Investigating the efficacy of integrated cognitive behavioral therapy for adult treatment seeking substance use disorder patients with comorbid ADHD: study protocol of a randomized controlled trial

Katelijne Van Emmerik–Van Oortmerssen,Jack J M Dekker,Kim De Bruijn,Maarten W Koeter,Wim Van Den Brink,Ellen Vedel,Robert A Schoevers

doi:10.1186/1471-244x-13-132

Abstract

BackgroundAttention deficit hyperactivity disorder (ADHD) frequently co-occurs with substance use disorders (SUD). The combination of ADHD and SUD is associated with a negative prognosis of both SUD and ADHD. Pharmacological treatments of comorbid ADHD in adult patients with SUD have not been very successful. Recent studies show positive effects of cognitive behavioral therapy (CBT) in ADHD patients without SUD, but CBT has not been studied in ADHD patients with comorbid SUD.Methods/designThis paper presents the protocol of a randomized controlled trial to test the efficacy of an integrated CBT protocol aimed at reducing SUD as well as ADHD symptoms in SUD patients with a comorbid diagnosis of ADHD. The experimental group receives 15 CBT sessions directed at symptom reduction of SUD as well as ADHD. The control group receives treatment as usual, i.e. 10 CBT sessions directed at symptom reduction of SUD only. The primary outcome is the level of self-reported ADHD symptoms. Secondary outcomes include measures of substance use, depression and anxiety, quality of life, health care consumption and neuropsychological functions.DiscussionThis is the first randomized controlled trial to test the efficacy of an integrated CBT protocol for adult SUD patients with a comorbid diagnosis of ADHD. The rationale for the trial, the design, and the strengths and limitations of the study are discussed.Trial registrationThis trial is registered in http://www.clinicaltrials.gov as NCT01431235.

Highlights

Attention deficit hyperactivity disorder (ADHD) frequently co-occurs with substance use disorders (SUD)
This is the first randomized controlled trial to test the efficacy of an integrated cognitive behavioral therapy (CBT) protocol for adult SUD patients with a comorbid diagnosis of ADHD
To the best of our knowledge, this is the first randomized controlled trial to test the efficacy of an integrated CBT protocol aimed at reducing SUD as well as ADHD symptoms in a SUD population with comorbid adult ADHD

Summary

Discussion

To the best of our knowledge, this is the first randomized controlled trial to test the efficacy of an integrated CBT protocol aimed at reducing SUD as well as ADHD symptoms in a SUD population with comorbid adult ADHD. The difference in time spent in therapy between the two conditions is relatively limited and may in reality even be smaller since not all patients will attend all sessions In this first study we want to explore whether a combination of a little extra time with a more specific ADHD treatment is effective at all and whether this is cost-effective. The presence of objective measures such as neuropsychological tests and biological markers of substance use will allow us to explore whether such bias really occurred and how such bias may have influenced the results Despite these challenges and limitations, we think that this study provides a first important step towards developing a tailored integrated treatment protocol for patients with SUD and comorbid ADHD. All authors have contributed to the writing of this paper and have read and approved the final paper

Background

Methods

Findings