This column provides recommendations about the diagnosis and treatment of attention-deficit hyperactivity (ADHD) disorder among cocaine dependent adults. The data were derived from a year long study of cocaine-dependent persons. ADHD is characterized by hyperactivity, disorganization, impulsivity, emotionality, unstable personality, fidgitiness, and inability to relax. It has been reported to be present in 17% to 40% of various cocaine dependent populations. Less well known is that cocaine modifies these symptoms, thus making it difficult to correctly diagnosis such patients. One reliable indicator of the presence of ADHD among adult cocaine-dependent people is the history of a paradoxical response to cocaine. A careful clinical history confirm that despite eventual deterioration as cocaine dependence develops, patients with ADHD initially derive symptomatic relief through their use of cocaine. If diagnosed, physicians may be reluctant to prescribe stimulants, generally part of pharmacotherapy, for fear of priming the use of cocaine. However, this concern may not be justified if the patient is in full remission form the cocaine addiction. This brief report describes the results of pharmacotherapy with this population, using stimulants and antidepressants. One patient did not receive any relief from ADHD symptoms. The majority eventually had symptom suppression on only one drug, a stimulant. Antidepressants proved to be of limited utility. Copyright 2000, American Psychiatric Association. Used with permission
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