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Hernández M, Levin FR, Campbell ANC. ADHD and Alcohol Use Disorder: Optimizing Screening and Treatment in Co-occurring Conditions. CNS Drugs 2025; 39:457-472. [PMID: 39979544 DOI: 10.1007/s40263-025-01168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2025] [Indexed: 02/22/2025]
Abstract
Attention deficit hyperactivity disorder (ADHD) is notably overrepresented in substance use treatment centers, with an estimated prevalence of 21-23% when screening practices are implemented. Many adults in these settings receive an ADHD diagnosis for the first time, highlighting the frequent underdiagnosis of ADHD among individuals seeking treatment for alcohol and substance use issues. Additionally, those entering treatment programs represent only a small fraction of the broader population with problematic alcohol use. This review explores the research on the prevalence and treatment of co-occurring ADHD and substance use disorders (SUD), with a particular emphasis on alcohol use disorders (AUD) as the most common SUD. It also provides clinical guidelines for the screening and diagnosis of ADHD in patients with active alcohol and substance use and offers recommendations to enhance screening practices and improve access to treatment for individuals with co-occurring ADHD and AUD.
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Affiliation(s)
- Mariely Hernández
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA.
- Division on Substance Use Disorders, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 20, New York, NY, 10032, USA.
- Department of Psychology, The City College of New York, New York, USA.
| | - Frances R Levin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 20, New York, NY, 10032, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
- Division on Substance Use Disorders, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 20, New York, NY, 10032, USA
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Frankl M, Wennberg P, Konstenius M, Philips B. Affect Phobia Group Therapy for Patients With Substance Use Disorders and Comorbid ADHD. Scand J Psychol 2025. [PMID: 40287918 DOI: 10.1111/sjop.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 03/19/2025] [Accepted: 04/12/2025] [Indexed: 04/29/2025]
Abstract
The aim of the present study was to evaluate the feasibility and analyze preliminary data of the effectiveness of affect phobia therapy (APT) adapted to a structured group format. APT is a treatment that targets emotional avoidance and deficiency in emotion regulation that often leads to psychological dysfunction. The target group was patients with comorbid substance use disorder (SUD) and ADHD with core features of affect phobia/emotion dysregulation. Patients in three group treatments with the aim of having eight participants in each group (n = 22) were included in an open design, where targeted symptoms psychological distress, craving, affect phobia, self-compassion, emotion dysregulation, and substance use were evaluated, with repeated measurements every week from the start of therapy to follow-up 4 weeks after the end of treatment. The results showed an increase in self-compassion and a decrease in affect phobia, but no change in symptoms of psychological distress or emotional dysregulation. No reliable reduction in alcohol or drug use could be related to treatment. Craving fluctuated throughout the study period and patients' drinking patterns changed toward more social drinking. The main finding of the study was that affect phobia therapy in a structured group format is a feasible treatment for the patient group and that the therapy showed preliminary effectiveness in increasing adaptive affective functioning and self-compassion. Future randomized controlled trials are needed for conclusive evidence on efficacy, also examining whether the therapy can help reduce substance use.
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Affiliation(s)
- My Frankl
- Scandinavian Academy for Psychotherapy Development (Högskolan Sapu), Stockholm, Sweden
| | - Peter Wennberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Maija Konstenius
- Stockholm Center for Dependency Disorders, Stockholm, Sweden
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Björn Philips
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Derksen M, van Beek M, Blankers M, Nasri H, de Bruijn T, Lommerse N, van Wingen G, Pauws S, Goudriaan AE. Effectiveness of Machine Learning-Based Adjustments to an eHealth Intervention Targeting Mild Alcohol Use. Eur Addict Res 2024; 31:47-59. [PMID: 39709958 DOI: 10.1159/000543252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 12/13/2024] [Indexed: 12/24/2024]
Abstract
INTRODUCTION This study aimed to evaluate effects of three machine learning based adjustments made to an eHealth intervention for mild alcohol use disorder, regarding (a) early dropout, (b) participation duration, and (c) success in reaching personal alcohol use goals. Additionally, we aimed to replicate earlier machine learning analyses. METHODS We used three cohorts of observational log data from the Jellinek Digital Self-help intervention. First, a cohort before implementation of adjustments (T0; n = 320); second, a cohort after implementing two adjustments (i.e., sending daily emails in the first week and nudging participants towards a "no alcohol use" goal; T1; n = 146); third, a cohort comprising the prior adjustments complemented with eliminated time constraints to reaching further in the intervention (T2; n = 236). RESULTS We found an increase in participants reaching further in the intervention, yet an increase in early dropout after implementing all adjustments. Moreover, we found that more participants aimed for a quit goal, whilst participation duration declined at T2. Intervention success increased, yet not significantly. Lastly, machine learning demonstrated reliability for outcome prediction in smaller datasets of an eHealth intervention. CONCLUSION Strong correlates as indicated by machine learning analyses were found to affect goal setting and use of an eHealth program for alcohol use problems.
