Observational Study

. 2024 Dec 23;86(1):24m15494.

doi: 10.4088/JCP.24m15494.

Treatments and Treatment Predictors in Patients With Substance Use Disorders and Comorbid Attention-Deficit/Hyperactivity Disorder: First Results From the International Naturalistic Cohort Study of ADHD and SUD (INCAS)

Christoffer Brynte^{1

2}, Arnt Schellekens³, Csaba Barta⁴, Alex H A Begeman⁵, Cleo L Crunelle⁶, Costanza Daigre^{7

8

9}, Zsolt Demetrovics^{10

11

12}, Geert Dom¹³, Lara Grau-López^{7

8

9

14}, Mariely Hernandez¹⁵, Romain Icick^{16

17

18}, Brian Johnson¹⁹, Máté Kapitány-Fövény^{20

21}, Michiel van Kernebeek⁶, Maija Konstenius¹, Frances R Levin²², Mathias Luderer²³, Frieda Matthys⁶, Franz Moggi²⁴, J Antoni Ramos-Quiroga^{7

8

9

14}, Laura Schleussner²³, Norman Therribout^{17

25}, Anil Thomas²⁶, Florence Vorspan^{16

17

18}, Wim van den Brink²⁷, Johan Franck¹

Affiliations

¹ Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
² Corresponding Author: Christoffer Brynte, MD, Dalagatan 86H, 122 43, Stockholm, Sweden (Christoffer.brynte@ki.se).
³ Department of Psychiatry, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, Radboud University Medical Centre, The Netherlands.
⁴ Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, Budapest, Hungary.
⁵ De Hoop ggz, Outpatient Treatment Centre Amersfoort, Amersfoort, The Netherlands.
⁶ Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
⁷ Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
⁸ Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
⁹ Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain.
¹⁰ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
¹¹ Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar.
¹² College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.
¹³ Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Wilrijk, Belgium.
¹⁴ Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
¹⁵ New York State Psychiatric Institute, Columbia University, New York, New York.
¹⁶ Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.
¹⁷ Université de Paris Cité, INSERM UMR-S1144, Paris, France.
¹⁸ FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France.
¹⁹ SUNY Upstate, Syracuse, New York, New York.
²⁰ Nyír}o Gyula National Institute of Psychiatry, and Addictology, Budapest, Hungary.
²¹ Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
²² Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, New York.
²³ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Hospital of the Goethe University, Goethe University Frankfurt, Frankfurt, Germany.
²⁴ University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
²⁵ Université Paris-Nanterre, UR 4430 CLIPSYD, Nanterre, France.
²⁶ NYU Grossman School of Medicine, New York, New York.
²⁷ Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands.

PMID: 39724095
PMCID: PMC11992959 (available on 2025-12-23)
DOI: 10.4088/JCP.24m15494

Observational Study

Treatments and Treatment Predictors in Patients With Substance Use Disorders and Comorbid Attention-Deficit/Hyperactivity Disorder: First Results From the International Naturalistic Cohort Study of ADHD and SUD (INCAS)

Christoffer Brynte et al. J Clin Psychiatry. 2024.

. 2024 Dec 23;86(1):24m15494.

doi: 10.4088/JCP.24m15494.

