Chronic exposure to cocaine is associated with persistent behavioral disturbances. A cross-sectional dimensional study i
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ORIGINAL INVESTIGATION
Chronic exposure to cocaine is associated with persistent behavioral disturbances. A cross-sectional dimensional study in outpatients with multiple substance use disorders Florence Vorspan 1,2,3 & Pauline de Witt 3,4 & El-hadi Zerdazi 3,5 & Emily Karsinti 1,3,6 & Kamilia Ksouda 7 & Romain Icick 1,3 & Frank Bellivier 1,2,3 & Nicolas Marie 8,9 & Georges Brousse 10 & Vanessa Bloch 3,11,12 Received: 14 October 2019 / Accepted: 27 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Rationale Behavioral disturbances (BD) are prevalent in patients with substance use disorders (SUD). Objectives To test the hypothesis that chronic exposure to cocaine could favor the acquisition of BD that were not present in childhood. Methods We used child and adult ADHD self-report screening scales (WURS-25 and ASRS-6, respectively, with their usual threshold) as assessment tools for significant BD. In a cross-sectional assessment of 382 patients with multiple SUD, we investigated BD and then “de novo” BD (i.e., by restricting the sample to patients below the threshold for childhood BD) (N = 214). We also tested for a gradient effect between patients’ lifetime DSM IV cocaine and opioid dependence status and the prevalence of BD. Results BD were found in 188/382 (42.9%) subjects and in 74/214 (34.6%) subjects. Three clinical factors were associated with BD in the whole sample: the number of cocaine dependence criteria (OR = 1.36 [1.14–1.64], p = 0.001), the number of opioid dependence criteria (OR = 0.69 [0.52–0.91], p = 0.010), and a personal history of using cocaine through rapid routes of administration (OR = 0.41 [0.19–0.88], p = 0.022). The same three factors were associated with “de novo” BD in the restricted sample: OR = 1.35 ([1.11–1.63], p = 0.002), OR = 0.83 ([0.70–0.99], p = 0.046), and OR 0.37 ([0.16–0.86], p = 0.022), respectively. There were significant gradients for BD according to the cocaine exposure categories in the whole (MantelHaenszel, p < 0.001) and in the restricted sample (Mantel-Haenszel, p = 0.002). Conclusions Cocaine exposure was positively associated with behavioral disturbances in a dose-dependent manner in this clinical sample, whilst opioid exposure showed a negative association. Keywords ADHD . Screening . Scales . Behavioral sensitization . Human . Cocaine . Opioids
* Florence Vorspan [email protected] 1
Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique – Hôpitaux de Paris, 200 rue du Faubourg Saint Denis, 75010 Paris, France
2
Faculté de Médecine, Université de Paris, Paris, France
3
Inserm UMR-S 1144 Therapeutic Optimization in Neurosychopharmacology, Université de Paris, Paris, France
4
Service de Psychiatrie et d’Addictologie, Hôpital Bichat, Assistance Publique – Hôpitaux de Paris, Paris, France
5
Service d’Addictologie, DHU Pe-Psy, Pôle de psychiatrie et d’addictologie, Hôpitaux universitaires Henri MONDOR, APHP, F94000 Créteil, France
6
EA 4430 CLIPSYD (Psychologie Clinique, Ps
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