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Affiliation(s)
- Marloes Derksen
- Arkin Mental Health Care, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Medical Informatics, eHealth Living & Learning Lab Amsterdam, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health & Mental Health, Amsterdam, The Netherlands
| | - Max van Beek
- Arkin Mental Health Care, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health & Mental Health, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Psychiatry, Amsterdam Institute for Addiction Research, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Matthijs Blankers
- Arkin Mental Health Care, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Psychiatry, Amsterdam Institute for Addiction Research, Location University of Amsterdam, Amsterdam, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Hamed Nasri
- Arkin Mental Health Care, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Psychiatry, Amsterdam Institute for Addiction Research, Location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Nick Lommerse
- Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Guido van Wingen
- Amsterdam UMC, Department of Psychiatry, Amsterdam Institute for Addiction Research, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Steffen Pauws
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands
| | - Anna E Goudriaan
- Arkin Mental Health Care, Amsterdam, The Netherlands
- Amsterdam Public Health, Digital Health & Mental Health, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Psychiatry, Amsterdam Institute for Addiction Research, Location University of Amsterdam, Amsterdam, The Netherlands
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Ward JH, McBride A, Price A, Delgado TN. Psychosocial interventions for improving the physical health of young people and adults with attention deficit hyperactivity disorder: a scoping review. BMC Psychiatry 2024; 24:569. [PMID: 39164688 PMCID: PMC11337789 DOI: 10.1186/s12888-024-06009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 08/08/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Young people and adults with ADHD are at risk of a range of physical health problems. There is limited guidance on how to approach health problems in ADHD, and especially around 16-25 year olds who will be transitioning from paediatric to adult care. The aim of this scoping review was to identify psychosocial interventions that target physical health in young people and adults with ADHD. METHODS We constructed searches in MEDLINE, PsycInfo, EMBASE of adolescents, young people and adults. Inclusion criteria were; studies of psychosocial interventions examining a component of physical health, applicable to people aged 16-25, with clinical or research diagnoses of ADHD. Data were extracted using a data extraction tool and tabulated, including study intervention framing/aims, population, intervention, and relevant outcomes (including specific statistics where relevant). RESULTS Our search identified 22 unique papers covering, psychosocial interventions targeting at least one of sleep (n=7), smoking (n=3), substance/alcohol use (n=4), physical health/exercise (n=6) and general health (n=3). Studies examined psychotherapy/behaviour interventions (n=12), psychoeducation (n=4), digital (n=2) and social interventions (n=4). There was significant heterogeneity in intervention framing, outcome measures and population. CONCLUSION Further work on the impact of targeted physical health interventions, with explicit reference to a conceptual framework of poor health in ADHD is required. Furthermore, future work standardising reporting of physical health outcomes in ADHD is crucial for the development of an evidence base in this field.
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Affiliation(s)
- John Headley Ward
- 2.05 South Cloisters, 2.05 South Cloisters, St Luke's Campus, University of Exeter Medical School, Heavitree Road, Exeter, EX2 4TH, UK.
- Royal Devon University NHS Foundation Trust, Exeter, UK.