Authors

Affiliations

¹ Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
² Corresponding Author: Christoffer Brynte, MD, Dalagatan 86H, 122 43, Stockholm, Sweden (Christoffer.brynte@ki.se).
³ Department of Psychiatry, Donders Institute for Brain, Cognition, and Behavior, Nijmegen, Radboud University Medical Centre, The Netherlands.
⁴ Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, Budapest, Hungary.
⁵ De Hoop ggz, Outpatient Treatment Centre Amersfoort, Amersfoort, The Netherlands.
⁶ Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
⁷ Department of Mental Health, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
⁸ Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
⁹ Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain.
¹⁰ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
¹¹ Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar.
¹² College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.
¹³ Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Wilrijk, Belgium.
¹⁴ Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
¹⁵ New York State Psychiatric Institute, Columbia University, New York, New York.
¹⁶ Assistance Publique - Hôpitaux de Paris, Hôpital Fernand-Widal, Département Universitaire de Psychiatrie et de Médecine Addictologique, Paris, France.
¹⁷ Université de Paris Cité, INSERM UMR-S1144, Paris, France.
¹⁸ FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France.
¹⁹ SUNY Upstate, Syracuse, New York, New York.
²⁰ Nyír}o Gyula National Institute of Psychiatry, and Addictology, Budapest, Hungary.
²¹ Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
²² Columbia University Irving Medical Center/New York State Psychiatric Institute, New York, New York.
²³ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Hospital of the Goethe University, Goethe University Frankfurt, Frankfurt, Germany.
²⁴ University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
²⁵ Université Paris-Nanterre, UR 4430 CLIPSYD, Nanterre, France.
²⁶ NYU Grossman School of Medicine, New York, New York.
²⁷ Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands.

PMID: 39724095
PMCID: PMC11992959 (available on 2025-12-23)
DOI: 10.4088/JCP.24m15494

Abstract

Background: Treatment of attention-deficit/ hyperactivity disorder (ADHD) in patients with a substance use disorder (SUD) and comorbid ADHD (SUD +ADHD) may have positive effects on the outcome of both conditions, but controversy exists regarding the preferred ADHD treatment in these patients. Little is known about the treatments that are provided for these patients in routine addiction care practice and the factors that are associated with treatment provision.

Objective: To describe the treatments provided in everyday clinical practice and to explore factors associated with ADHD treatment provision in patients with SUD +ADHD.

Methods: An international multicenter observational prospective cohort design was employed. Patients with moderate to severe SUD and comorbid ADHD according to DSM-5 were invited to participate at the start of a new SUD treatment episode between June 2017 and May 2021. Clinical and sociodemographic data were collected at 12 study sites in 9 countries through patient interviews, interviews with treatment providers, and patient files. Treatment variation across studies was described, and mixed-effect logistic regression was used to identify factors associated with ADHD treatment provision.

Results: A total of 578 treatment-seeking patients with SUD +ADHD (274 inpatients, 303 outpatients, and 1 unknown) were recruited. About two thirds received some kind of ADHD treatment (62.8%), with 54.0% receiving pharmacologic, 34.0% receiving psychological treatment, and 25.1% receiving combined pharmacologic and psychological treatment. The treatment site explained more of the variation in ADHD treatment provision than individual patient factors. In addition, higher ADHD symptom severity and sobriety at intake were associated with receiving ADHD treatment.

Conclusion: These findings suggest that treatment of SUD +ADHD patients is suboptimal even in specialized centers with substantial practice variation. Further research is needed to better understand the barriers to implement treatment guidelines for ADHD + SUD and, thus, to improve quality of care.

Trial Registration: ISRCTN: 15998989 20/12/2019 (https://doi.org/10.1186/ISRCTN15998989).

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References

1. Rohner H, Gaspar N, Philipsen A, et al. Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among Substance Use Disorder (SUD) populations: meta-analysis. Int J Environ Res Public Health. 2023;20(2):1275. - PMC - PubMed
1. Groenman AP, Janssen TWP, Oosterlaan J. Childhood psychiatric disorders as risk factor for subsequent substance abuse: a meta-analysis. J Am Acad Child Adolesc Psychiatry. 2017;56(7):556–569. - PubMed
1. Kaye S, Ramos-Quiroga JA, van de Glind G, et al. Persistence and subtype stability of ADHD among substance use disorder treatment seekers. J Atten Disord. 2019;23(12):1438–1453. - PMC - PubMed
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Treatments and Treatment Predictors in Patients With Substance Use Disorders and Comorbid Attention-Deficit/Hyperactivity Disorder: First Results From the International Naturalistic Cohort Study of ADHD and SUD (INCAS)

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Treatments and Treatment Predictors in Patients With Substance Use Disorders and Comorbid Attention-Deficit/Hyperactivity Disorder: First Results From the International Naturalistic Cohort Study of ADHD and SUD (INCAS)

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