Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders

Wilens, Timothy E.; Adler, Lenard A.; Weiss, Margaret D.; Michelson, David; Ramsey, Janet L.; Moore, Rodney J.; Renard, Didier; Brady, Kathleen T.; Trzepacz, Paula T.; Schuh, Leslie M.; Ahrbecker, Lisa M.; Levine, Louise R.

doi:10.1016/j.drugalcdep.2008.02.009

Cited by 171Attention Deficit Hyperactivity DisorderSubstance Abuse Treatment and OutcomesNeurotransmitter Receptor Influence on Behavior

Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders

Wilens, Timothy E., Adler, Lenard A., Weiss, Margaret D., Michelson, David, Ramsey, Janet L., Moore, Rodney J., Renard, Didier, Brady, Kathleen T. +4 more·2008·Drug and Alcohol Dependence

DOI 10.1016/j.drugalcdep.2008.02.009

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Abstract

Objective Adults with attention-deficit/hyperactivity disorder (ADHD) have higher rates of alcohol and drug use disorders than adults without ADHD. The study aim was to determine if atomoxetine was superior to placebo in improving ADHD and alcohol use in recently abstinent adults with ADHD and comorbid alcohol use disorder.Methods Adults with DSM-IV diagnoses of ADHD and alcohol abuse and/or dependence were abstinent from alcohol at least 4 days (maximum 30 days) before study randomization. Participants received atomoxetine (25-100mg daily) or placebo for 12 weeks. ADHD symptoms were assessed using ADHD Investigator Symptom Rating Scale (AISRS) total score. Time-to-relapse to heavy alcohol use was analyzed using a 2-sided log-rank test based on Kaplan-Meier estimates and cumulative heavy drinking events over time were evaluated post hoc with recurrent-event analysis.Results Subjects received atomoxetine (n=72) or placebo (n=75) and 80 subjects completed the 12-week double-blind period (n=32 and 48, respectively). ADHD symptoms were significantly improved in the atomoxetine cohort compared to placebo (AISRS total score mean [S.D.], atomoxetine: -13.63 [11.35], P<.001; placebo: -8.31 [11.44], P<.001, difference: P=.007; effect size=0.48). No significant differences between treatment groups occurred in time-to-relapse of heavy drinking (P=.93). However, cumulative heavy drinking days were reduced 26% in atomoxetine-treated subjects versus placebo (event ratio=0.74, P=.023). There were no serious adverse events or specific drug-drug reactions related to current alcohol use.Conclusions This 3-month, double-blind, placebo-controlled study of atomoxetine in adults with ADHD and comorbid alcohol use disorder demonstrates clinically significant ADHD improvement, and inconsistent effects on drinking behavior.

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Atomoxetine may be an alternative to stimulant treatment in substance abuse patients with ADHD, although studies showing superiority over stimulants in this population are still lacking.
“The non stimulant atomoxetine may be an alternative to treatment with stimulants in substance abuse patients with ADHD, although studies showing superiority over stimulants in this difficult patient population are still lacking [200,284-286].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [285]

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Atomoxetine treatment of adults with ADHD and comorbid alcohol abuse disorder
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Authors: Wilens, T. E., Adler, L. A., Weiss, M. D., Michelson, D., Ramsey, J. L., Moore, R. J., Renard, D., Brady, K. T., Trzepacz, P. T., Schuh, L. M., Ahrbecker, L. M., & Levine, L. R.
Affiliations: Massachusetts General Hospital (US)
New York University (US)
University of British Columbia (CA)
Eli Lilly (United States) (US)
Medical University of South Carolina (US)
Corresponding author: Wilens, Timothy E.
ORCID: Wilens, Timothy E.
Adler, Lenard A.
Weiss, Margaret D.
Michelson, David
Moore, Rodney J.
Renard, Didier
Brady, Kathleen T.
Schuh, Leslie M.
Venue: Drug and Alcohol Dependence
Publisher: Elsevier BV
Published: 2008-07
Volume: 96
Issue: 1-2
Pages: 145-154
ISSN: 0376-8716 (ISSN-L)
DOI: 10.1016/j.drugalcdep.2008.02.009
OpenAlex: W2061126019
Cited by: 171
References: 69
Citations by year: 2026: 5 · 2025: 3 · 2024: 2 · 2023: 5 · 2022: 5 · 2021: 12 · 2020: 8 · 2019: 9 · 2018: 8 · 2017: 10 · 2016: 9 · 2015: 13 · 2014: 14 · 2013: 14 · 2012: 12
FWCI: 9.81
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Drug and Alcohol Dependence (publishedVersion)
PubMed (publishedVersion)
Funders: Eli Lilly and Company (5U10DA015831-0, K24 DA016264)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Keywords: atomoxetine, adult ADHD, alcoholism, comorbidities, alcohol relapse, heavy drinking, ADHD symptoms, pharmacotherapy
MeSH terms: Atomoxetine Hydrochloride, Adult, Alcohol Drinking, Attention Deficit Disorder with Hyperactivity, Double-Blind Method, Female, Humans, Male, Placebos, Propylamines, Psychiatric Status Rating Scales, Comorbidity, Treatment Outcome, Adrenergic Uptake Inhibitors, Alcohol-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders

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Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders

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