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Audrey McBride
- 2.05 South Cloisters, 2.05 South Cloisters, St Luke's Campus, University of Exeter Medical School, Heavitree Road, Exeter, EX2 4TH, UK
| | - Anna Price
- 2.05 South Cloisters, 2.05 South Cloisters, St Luke's Campus, University of Exeter Medical School, Heavitree Road, Exeter, EX2 4TH, UK
| | - Tamsin Newlove Delgado
- 2.05 South Cloisters, 2.05 South Cloisters, St Luke's Campus, University of Exeter Medical School, Heavitree Road, Exeter, EX2 4TH, UK
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Lozano-Rojas ÓM, Gómez-Bujedo J, Pérez-Moreno PJ, Lorca-Marín JA, Vera BDV, Moraleda-Barreno E. Impulsivity Predicts Relapse—but Not Dropout—in Outpatients with SUD: a Longitudinal Study. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
AbstractThe objective of this study was to compare performance on a comprehensive impulsivity battery of SUD outpatients who dropout versus those who do not dropout and of abstainers versus relapsers at 3 and 12 months of treatment follow-up. Impulsivity was measured at the start of treatment and adherence and relapse at 3 and 12 months. The participants are 115 outpatients with SUD. Motor impulsivity (Affective Go/No Go), attentional impulsivity (Stroop), delay discounting (Monetary Choice Questionnaire; MCQ), and decision making (Iowa Gambling Task; IGT) were assessed. Impulsivity was not associated with dropout. There were no relationships between treatment outcomes and the MCQ and IGT. Stroop and affective Go-No Go were associated with relapse at 3 and 12 months. Affective motor disinhibition and cognitive disinhibition predict relapse in outpatients. No cognitive aspect of impulsiveness is related to dropout.
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ADHD Follow-Up in Adulthood among Subjects Treated for the Disorder in a Child and Adolescent Mental Health Service from 1995 to 2015. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020338. [PMID: 36837537 PMCID: PMC9966311 DOI: 10.3390/medicina59020338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
Background and Objectives: ADHD is a neurodevelopmental disorder characterized by inattention and hyperactivity/impulsivity and can persist in adulthood. The aim of this study is to deepen knowledge about adult ADHD follow-up. Materials and Methods: This observational study consists of one retrospective part aimed at collecting records of children and adolescents treated for ADHD in the Children and Adolescent Mental Health Service (CAMHS) from 1995 to 2015 and, successively, at identifying their adult follow-up in Adult Mental Health Service (AMHS); the second part consists of ADHD scale administration, Diagnostic Interview for ADHD in Adults (DIVA 2-0) and Adult Self Rating Scale (ASRSv1.1), for the subjects currently being treated at AMHS who agreed to participate in the study. Results: We observed that among the 55 patients treated at CAMHS between 1995 and 2015 for ADHD and subsequently at the AMHS, none presented a diagnosis of ADHD; instead, they were treated for Intellectual Dysfunction (33%), Borderline Personality Disorder (15%) and Anxiety Disorders (9%), and two individuals were also diagnosed with comorbid substance/alcohol abuse (4%). Of the 55 patients, only 25 (45%) were treated at AMHS during the study period. Though we asked for their informed consent to administer the questionnaires, we were able to test only seven patients. The ASRS-V1.1 score showed that 43% of patients reported symptoms of ADHD persistence in adulthood. For DIVA 2.0, 57% of individuals reported scores indicating the persistence of the ADHD inattention component, and 43% the persistence of both ADHD dimensions. Conclusions: ADHD cannot be considered a disorder confined to childhood/adolescence but instead is a chronic and complex condition that can persist into adulthood. The very small size of our final sample may account for both the high ADHD dropout rate over the long follow-up period and the difficult transition from child to adult health care in ADHD treatment. Our investigation suggests the need for specific training in the diagnosis and treatment of adult ADHD and the implementation of transition protocols between minor and adult services to improve long-term treatments.
