{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T05:22:09Z","timestamp":1767158529045,"version":"3.48.0"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,28]],"date-time":"2025-12-28T00:00:00Z","timestamp":1766880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Adults with attention-deficit\/hyperactivity disorder (ADHD) often have comorbid substance use disorders (SUDs). In Italy, individuals with both ADHD and heroin use disorder (HUD) are usually treated in addiction services with opioid agonist therapy (OAT), but stimulant medications are rarely prescribed. This may create a treatment gap for core ADHD symptoms. Aim: This study examined the clinical and behavioural profiles of ADHD patients with HUD who receive OAT but no stimulant treatment, compared to ADHD patients without opioid use disorder (ADHD\/NoHUD) on standard pharmacotherapy. All participants were considered treatment responders in their respective services. Methods: Data were collected from two outpatient clinics and included 103 adult ADHD patients assessed using validated tools for symptom severity, emotional dysregulation, and global functioning. Differences between groups were analysed using univariate tests and logistic regression. Results: The ADHD+HUD group was significantly older and showed higher levels of emotional dysregulation, impulsivity, and current cocaine use. Despite clinical stability, these individuals presented a more severe psychopathological profile than their ADHD\/NoHUD counterparts, who received stimulant-based treatment. Conclusions: Although limited by its cross-sectional nature and setting-related confounders, the study indicates that OAT alone may not be sufficient to manage neurodevelopmental symptoms in ADHD+HUD patients. Further research is necessary to assess the safety and efficacy of integrated stimulant-based treatments, ideally within dual disorder services combining psychiatric and addiction expertise.<\/jats:p>","DOI":"10.3390\/ijerph23010040","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T06:25:51Z","timestamp":1766989551000},"page":"40","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stimulant Treatment Gap in ADHD Patients with Heroin Use Disorder: Clinical and Behavioural Consequences"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7281-1337","authenticated-orcid":false,"given":"Alessandro","family":"Pallucchini","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Addictions, Section of Addictions, North-Western Tuscany Local Health Unit, Apuan Zone, Via Carriona 245, 54033 Carrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizio","family":"Varese","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Addictions, Section of Addictions, North-Western Tuscany Local Health Unit, Apuan Zone, Via Carriona 245, 54033 Carrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Pergentini","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Addictions, Section of Addictions, North-Western Tuscany Local Health Unit, Lucca Zone, Viale Marti 263, 55100 Lucca, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-8022-7624","authenticated-orcid":false,"given":"Samuele","family":"Gemignani","sequence":"additional","affiliation":[{"name":"V.P. Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Parapetto","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Addictions, Section of Addictions, North-Western Tuscany Local Health Unit, Livorno Zone, Via Tiberio Scali 11, 57121 Livorno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6324-0576","authenticated-orcid":false,"given":"Icro","family":"Maremmani","sequence":"additional","affiliation":[{"name":"V.P. Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy"},{"name":"Saint Camillus International University of Health Sciences, Via di Sant\u2019Alessandro 8, 00131 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7728-3705","authenticated-orcid":false,"given":"Angelo Giovanni Icro","family":"Maremmani","sequence":"additional","affiliation":[{"name":"V.P. Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy"},{"name":"Saint Camillus International University of Health Sciences, Via di Sant\u2019Alessandro 8, 00131 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1177\/10600280221141065","article-title":"Gaps in Evidence-based Treatment of Concurrent Attention Deficit Hyperactivity Disorder and Opioid Use Disorder: A Scoping Review","volume":"57","author":"Ramey","year":"2023","journal-title":"Ann. Pharmacother."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Rocco, P. (2023). Prevalence of ADHD in a Sample of Heroin Addicts Receiving Agonist Treatment-Study Conducted in a Public Addiction Service. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20032602"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"168","DOI":"10.20882\/adicciones.1569","article-title":"Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use","volume":"34","author":"Cunill","year":"2022","journal-title":"Adicciones"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/0269881114544777","article-title":"Pharmacological treatment of attention deficit hyperactivity disorder with co-morbid drug dependence","volume":"29","author":"Cunill","year":"2015","journal-title":"J. Psychopharmacol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"107700","DOI":"10.1016\/j.drugalcdep.2019.107700","article-title":"Extended release mixed amphetamine salts and topiramate for cocaine dependence: A randomized clinical replication trial with frequent users","volume":"206","author":"Levin","year":"2020","journal-title":"Drug Alcohol. Depend."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Maremmani, A.G.I., Rocco, P., Rocca, F.D., Perugi, G., Miccoli, M., and Maremmani, I. (2021). Adult-Attention Deficit Hyperactive Disorder Symptoms Seem Not to Influence the Outcome of an Enhanced Agonist Opioid Treatment: A 30-Year Follow-Up. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182010997"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1177\/10870547241312575","article-title":"Assessing the Construct Validity of the Adult ADHD Self-report Scale for DSM-5 and Prevalence of ADHD in a Danish Population Sample","volume":"29","author":"Storebo","year":"2025","journal-title":"J. Atten. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.jad.2019.07.028","article-title":"Reactivity, Intensity, Polarity and Stability questionnaire (RIPoSt-40) assessing emotional dysregulation: Development, reliability and validity","volume":"257","author":"Brancati","year":"2019","journal-title":"J. Affect. