália. Eles foram avaliados usando os seguintes instrumentos: Structured Clinical Interview for DSM-5 (SCID-5), SCID-5 for Personality Disorders (SCID-5-PD), Diagnostic Interview for Adult TDAH, second edition (DIVA 2.0) e Clinical Opiate Withdrawal Scale (COWS). Variáveis categóricas foram examinadas utilizando o teste do qui-quadrado, e variáveis contínuas, o teste t e o teste U de Mann-Whitney para dados com distribuição normal e não normal, respectivamente. A distribuição dos dados foi avaliada usando o teste de Shapiro-Wilk. O nível de significância foi estabelecido em p=0,05. A correção de Bonferroni foi aplicada (0,0063) para evitar erro tipo I. Resultados Um total de 104 pacientes foram incluídos no estudo: 14 com TDAH (13,5%) e 90 sem (86,5%). Pacientes com TDAH mostraram maior intensidade de fissura por heroína do que pacientes sem TDAH na ausência de sintomas de abstinência. Conclusão Adição e TDAH compartilham mecanismos neurobiológicos que influenciam mutuamente a evolução dos dois transtornos. Em particular, a disfunção da dopamina em vários circuitos cerebrais pode influenciar os níveis de impulsividade, motivação, controle inibitório, funções executivas e comportamento, e, portanto, a intensidade da fissura.


Fissura, adição, TDAH, heroína


Volkow ND, Swanson JM. Adult attention deficit-hyperactivity disorder. N Engl J Med. 2013;369:1935-44.

Wender PH. Attention deficit-hyperactivity disorder in adults. Psychiatr Clin North Am. 1988;21:761-74.

Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow up studies. Psychol Med. 2006;36:159-65.

Wilens TE, Biederman J, Mick E. Does ADHD affect the course of substance abuse? Findings from a sample of adults with and without ADHD. Am J Addict. 1998;7:156-63.

Gholamalinezhad F, Abdolmanafi A, Rostami R, Farhoodi F. Comparison of craving in substance use patients with the history of ADHD and substance use without ADHD history. Procedia Soc Behav Sci. 2010;5.

Frodl T. Comorbidity of ADHD and substance use disorder (SUD): a neuroimaging perspective. J Atten Disord. 2010;14:109-20.

Volkow ND, Wang GJ, Kollins SH, Wigal TL, Newcorn JH, Telang F. Evaluating dopamine reward pathway in ADHD. JAMA. 2009;302:1084-91.

Zulauf CA, Sprich SE, Safren SA, Wilens TE. The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders. Curr Psychiatry Rep. 2014;16.

Oshri A, Kogan SM, Kwon JA, Wickrama KAS, Vanderbroek L, Palmer AA. Impulsivity as a mechanism linking child abuse and neglect with substance use in adolescence and adulthood. Dev Psychopathol. 2017;30:417-35.

Gipson CD, Beckmann JS, Adams ZW, Marusich JA, Nesland TO, Yates JR. A translational behavioral model of mood-based impulsivity: Implications for substance abuse. Drug Alcohol Depend. 2012;122:93-9.

First MB, Williams JWB, Karg RS, Spitzer RL. Structured Clinical Interview for DSM-5® Disorders--Clinician Version (SCID-5-CV). 2016.

Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs. 2003;35:253-9.

Ramos-Quiroga JA, Nasillo V, Richarte V, Corrales M, Palma F, Ibáñez P. Criteria and concurrent validity of DIVA 2.0: a semi-structured diagnostic interview for adult ADHD. J Atten Disord. 2016.

First MB, Williams JWB, Karg RS, Spitzer RL. Structured Clinical Interview for DSM-5® Personality Disorders (SCID-5-PD). 2016.

Hassani-Abharian P, Ganjgahi H, Tabatabaei-Jafari H, Oghabian MA, Mokri A, Ekhtiari H. Exploring neural correlates of different dimensions in drug craving self-reports among heroin dependents. Basic Clin Neurosci. 2015;6:271-84.

Falcato L, Beck T, Reimer J, Verthein U. Self-reported cravings for heroin and cocaine during maintenance treatment with slow-release oral morphine compared with methadone: a randomized, crossover clinical trial. J Clin Psychopharmacol. 2015;35:150-7.

Zhao M, Fan C, Du J, Jiang H, Chen H, Sun H. Cue-induced craving and physiological reactions in recently and long-abstinent heroin-dependent patients. Addict Behav. 2012;37:393-8.

van Emmerik-van Oortmerssena K, van de Glindc G, van den Brinkb W, Smitc F, Crunelle CL, Swetsa M. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis. Drug Alcohol Depend. 2012;122:11-9.

Stein MT. ADHD: The diagnostic process from different perspectives. J Dev Behav Pediatr. 2004;25:S54-8.

Regnart J, Truter I, Meyer A. Critical exploration of co-occurring attention-deficit/hyperactivity disorder, mood disorder and substance use disorder. Expert Rev Pharmacoecon Outcomes Res. 2017;17:275-82.

Volkowa ND, Wangc GJ, Fowlerc JS, Tomasib D, Telangb F. Addiction: beyond dopamine reward circuitry. PANS. 2011;108:15037-42.

Scott JG, Giørtz Pedersen M, Erskine HE, Bikic A, Demontis D, McGrath JJ. Mortality in individuals with disruptive behavior disorders diagnosed by specialist services - A nationwide cohort study. Psychiatry Res. 2017;251:255-60.

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