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Luderer M, Seidt J, Gerhardt S, Hoffmann S, Vollstädt-Klein S, Reif A, Sobanski E. Drinking alcohol to cope with hyperactive ADHD? Self-reports vs. continuous performance test in patients with ADHD and/or alcohol use disorder. Front Psychiatry 2023; 14:1112843. [PMID: 36950259 PMCID: PMC10025293 DOI: 10.3389/fpsyt.2023.1112843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
Rationale Attention deficit/hyperactivity disorder (ADHD) is common in alcohol use disorder (AUD). Continuous performance tests (CPTs) allow to measure ADHD related deficits in a laboratory setting. Most studies on this topic focused on CPTs measuring inattention or impulsivity, disregarding hyperactivity as one of the core symptoms of ADHD. Methods We examined N = 47 in three groups (ADHD N = 19; AUD N = 16; ADHD + AUD N = 12) with questionnaires on ADHD core symptoms, executive functioning (EF), mind wandering, and quality of life (QoL). N = 46 (ADHD N = 16; AUD N = 16; ADHD + AUD N = 14) were examined with a CPT (QbTest®) that also measures motor activity objectively. Results Inattention and impulsivity were significantly increased in AUD vs. ADHD and in AUD vs. ADHD + AUD. Hyperactivity was significantly higher in ADHD + AUD vs. ADHD and ADHD + AUD vs. AUD, but not in ADHD vs. AUD. EF was lower in both ADHD groups vs. AUD. Mind wandering was increased in both ADHD groups vs. AUD. QoL was significantly lower in ADHD + AUD compared to AUD. In contrast, results of the QbTest were not significantly different between groups. Conclusion Questionnaires are more useful in assessing ADHD core symptoms than the QbTest®. Hyperactivity appears to be a relevant symptom in ADHD + AUD, suggesting a possible pathway from ADHD to AUD. The lower QoL in ADHD + AUD emphasizes the need for routine screening, diagnostic procedures and treatment strategies for this patient group.
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Affiliation(s)
- Mathias Luderer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- *Correspondence: Mathias Luderer,
| | - Johanna Seidt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Behle N, Kamp F, Proebstl L, Hager L, Riebschläger M, Schacht-Jablonowsky M, Hamdorf W, Neumann S, Krause D, Manz K, Franke AG, Koller G, Soyka M. Treatment outcome, cognitive function, and psychopathology in methamphetamine users compared to other substance users. World J Psychiatry 2022; 12:944-957. [PMID: 36051595 PMCID: PMC9331444 DOI: 10.5498/wjp.v12.i7.944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/28/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The rising number of people using methamphetamine leads to an increasing need for treatment options for this patient group. Evidence-based research on the efficacy of treatment programs for methamphetamine users is limited. Due to specific characteristics of methamphetamine users, the question arises whether established treatment methods for individuals using other substances can be effective for the treatment of methamphetamine dependence as well. We hypothesize that there are significant differences between the two groups that may affect the effectiveness of treatment and worsen the prognosis of treatment outcomes for methamphetamine users compared to consumers of other substances.
AIM To investigate potential differences in cognitive functioning and psychopathology between methamphetamine users and other substance users and possible correlations with treatment outcomes.
METHODS A total of 110 subjects were recruited for an observational, longitudinal study from a German inpatient addiction treatment center: 55 patients with methamphetamine dependence and 55 patients with dependence of other substances (“OS group”). Both groups were examined at beginning (baseline) and end of treatment (after 6 mo) with regard to treatment retention, craving, cognitive functioning, psychosocial resources, personality traits, depression, and other psychiatric symptoms. Instruments used were Raven’s IQ test, Mannheimer craving scale, cognitrone cognitive test battery, NEO personality factors inventory, Hamilton depression scale, Becks depression inventory, and a symptom checklist. The statistical methods used were χ2-test, t-test and multiple mixed ANOVAs.
RESULTS A total drop-out rate of 40% (methamphetamine-group: 36.4%; OS-group: 43.6%) was observed without significant differences between groups. At baseline, methamphetamine-group subjects significantly differed from OS-group individuals in terms of a lower intelligence quotient, fewer years of education, slower working speed, and decreased working accuracy, as well as less cannabinoid and cocaine use. Methamphetamine-group subjects further showed a significantly lower score of conscientiousness, depressive, and psychiatric symptoms than subjects from the OS-group. In both groups, a reduction of craving and depressive symptoms and an improvement of working speed and working accuracy was noted after treatment.
CONCLUSION There are differences between methamphetamine users and users of other drugs, but not with regard to the effectiveness of treatment in this inpatient setting. There are differences in cognitive function and psychopathology between methamphetamine and other drugs users. The existing treatment options seem to be an effective approach in treating methamphetamine dependence.
