SUBSTANCE USE DISORDERS AND CO-OCCURRING ATTENTION DEFICIT DISORDER

UNODC Scientific Consultation – December 2015

SUBSTANCE USE DISORDERS AND CO-OCCURRING ATTENTION DEFICIT DISORDER

Willem van den Brink, Professor, University of Amsterdam

About 15-20% of all treatment seeking substance use disorder (SUD) patients meet criteria for adult attention deficit/hyperactive disorder (ADHD). This does not come as a surprise since we know that about 50% of all youngsters with ADHD develop SUD.

In this presentation, I will show that this high phenotypic overlap between ADHD and SUD is mainly due to genetic overlap. This genetic overlap is also manifested in a clear overlap in cognitive and other neurobiological risk factors. The latter may (partly) explain why early stimulant treatment of ADHD may prevent the development of SUD in youngsters with ADHD.

Treatment of SUD patients with comorbid adult ADHD often fails, whereas the treatment of ADHD in patients with a comorbid SUD is equally unsuccessful. A possible explanation for the latter finding is that dopamine transporter occupancy by methylphenidate (MPH) in patients with ADHD and cocaine dependence is lower than in patients with ADHD alone and that dopamine release after a MPH challenge is lower in cocaine dependent patients than in healthy controls. It therefore does not as a surprise that recent trials with a high dose of extended release MPH (up to 180 mg/day) and robust doses of extended release dexamphetamine (60-80 mg/day) have been successful in terms of both reduction of ADHD symptoms and drug use.

The presentation concludes that SUD and ADHD are highly comorbid and share genetic and other neurobiological risk factors, that youngsters with ADHD should be treated as early as possible to prevent the development of SUD, and that patients with comorbid SUD and ADHD are likely to benefit most from treatments with a high dose of extended- release stimulants.

About the author

Wim van den Brink, MD PhD. Wim van den Brink (1952) received his medical degree in 1981 from the Free University in Amsterdam. After his psychiatric residency in Groningen (1981-1986), he was a fellow at the Psychiatric Epidemiology Training program at Columbia University in New York. In 1989 he received his PhD degree from the State University of Groningen, the Netherlands. Since 1992 he is full professor of Psychiatry and Addiction at the Academic Medical Center of the University of Amsterdam. He is also the director of the Amsterdam Institute for Addiction Research (AIAR). In 2014 he received the life time achievement award for science from the Netherlands Association of Psychiatry and in 2015 he was granted the status of honorable member of the Spanish Society for Dual disorders. He is a (co)author of more than 500 peer reviewed scientific papers (HI=53) and has been a thesis advisor of more than 60 PhD students. He is currently one of the chief-editors of European Addiction Research. He has been the chair of the Workgroups that developed the Dutch Interdisciplinary Treatment Guideline on Alcohol Use Disorders and the Dutch Interdisciplinary Guideline on Opiate Addiction. He is one of the founders and the president of the International Collaboration of ADHD and Substance Abuse (ICASA). Until 2015 he was the chair of the Scientific Program Committee of the European College of Neuropsychopharmacology (ECNP). His main scientific interest are related to the neurobiology of substance use disorders and behavioral addictions, the pharmacological treatment of addiction and related comorbidities, and the reduction of stigma regarding patients with an addiction.

Email: w [dot] vandenbrink [at] amc [dot] uva [dot] nl