Treatment of Adult ADHD without Stimulants: Effectiveness in A Dually Diagnosed Correctional Population

• Published in: Psychiatric quarterly 2019-03, Vol.90 (1), p.41-46
• Main Authors: Bastiaens, Leo, Scott, Olivia, Galus, James
• Format: Article
• Language: English
• Subjects: Addictions; Adrenergic Agents - pharmacology; Adult; Antisocial personality disorder; Atomoxetine Hydrochloride - pharmacology; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention deficit hyperactivity disorder; Chart reviews; Comorbidity; Diagnosis, Dual (Psychiatry); Drug use; Female; Follow-Up Studies; Guanfacine - pharmacology; Humans; Male; Medical diagnosis; Medical treatment; Medicine; Medicine & Public Health; Mental Disorders - epidemiology; Nortriptyline - pharmacology; Original Paper; Outcome Assessment, Health Care; Patients; Personality development; Population; Prisoners; Psychiatry; Psychosocial factors; Psychosocial intervention; Public Health; Remission; Remission (Medicine); Retrospective Studies; Severity; Severity of Illness Index; Social behavior; Sociology; Stimulants; Substance use disorder; Substance-Related Disorders - epidemiology
• ISSN: 0033-2720; 1573-6709
• DOI: 10.1007/s11126-018-9602-7

Adult ADHD has received increased attention in the past two decades. There is a complex relationship between ADHD and substance use disorders, with ADHD being a risk factor for and a moderator in the treatment of addiction. ADHD is also a risk factor for the development of antisocial personality disorder. As a result, ADHD is prevalent in a correctional dually diagnosed population. This retrospective chart review reports on the effectiveness of the treatment for ADHD in a population with substance use disorders, residing in a correctional community center for treatment and reintegration purposes. Only patients with a primary diagnosis of ADHD were included and only nonstimulants were used. After an average of four visits, or approximately four months, patient showed a moderate response with a pretreatment to posttreatment effect size of 1.4. Sixty-four percent of patients responded and 35% remitted, according to the Clinical Global Index Severity Scale as the primary outcome measure. While stimulants are considered the first-line treatment for ADHD, they clearly present challenges in certain populations, especially in patients with significant antisocial and addiction histories. It does appear that non-stimulants are effective in this population. It is speculated that the response and remission rate could be improved by adding ADHD specific psychosocial interventions.