Cocaine Effect Expectancies among Patients with Cocaine Use Disorder with and without Adult Attention Deficit Hyperactivity Disorder: Are There Any Relevant Differences?

ABSTRACT

Cocaine use could be modulated by drug expectancies based on previously experienced subjective effects. Some patients perceive a paradoxical calming effect after cocaine use. This study was performed to explore cocaine effect expectancies in patients diagnosed with cocaine use disorder, with and without co-occurring adult attention deficit hyperactivity disorder (ADHD). Secondly, we sought to empirically determine the presence of this paradoxical calming effect after cocaine use in patients with co-occurring adult ADHD to identify the individuals most at risk of cocaine use and relapse. Cross-sectional study using a consecutive sampling method of patients diagnosed with cocaine use disorder (n = 221) treated at public therapeutic communities in Andalusia (Spain). Participants completed a battery of instruments to assess the following variables: cocaine effect expectancies, paradoxical calming effect, adult ADHD, and other co-occurring psychiatric disorders. A multivariate binary logistic regression analysis showed that two variables, the paradoxical calming effect and antisocial personality disorder (ASPD), were independently associated with the probability of being diagnosed with adult ADHD (OR = 3.43, 95% CI = 1.88–6.26 and OR = 3.42, 95% CI = 1.30–8.95, respectively). The presence of a paradoxical calming reaction to cocaine and/or a diagnosis of ASPD in patients with cocaine use disorder increases the diagnostic suspicion of co-occurring adult ADHD.

KEYWORDS:

• Paradoxical calming effects
• cocaine
• adult attention deficit hyperactivity disorder
• antisocial personality disorder
• dual diagnosis

Acknowledgments

We are grateful to the patients who kindly participated in the study, to Esther Berrocoso Domínguez (Psychology Department, Universidad of Cádiz) and to Manuel Trujillo (Department of Psychiatry, Bellevue Hospital, New York University School of Medicine) for their interesting comments to the manuscript. We would also like to thank Bradley Londres for his assistance in improving the English in this text.

Disclosure statement

Francisco Gonzalez-Saiz have received grant support for research and educational activities from Janssen and Lilly. All other authors declare no financial interests or potential conflicts of interest related directly or indirectly to this work.

Contributors

FGS are the principal investigator for this research project. FGS and EVM specifically developed the design and methods for this study. FGS and JT performed the statistical analyses and wrote the manuscript. The clinical interviews were conducted by EVM, who revised the manuscript and contributed to writing it. All authors have approved the final manuscript.

Additional information

Funding

The present study was funded by the National Plan on Drugs, Ministry of Health, Consumption and Social Welfare, Government of Spain [2007 no. 2007i078]. Views expressed are those of the authors and do not necessarily represent those of the funding source.