Bupropion for ADHD in Adolescents with Substance Use Disorders

安非他酮治疗患有药物使用障碍的青少年多动症

• 批准号: 7367685
• 负责人: Paula DeGraffenreid Riggs
• 金额: $ 56.81万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7367685
• 关键词: Abstinence; Address; Adolescent; Adult; Alcohol or Other Drugs use; Area; Attention deficit hyperactivity disorder; Bupropion; Cannabis; Cannabis Abuse; Clinical; Cognitive Therapy; Communities; Comorbidity; Complex; Controlled Study; Dependence; Development; Diagnostic and Statistical Manual; Disease; Dopamine Agonists; Drug Use Disorder; Drug abuse; Drug usage; Failure; Frustration; General Population; High Prevalence; Impairment; Impulsivity; Individual; Intervention; Light; Marijuana Dependence; Marijuana Smoking; Mental Depression; Mental Health; Mental disorders; Methamphetamine; Modality; Morbidity - disease rate; Nicotine; Nicotine Dependence; Nicotine Withdrawal; Nucleus Accumbens; Numbers; Outpatients; Participant; Pathological Gambling; Pharmaceutical Preparations; Pharmacotherapy; Placebos; Population; Process; Property; Public Health; Publishing; Randomized Controlled Trials; Rate; Reporting; Research; Research Design; Safety; Schools; Severities; Student Dropouts; Substance Use Disorder; Substance abuse problem; Substance of Abuse; Symptoms; System; Thinking; Time; Treatment outcome; Ventral Tegmental Area; Week; Youth; addiction; adolescent substance abuse; base; craving; depressive symptoms; dysphoria; emotional abuse; expectation; mortality; neurotoxicity; nicotine craving; outcome forecast; protective effect; psychosocial; randomized placebo controlled trial; research and development; response; smoking cessation; treatment program

DESCRIPTION (provided by applicant): This application is a revised resubmission of R01 DA022284, initially reviewed by NIDA-L in June 2006. The application proposes a randomized, placebo-controlled trial of bupropion + cognitive behavioral therapy (CBT) to evaluate the efficacy of this combined therapy for attention deficit hyperactivity disorder (ADHD) in adolescents in whom these disorders commonly co-occur. ADHD is one of the most common co-occurring psychiatric disorders (30-50%) in adolescents with substance use disorders (SUD) and has been associated with more severe drug abuse, school failure, long-term psychosocial impairment, and poorer substance treatment outcomes. Research has shown that bupropion is a safe and effective treatment for both ADHD and nicotine dependence in individuals without SUD, and newer research provides empirical support for its unique pharmacotherapeutic properties and potential for treating other addictive disorders (e.g., methamphetamine dependence, pathological gambling). No controlled studies have yet evaluated bupropion's safety and efficacy for ADHD and SUD (including nicotine and cannabis) in adolescents. The lack of research on the safety and efficacy of medications in adolescents with SUD and psychiatric comorbidities contributes to a serious lack of integrated treatment for commonly co-occurring mental health and substance problems in community-based adolescent drug treatment programs. This then contributes to poorer treatment outcomes and prognosis for the large number of comorbid youths with substance abuse and mental health problems that significantly impact public health. The specific aims of the proposed study will address this research gap by conducting a 16-week randomized controlled trial of bupropion vs. placebo to evaluate the safety and efficacy of this low abuse potential medication on ADHD, nicotine dependence, and cannabis use disorders (not excluding other SUD) in 130 adolescents (13-19) receiving concurrent outpatient substance treatment (CBT). The study design and analytic approach will enable assessment of the complex inter-relationship between change in ADHD, depression/dysphoria (and other psychiatric symptoms) and change in nicotine, cannabis and other substance use within and between treatment groups. Thus, the application addresses important research gaps in at least two priority areas of the NIDA/NIH research agenda: 1) research on effective treatments for adolescents with addiction and psychiatric comorbidity, and 2) medications development research for nicotine and cannabis use disorders in adolescents.

描述（由申请人提供）：本申请是R01 DA022284的修订版重新提交，最初由NIDA-L于2006年6月进行审查。该申请提出了一项安非他酮+认知行为疗法（CBT）的随机、安慰剂对照试验，以评估这种联合疗法对注意缺陷多动障碍（ADHD）青少年的疗效，这些障碍通常同时发生。ADHD是物质使用障碍（SUD）青少年中最常见的并发精神疾病之一（30 - 50%），与更严重的药物滥用，学业失败，长期心理社会障碍和较差的物质治疗结果有关。研究表明，安非他酮是一种安全有效的治疗ADHD和尼古丁依赖的个人没有SUD，和新的研究提供了经验支持，其独特的药理学特性和治疗其他成瘾性疾病的潜力（例如，甲基苯丙胺依赖、病态赌博）。目前还没有对照研究评估安非他酮对青少年ADHD和SUD（包括尼古丁和大麻）的安全性和有效性。缺乏对SUD和精神共病青少年药物治疗的安全性和有效性的研究，导致社区青少年药物治疗计划中普遍存在的精神健康和物质问题严重缺乏综合治疗。这导致大量患有药物滥用和精神健康问题的共病青年的治疗结果和预后较差，这些问题严重影响了公共卫生。拟议研究的具体目的将通过进行一项为期16周的安非他酮与安慰剂的随机对照试验来解决这一研究空白，以评估这种低滥用潜力药物对130名接受同时门诊药物治疗（CBT）的青少年（13 - 19）的ADHD，尼古丁依赖和大麻使用障碍（不排除其他SUD）的安全性和有效性。研究设计和分析方法将能够评估治疗组内和治疗组之间ADHD、抑郁/烦躁不安（和其他精神症状）变化与尼古丁、大麻和其他物质使用变化之间的复杂相互关系。因此，该申请解决了NIDA/NIH研究议程中至少两个优先领域的重要研究差距：1）对成瘾和精神病合并症青少年的有效治疗研究，以及2）青少年尼古丁和大麻使用障碍的药物开发研究。