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Guy, W. (1976). ECDEU Assessment Manual for Psychopharmacology. Clinical Global Impressions, U.S. Department of Health, Education, and Welfare.","DOI":"10.1037\/e591322011-001"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"146","DOI":"10.3109\/09638288.2013.782360","article-title":"WHODAS 2.0 in community rehabilitation: A qualitative investigation into the validity of a generic patient-reported measure of disability","volume":"36","author":"Kulnik","year":"2014","journal-title":"Disabil. Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1080\/02791072.2022.2151951","article-title":"Cocaine Effect Expectancies among Patients with Cocaine Use Disorder with and without Adult Attention Deficit Hyperactivity Disorder: Are There Any Relevant Differences?","volume":"56","author":"Trujols","year":"2024","journal-title":"J. Psychoact. Drugs"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/j.1521-0391.2013.12086.x","article-title":"The self-medication hypothesis and psychostimulant treatment of cocaine dependence: An update","volume":"23","author":"Mariani","year":"2014","journal-title":"Am. J. Addict."},{"key":"ref_13","first-page":"28","article-title":"The clinical global impressions scale: Applying a research tool in clinical practice","volume":"4","author":"Busner","year":"2007","journal-title":"Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.brainres.2006.12.079","article-title":"Effects of early methylphenidate exposure on morphine- and sucrose-reinforced behaviors in adult rats: Relationship to dopamine D2 receptors","volume":"1139","author":"Crawford","year":"2007","journal-title":"Brain Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.pbb.2008.11.011","article-title":"Methylphenidate potentiates morphine-induced antinociception, hyperthermia, and locomotor activity in young adult rats","volume":"92","author":"Halladay","year":"2009","journal-title":"Pharmacol. Biochem. Behav."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1002\/syn.890030108","article-title":"Cocaine alters opiate receptor binding in critical brain reward regions","volume":"3","author":"Hammer","year":"1989","journal-title":"Synapse"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.ejphar.2007.09.042","article-title":"PET imaging of dopamine transporter and drug craving during methadone maintenance treatment and after prolonged abstinence in heroin users","volume":"579","author":"Shi","year":"2008","journal-title":"Eur. J. Pharmacol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117099","DOI":"10.1016\/j.jns.2020.117099","article-title":"The associations of comorbid substance use disorders and psychiatric conditions with adolescent brain structure and function: A review","volume":"418","author":"Kroll","year":"2020","journal-title":"J. Neurol. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1007\/s40429-020-00321-z","article-title":"Directional effects of anxiety and depressive disorders with Sub- stance Use: A review of recent prospective research","volume":"7","author":"Garey","year":"2020","journal-title":"Curr. Addict. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1590\/S0004-282X2004000300005","article-title":"The effect of methylphenidate on oppositional defiant disorder comorbid with attention deficit\/hyperactivity disorder","volume":"62","author":"Mattos","year":"2004","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1176\/appi.ajp.2013.13070966","article-title":"Emotion dysregulation in attention deficit hyperactivity disorder","volume":"171","author":"Shaw","year":"2014","journal-title":"Am. J. Psychiatry"},{"key":"ref_22","first-page":"5","article-title":"Methadone maintenance treatment and mood disturbances: Pharmacological and psychological implications","volume":"7","author":"Dyer","year":"2005","journal-title":"Heroin Addict. Relat. Clin. Probl."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Umbricht, A., and Velez, M.L. (2015). Benzodiazepine Abuse and Addiction. Textbook of Addiction Treatment: International Perspectives, Springer.","DOI":"10.1007\/978-88-470-5322-9_102"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1126\/science.178.4064.984","article-title":"Blood-brain barrier: Penetration of morphine, codeine, heroin, and methadone after carotid injection","volume":"178","author":"Oldendorf","year":"1972","journal-title":"Science"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zheng, R., Hao, L., Li, Y., Zhang, T., Bai, D., Zhang, L., Li, D., and Hao, W. (2021). Commentary: Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.615921"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"107431","DOI":"10.1016\/j.pharmthera.2019.107431","article-title":"Adolescent neurodevelopment and substance use: Receptor expression and behavioral consequences","volume":"206","author":"Thorpe","year":"2020","journal-title":"Pharmacol. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1124\/pharmrev.120.000083","article-title":"Drug Addiction: Hyperkatifeia\/Negative Reinforcement as a Framework for Medications Development","volume":"73","author":"Koob","year":"2021","journal-title":"Pharmacol. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1186\/s12954-024-01079-7","article-title":"ADHD: Prevalence and effect on opioid use disorder treatment outcome in a French sample of patients receiving medication for opioid use disorder-the influence of impulsivity as a mediating factor","volume":"21","author":"Beslot","year":"2024","journal-title":"Harm Reduct. J."},{"key":"#cr-split#-ref_29.1","doi-asserted-by":"crossref","unstructured":"Vold, J.H., Aas, C., Skurtveit, S., Odsbu, I., Chalabianloo, F., Halmoy, A., Johansson, K.A., and Fadnes, L.T. (2020). Dispensation of attention deficit hyperactivity disorder (ADHD) medications in patients receiving opioid agonist therapy","DOI":"10.21203\/rs.2.14354\/v2"},{"key":"#cr-split#-ref_29.2","unstructured":"a national prospective cohort study in Norway from 2015 to 2017. BMC Psychiatry, 20."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1159\/000353969","article-title":"Prescribing of drugs for attention-deficit hyperactivity disorder in opioid maintenance treatment patients in Norway","volume":"20","author":"Karlstad","year":"2014","journal-title":"Eur. Addict. Res."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Bahji, A., Danilewitz, M., and Crockford, D. (2023). Navigating Evidence, Challenges, and Caution in the Treatment of Stimulant Use Disorders. Brain Sci., 13.","DOI":"10.3390\/brainsci13101416"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/1\/40\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T05:20:29Z","timestamp":1767158429000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/1\/40"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,28]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["ijerph23010040"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23010040","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2025,12,28]]}}}