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: 8322985
• 负责人: Paula DeGraffenreid Riggs
• 金额: $ 12.26万
• 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/8322985
• 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; 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; Methamphetamine dependence; Modality; Morbidity - disease rate; National Institute of Drug Abuse; Nicotine; Nicotine Dependence; Nicotine Withdrawal; Nucleus Accumbens; Outpatients; Participant; Pathological Gambling; Pharmaceutical Preparations; Pharmacotherapy; Placebos; Population; Process; Property; Public Health; Publishing; Randomized Controlled Trials; Reporting; Research; Research Design; Safety; Schools; Severities; Student Dropouts; Substance Use Disorder; Substance abuse problem; Substance of Abuse; Symptoms; System; Time; Treatment outcome; United States National Institutes of Health; Ventral Tegmental Area; Youth; addiction; adolescent substance abuse; base; control trial; craving; depressive symptoms; dysphoria; effective therapy; 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）：该申请是R01 DA022284的修订再提交，NIDA-L于2006年6月初步审查了该申请。本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青少年注意缺陷多动障碍（ADHD）的疗效，这些障碍通常同时发生。ADHD是青少年物质使用障碍（SUD）中最常见的并发精神疾病之一（30-50%），并与更严重的药物滥用、学业失败、长期心理障碍和较差的药物治疗结果相关。研究表明，安非他酮是一种安全有效的治疗ADHD和尼古丁依赖的方法，并且新的研究为其独特的药物治疗特性和治疗其他成瘾疾病（如甲基苯丙胺依赖，病理性赌博）的潜力提供了实证支持。目前还没有对照研究评估安非他酮治疗青少年ADHD和SUD（包括尼古丁和大麻）的安全性和有效性。由于缺乏对患有SUD和精神合并症的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项目严重缺乏对共同发生的精神健康和物质问题的综合治疗。这就导致大量有药物滥用和精神健康问题的合并症青年的治疗结果和预后较差，从而严重影响公共卫生。拟议研究的具体目的是通过对130名接受门诊药物治疗（CBT）的青少年（13-19岁）进行为期16周的安非他酮与安慰剂的随机对照试验，以评估这种低滥用潜力药物对多动症、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，从而解决这一研究空白。研究设计和分析方法将能够评估ADHD、抑郁/烦躁不安（和其他精神症状）的变化与治疗组内部和治疗组之间尼古丁、大麻和其他物质使用的变化之间复杂的相互关系。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空白：1)对成瘾和精神共病青少年的有效治疗研究，以及2)针对青少年尼古丁和大麻使用障碍的药物开发研究。