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Title: Atomoxetine Effective for ADHD in Teens With Substance Use Disorders: Presented at AACAP

"Atomoxetine Effective for ADHD in Teens With Substance Use Disorders: Presented at AACAP"

By Laura Gater CHICAGO -- November 4, 2008 -- Atomoxetine is generally well tolerated in adolescents with substance use disorder and symptoms of attention deficit hyperactivity disorder (ADHD) when used in combination with cognitive behaviour therapy (CBT), according to research presented here at the American Academy of Child and Adolescent Psychiatry (AACAP) 55th Annual Meeting. Christian Thurstone, MD, Denver Health and Hospital Authority, University of Colorado, Denver, Colorado, presented the results in a poster on October 31. Teens presenting for treatment of substance use disorders have rates of ADHD of about 40%, and comorbid ADHD is associated with worse outcomes in these patients, according to Dr. Thurstone. There is only 1 published drug trial for teens with ADHD and substance use disorder, which showed some efficacy of pemoline for ADHD in adolescents with substance use disorder, pointed out Dr. Thurstone.(1) A lack of research may explain why clinicians have been reluctant to provide integrated treatment, he said. To address this research gap, Dr. Thurstone and colleagues conducted a 12-week trial of atomoxetine versus placebo for treatment of ADHD in youth with substance use disorder. The trial's 70 subjects were aged 13 to 19 years and were diagnosed with ADHD according to the [Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). Patients had at least 1 nontobacco substance use disorder. They were randomised to placebo or atomoxetine starting at 0.5 mg/kg daily and titrated to 1.5 mg/kg daily in weekly increments of 25 mg. All patients also received CBT. Patients were evaluated using the ADHD checklist of the DSM-IV.

Results showed that symptoms of ADHD decreased significantly in the atomoxetine group from a mean score of 41.6 to a mean score of 23.1 (P < .05) and in the placebo group from 38.5 to 20.5 (P < .05). However, the difference between treatment arms was not significant.

The study also showed a larger than expected reduction in ADHD symptoms in the placebo plus CBT group that was similar to findings from several studies done of adults with ADHD and substance use disorder.(2-4)

Dr. Thurstone concluded that a longer study may be needed to assess differences between atomoxetine versus placebo.

Funding for this study was provided in part by Eli Lilly and Company.

1. Riggs PD et al. J Am Acad Child Adolesc Psychiatry. 2004;43:420-429.
2. Carpentier PJ et al. Addiction. 2005;100:1868-1874.
3. Levin FR et al. Drug Alcohol Depend. 2006;81:137-148.
4. Levin FR et al. Drug Alcohol Depend. 2007;87:20-29.

[Presentation title: A Randomized, Controlled Trial of Atomoxetine for ADHD in Teens With Substance Use Disorders. Abstract 6.1]

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