Background: Cocaine-dependent individuals (CDI) display increased impulsivity. However, despite its multifactorial nature most studies in CDI have treated impulsivity monolithically. Moreover, the impact of attention-deficit/hyperactivity disorder (ADHD) has often not been taken into account. This study investigates whether CDI with ADHD (CDI+ADHD) differ from CDI without an ADHD diagnosis and healthy controls (HC) on several impulsivity measures. Methods: Thirty-four CDI, 25 CDI+ADHD and 28 HC participated in this study. Trait impulsivity was assessed with the motor, attentional and non-planning subscales of the Barratt Impulsiveness Scale (BIS-11). Neurocognitive dimensions of impulsivity were examined with the stop signal task (SST), delay discounting task (DDT) and information sampling task (IST). Results: Relative to HC, both CDI and CDI+ADHD scored higher on all BIS-11 subscales, required more time to inhibit their responses (SST) and sampled less information before making a decision (IST). Greater discounting of delayed rewards (DDT) was only found among CDI+ADHD. Compared to CDI without ADHD, CDI+ADHD scored higher on the BIS-11 non-planning and total scale and showed higher discounting rates. Conclusion: CDI score higher on several indices of impulsivity relative to HC, regardless of whether they have concomitant ADHD or not. CDI+ADHD are specifically characterized by a lack of future orientation compared to CDI without ADHD.

1.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 5. Washington, American Psychiatric Association, 2013.
2.
Eysenck SBG, Pearson PR, Easting G, Allsopp JF: Age norms for impulsiveness, venturesomeness and empathy in adults. Pers Individ Dif 1985;6:613-619.
3.
Zuckerman M, Kuhlman D, Joireman J, Teta P, Kraft M: A comparison of the three structural models for the personality: the big three, the big five and the alternative five. J Pers Soc Psychol 1993;65:747-768.
4.
Verdejo-Garcia A, Lawrence AJ, Clark L: Impulsivity as a vulnerability marker for substance-use disorders: review of findings from high-risk research, problem gamblers and genetic association studies. Neurosci Biobehav R 2008;32:777-810.
5.
Winstanley CA, Eagle DM, Robbins TW: Behavioral models of impulsivity in relation to ADHD: translation between clinical and preclinical studies. Clin Psychol Rev 2006;26:37-96.
6.
Logan GD, Cowan WB, Davis KA: On the ability to inhibit simple and choice reaction time responses: a model and a method. J Exp Psychol Hum Percept Perform 1984;10:276-291.
7.
Clark L, Robbins RW, Ersche KD, Sahakian BJ: Reflection-impulsivity in current and former substance users. Biol Psychiatry 2006;60:515-522.
8.
Dalley JW, Everitt BJ, Robbins TW: Impulsivity, compulsivity and top-down cognitive control. Neuron 2011;69:680-694.
9.
Moeller FG, Dougherty DM, Barratt ES, Oderinde V, Mathias CW, Harper RA, Swann AC: Increased impulsivity in cocaine dependent subjects independent of antisocial personality disorder and aggression. Drug Alcohol Depend 2002;68:105-111.
10.
Fillmore MT, Rush CR: Impaired inhibitory control of behavior in chronic cocaine users. Drug Alcohol Depend 2002;66:265-273.
11.
Coffey SF, Gudleski GD, Saladin ME, Brady KT: Impulsivity and rapid discounting of delayed hypothetical rewards in cocaine-dependent individuals. Exp Clin Psychopharmacol 2003;11:18-25.
12.
Heil SH, Johnson MW, Higgins ST, Bickel WK: Delay discounting in currently using and currently abstinent cocaine-dependent outpatients and non-drug-using matched controls. Addict Behav 2006;31:1290-1294.
13.
Kirby KN, Petry NM: Heroin and cocaine abusers have higher discount rates for delayed rewards than alcoholics or non-drug-using controls. Addiction 2004;99:461-471.
14.
De Wilde B, Verdejo-Garcia A, Sabbe B, Hulstijn W, Dom G: Affective decision-making is predictive of three-month relapse in polysubstance-dependent alcoholics. Eur Addict Res 2013;19:21-28.
15.
Stevens L, Verdejo-García A, Goudriaan AE, Roeyers H, Dom G, Vanderplasschen W: Impulsivity as a vulnerability factor for poor addiction treatment outcomes: a review of neurocognitive findings among individuals with substance use disorders. J Subst Abuse Treat 2014;47:58-72.
16.
Stevens L, Betanzos-Espinosa P, Crunelle CL, Vergara-Moragues E, Roeyers H, Lozano O, Dom G, Gonzalez-Saiz F, Vanderplasschen W, Verdejo-García A, Pérez-García M: Disadvantageous decision-making as a predictor of drop-out among cocaine-dependent individuals in long-term residential treatment. Front Psychiatry 2013;4:149.