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Affiliation(s)
- Nina Behle
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich 80336, Germany
| | - Felicia Kamp
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich 80336, Germany
| | - Lisa Proebstl
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich 80336, Germany
| | - Laura Hager
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich 80336, Germany
| | | | | | | | | | - Daniela Krause
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians University, Munich 80336, Germany
| | - Kirsi Manz
- Institute for Medical Information Processing, Ludwig Maximilians University, Munich 81377, Germany
| | - Andreas Guenter Franke
- University of Applied Labour Studies of the Federal Employment Agency, Mannheim 68163, Germany
| | - Gabriele Koller
- Department of Psychiatry, Ludwig Maximilians University, Munich 80336, Germany
| | - Michael Soyka
- Department of Psychiatry, Ludwig Maximilians University, Munich 80336, Germany
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Rudner T, Hume DJ, Larmuth K, Atterbury E, Rauch HGL, Kroff J. Substance use disorder and obesogenic eating: Does working memory training strengthen ability to abstain from unwanted behaviors? A systematic review. J Subst Abuse Treat 2021; 137:108689. [PMID: 34952746 DOI: 10.1016/j.jsat.2021.108689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/06/2021] [Accepted: 12/07/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Abstaining from unwanted behaviors requires a sufficient balance between the executive and impulsive cognitive systems. Working memory (WM) is a vital component of both systems, identified in a wide range of research as the central and dominant component of executive function. WM potentially modulates the desires, tendencies, and behaviors specific to and seen in individuals with substance use disorder (SUD) and obesogenic eating (OE). Compared to healthy populations, research has shown individuals with SUD, as well as those who display OE, to have some degree of executive dysfunction, and both conditions have far-reaching health care implications. Additionally, these deficits are associated with impulsive behavior. Research has proposed that impulsive and so-called reward-driven responses could be altered through cognitive therapy and that both SUD and OE could benefit from working memory training (WMT). METHOD In this narrative review, we systematically align extant empirical reasoning and evidence with these assumptions. Our main aim is to ascertain and summarize the value of WMT for the treatment of both SUD and food reward consummatory behaviors. As a means to include detailed narrative accounts of all papers of potential value, our thresholds for meaningful improvements in both WM and unwanted behaviors are broad. RESULTS The results from the eleven qualifying studies are as follows: Nine of ten studies show a significant positive training effect of WMT on one or more components of WM capacity; three of six eligible papers (two on alcohol and one on opioid addiction) deliver notable improvements in SUD in response to WMT. One of two suitable studies showed WMT to be a moderately efficacious form of therapy for OE. Conversely, WMT appears to have negligible therapeutic benefit for cognitive function deficits or psychopathology unrelated to WM, suggesting that WMT has unique treatment efficacy for impulsive human behaviors. CONCLUSION In conclusion, more rigorous and uniform studies on WMT and impulsive harmful behaviors are required to give proof of the benefits of this potential useful treatment.
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Affiliation(s)
- Trinity Rudner
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - David J Hume
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kate Larmuth
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Elizabeth Atterbury
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - H G Laurie Rauch
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jacolene Kroff
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
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10
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Ramos LA, Blankers M, van Wingen G, de Bruijn T, Pauws SC, Goudriaan AE. Predicting Success of a Digital Self-Help Intervention for Alcohol and Substance Use With Machine Learning. Front Psychol 2021; 12:734633. [PMID: 34552539 PMCID: PMC8451420 DOI: 10.3389/fpsyg.2021.734633] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Digital self-help interventions for reducing the use of alcohol tobacco and other drugs (ATOD) have generally shown positive but small effects in controlling substance use and improving the quality of life of participants. Nonetheless, low adherence rates remain a major drawback of these digital interventions, with mixed results in (prolonged) participation and outcome. To prevent non-adherence, we developed models to predict success in the early stages of an ATOD digital self-help intervention and explore the predictors associated with participant's goal achievement. Methods We included previous and current participants from a widely used, evidence-based ATOD intervention from the Netherlands (Jellinek Digital Self-help). Participants were considered successful if they completed all intervention modules and reached their substance use goals (i.e., stop/reduce). Early dropout was defined as finishing only the first module. During model development, participants were split per substance (alcohol, tobacco, cannabis) and features were computed based on the log data of the first 3 days of intervention participation. Machine learning models were trained, validated and tested using a nested k-fold cross-validation strategy. Results From the 32,398 participants enrolled in the study, 80% of participants did not complete the first module of the intervention and were excluded from further analysis. From the remaining participants, the percentage of success for each substance was 30% for alcohol, 22% for cannabis and 24% for tobacco. The area under the Receiver Operating Characteristic curve was the highest for the Random Forest model trained on data from the alcohol and tobacco programs (0.71 95%CI 0.69-0.73) and (0.71 95%CI 0.67-0.76), respectively, followed by cannabis (0.67 95%CI 0.59-0.75). Quitting substance use instead of moderation as an intervention goal, initial daily consumption, no substance use on the weekends as a target goal and intervention engagement were strong predictors of success. Discussion Using log data from the first 3 days of intervention use, machine learning models showed positive results in identifying successful participants. Our results suggest the models were especially able to identify participants at risk of early dropout. Multiple variables were found to have high predictive value, which can be used to further improve the intervention.
