Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence: a 24‐week randomized placebo‐controlled trial

Abstract

Aim To test the efficacy and safety of osmotic release oral system (OROS) methylphenidate (MPH) in doses up to 180 mg/day to treat attention deficit hyperactivity disorder (ADHD) and prevent any drug relapse in individuals with a co‐diagnosis of ADHD and amphetamine dependence. Design Randomized placebo‐controlled 24‐week double‐blind trial with parallel groups design. Setting Participants were recruited from medium security prisons in Sweden. The medication started within 2 weeks before release from prison and continued in out‐patient care with twice‐weekly visits, including once‐weekly cognitive behavioural therapy. Participants Fifty‐four men with a mean age of 42 years, currently incarcerated, meeting DSM‐IV criteria for ADHD and amphetamine dependence. Measurements Change in self‐reported ADHD symptoms, relapse to any drug use (amphetamine and other drugs) measured by urine toxicology, retention to treatment, craving and time to relapse. Findings The MPH‐treated group reduced their ADHD symptoms during the trial (P = 0.011) and had a significantly higher proportion of drug‐negative urines compared with the placebo group (P = 0.047), including more amphetamine‐negative urines (P = 0.019) and better retention to treatment (P = 0.032). Conclusions Methylphenidate treatment reduces attention deficit hyperactivity disorder symptoms and the risk for relapse to substance use in criminal offenders with attention deficit hyperactivity disorder and substance dependence.