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Affiliation(s)
- Lucas A Ramos
- Department of Psychiatry, Amsterdam UMC, and Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, Netherlands
| | - Matthijs Blankers
- Department of Psychiatry, Amsterdam UMC, and Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, Netherlands.,Arkin Mental Health Care, Amsterdam, Netherlands.,Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam UMC, and Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, Netherlands
| | | | - Steffen C Pauws
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands.,Department of Remote Patient Management and Chronic Care, Philips Research, Eindhoven, Netherlands
| | - Anneke E Goudriaan
- Department of Psychiatry, Amsterdam UMC, and Amsterdam Institute for Addiction Research, University of Amsterdam, Amsterdam, Netherlands.,Arkin Mental Health Care, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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11
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Riedel P, Wolff M, Spreer M, Petzold J, Plawecki MH, Goschke T, Zimmermann US, Smolka MN. Acute alcohol does not impair attentional inhibition as measured with Stroop interference scores but impairs Stroop performance. Psychopharmacology (Berl) 2021; 238:1593-1607. [PMID: 33660080 PMCID: PMC8139883 DOI: 10.1007/s00213-021-05792-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
RATIONALE Inhibition is a core executive function and refers to the ability to deliberately suppress attention, behavior, thoughts, and/or emotions and instead act in a specific manner. While acute alcohol exposure has been shown to impair response inhibition in the stop-signal and Go/NoGo tasks, reported alcohol effects on attentional inhibition in the Stroop task are inconsistent. Notably, studies have operationalized attentional inhibition variably and there has been intra- and inter-individual variability in alcohol exposure. OBJECTIVE This study aimed to examine the acute effects of alcohol on attentional inhibition, considering previous limitations. METHODS In a single-blind, cross-over design, 40 non-dependent participants with a medium-to-high risk drinking behavior performed a Counting Stroop task (CST) under a baseline and an arterial blood alcohol concentration (aBAC) clamp at 80 mg%. Attentional inhibition was assessed as the alteration of reaction times (RT), error rates (ER), and inverse efficiency scores (IES) between incongruent and congruent trials (interference score). Stroop performance was also assessed regardless of trial-type. RESULTS Compared to saline, acute alcohol exposure via an aBAC clamp did not affect CST interference scores but increased RTs and IES in both incongruent and congruent trials. CONCLUSIONS Attentional inhibition (Stroop interference score) was not impaired by clamped moderate alcohol exposure. Acute alcohol impaired Stroop performance evidenced by a general increase in response times. Our findings suggest that response and attentional inhibition do not share the same neurocognitive mechanisms and are affected differently by alcohol. Results could also be explained by automated behaviors known to be relatively unaffected by acute alcohol.
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Affiliation(s)
- P Riedel
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - M Wolff
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Department of General Psychology, Technische Universität Dresden, Zellescher Weg 17, 01069, Dresden, Germany
| | - M Spreer
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - J Petzold
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany
| | - M H Plawecki
- Department of Psychiatry, Indiana University School of Medicine, 355 West 16th Street, Indianapolis, IN, 46202, USA
| | - T Goschke
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany
- Department of General Psychology, Technische Universität Dresden, Zellescher Weg 17, 01069, Dresden, Germany
| | - U S Zimmermann
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Department of Addiction Medicine and Psychotherapy, kbo-Isar-Amper-Klinikum München-Ost, Vockestraße 72, 85540, Haar, Germany
| | - M N Smolka
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany.
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Problematic internet use: The effect of comorbid psychopathology on treatment outcomes. Psychiatry Res 2021; 298:113789. [PMID: 33639406 DOI: 10.1016/j.psychres.2021.113789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/03/2021] [Indexed: 12/26/2022]
Abstract
Problematic Internet use (PIU) behaviours involve one's maladaptive Internet use and have been often described as secondary manifestations of pre-existing psychopathology. Furthermore, different profiles of PIU sufferers have been proposed. However, little is known of the impact these may be having on treatment responses. Thus, this study aims to investigate the psychopathological profiles of those who seek treatment for PIU within a specialised public outpatient unit and whether these influence treatment outcomes. This research utilised 203 treatment seekers of the Specialized Department of Problematic Internet Use (SD-PIU) of the Psychiatric Hospital of Attica, in Greece (mean age = 26.02; SD = 7.9). To assess psychopathology, the Symptom Checklist-90 Revised (SCL-90-R) was used. Treatment responses were reported either as completed, continued, or drop out. A Latent Class/Profiling-Analysis (LCA) was performed, guided by variations across the SCL-90-R psychopathologies. It indicated two naturally occurring profiles of comorbid psychological symptoms; 66% were classified as the "High Comorbidity" (HC) and 34% as the "Low Comorbidity" (LC) profile. Regarding treatment outcomes, LC patients presented with significantly lower dropout rates and higher levels of completion. The present study poses imperative clinical implications regarding the necessity of specialized treatment planning based on the different PIU treatment seekers psychopathological comorbidities.
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Does ADHD Symptomatology Influence Treatment Outcome and Dropout Risk in Eating Disorders? A longitudinal Study. J Clin Med 2020; 9:jcm9072305. [PMID: 32698514 PMCID: PMC7408799 DOI: 10.3390/jcm9072305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 12/28/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and its symptoms have been shown to be present in patients with eating disorders (EDs) and are associated with increased psychopathology and more dysfunctional personality traits. This study aimed to assess if the presence of ADHD symptoms in patients with EDs affects their short and long-term therapy outcome. A total of 136 consecutively treated ED patients were considered in this study. Baseline pre-treatment evaluation included the Adult ADHD Self-Report Scale (ASRS v1.1) for ADHD symptoms and the assessment of eating symptomatology using the Eating Disorders Inventory (EDI-2). Treatment outcome was evaluated in terms of ED symptoms after cognitive behavioral therapy (CBT) and dropout rate during treatment. Furthermore, we evaluated ED symptoms in treatment completers after a follow-up of 8 years on average. Path analyses assessed the potential mediational role of the EDI-2 total score in the relationship between ADHD and treatment outcome. Results showed that baseline symptoms of ADHD indirectly affected treatment outcome after CBT; the ASRS positive screening was related to higher eating symptomatology (standardized coefficient B = 0.41, p = 0.001, 95% CI: 0.26 to 0.55), and the presence of high ED levels contributed to the increase of dropout (B = 0.15, p = 0.041, 95% CI: 0.03 to 0.33) and a worse treatment outcome (B = 0.18, p = 0.041, 95% CI: 0.01 to 0.35). No direct effect was found between the ASRS positive screening with the risk of dropout (B = -0.08, p = 0.375) and worse treatment outcome (B = -0.07, p = 0.414). These results suggest the relevance of identifying specific treatment approaches for patients with ADHD symptoms and severe eating symptomatology.
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Schellekens AF, van den Brink W, Kiefer F, Goudriaan AE. Often Overlooked and Ignored, but Do Not Underestimate Its Relevance: ADHD in Addiction − Addiction in ADHD. Eur Addict Res 2020; 26:169-172. [PMID: 32615559 PMCID: PMC7949230 DOI: 10.1159/000509267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Arnt F.A. Schellekens
- Professor of Psychiatry and Addiction, Department of Psychiatry, RadboudUmc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands,Scientific Director Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands,*Arnt F.A. Schellekens, Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, PO Box 9101, NL– 6500 HB Nijmegen (The Netherlands),
| | - Wim van den Brink
- Emeritus Professor of Psychiatry and Addiction, Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Falk Kiefer
- Professor of Psychiatry and Psychotherapy, University of Heidelberg, Mannheim, Germany,Director of Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Anneke E. Goudriaan
- Professor of Working Mechanisms and Treatment of Addiction, Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands,Director Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
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