17.
Dawe S, Gullo MJ, Loxton NL: Reward drive and rash impulsiveness as dimensions of impulsivity: implications for substance misuse. Addict Behav 2004;29:1389-1405.
18.
Dom G, Wilde B, Hulstijn W, Sabbe B: Dimensions of impulsive behaviour in abstinent alcoholics. Pers Individ Dif 2007;42:465-476.
19.
Reynolds B, Ortengren A, Richards JB, Wit H: Dimensions of impulsive behaviour: personality and behavioural measures. Pers Individ Dif 2006;40:305-315.
20.
Whiteside SP, Lynam DR: The Five Factor Model and impulsivity: using a structural model of personality to understand impulsivity. Pers Individ Diff 2001;30:669-689.
21.
Diergaarde L, Pattij T, Poortvliet I, Hogenboom F, de Vries W, Schoffelmeer AN, et al: Impulsive choice and impulsive action predict vulnerability to distinct stages of nicotine seeking in rats. Biol Psychiatry 2008;63:301-308.
22.
Najt P, Perez J, Sanches M, Peluso M, Glahn D, Soares J: Impulsivity and bipolar disorder. Eur Neuropsychopharmacol 2007;17:313-320.
23.
Swann AC, Lijffijt M, Lane SD, Steinberg JL, Moeller FG: Trait impulsivity and response inhibition in antisocial personality disorder. J Psychiatr Res 2009;43:1057-1063.
24.
Alderson RM, Rapport MD, Kofler MJ: Attention-deficit/hyperactivity disorder and behavioral inhibition: a meta-analytic review of the stop-signal paradigm. J Abnorm Child Psychol 2007;35:745-758.
25.
Dai Z, Harrow SE, Song X, Rucklidge J, Grace R: Gambling, delay, and probability discounting in adults with and without ADHD. J Atten Disord 2013, Epub ahead of print.
26.
Oosterlaan J, Sergeant JA: Response inhibition and response re-engagement in attention-deficit/hyperactivity disorder, disruptive, anxious and normal children. Behav Brain Res 1998;94:33-43.
27.
Paloyelis Y, Asherson P, Kuntsi J: Are ADHD symptoms associated with delay aversion or choice impulsivity? A general population study. J Am Acad Child Adolesc Psychiatry 2009;48:837-846.
28.
Wilson VB, Mitchell SH, Musser ED, Schmitt CF, Nigg JT: Delay discounting of reward in ADHD: application in young children. J Child Psychol and Psychiatry 2011;52:256-264.
29.
Sonuga-Barke EJS, Taylor E, Sembi S, Smith J: Hyperactivity and delay aversion. The effect of delay on choice. J Child Psychol Psychiatry 1992;33:387-398.
30.
van Emmerik-van Oortmerssen K, van de Glind G, van den Brink W, Smit F, Crunelle CL, Swets M, Schoevers RA: Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend 2012;122:11-19.
31.
Carroll KM, Rounsaville BJ: History and significance of childhood attention deficit disorder in treatment-seeking cocaine abusers. Compr Psychiatry 1993;34:75-82.
32.
Levin FR, Evans SM, Kleber HD: Prevalence of adult attention-deficit hyperactivity disorder among cocaine abusers seeking treatment. Drug Alcohol Depend 1998;52:15-25.
33.
Perez de los Cobos J, Sinol N, Pureta C, Cantillano V, Zurita CL, Trujols J: Features and prevalence of patients with probable adult attention deficit hyperactivity disorder who requested treatment for cocaine use disorders. Psychiatry Res 2011;185:205-210.
34.
Ros SA, Valoria MA, Nieto MJ: Cocaine and other psychostimulant consumption: their relationship with the childhood hyperactivity syndrome. Actas Esp Psiquiatr 2004;32:346-352.
35.
Grall-Bronnec M, Wainstein L, Augy J, Bouju G, et al: Attention deficit hyperactivity disorder among pathological and at-risk gamblers seeking treatment: a hidden disorder. Eur Addict Res 2011;17:231-240.
36.
Latimer WW, Ernst J, Hennessey J, Stinchfield RD, Winters KC: Relapse among adolescent drug abusers following treatment: the role of probable ADHD status. J Child Adolesc Subst 2004;13:1-16.
37.
Levin FR, Evans SM, Vosburg SK, Horton T, Brooks D, Ng J: Impact of attention-deficit hyperactivity disorder and other psychopathology on treatment retention among cocaine abusers in a therapeutic community. Addict Behav 2004;29:1875-1882.
38.
Passetti F, Clark L, Mehta MA, Joyce E, King M: Neuropsychological predictors of clinical outcome in opiate addiction. Drug Alcohol Depend 2008;94:82-91.
39.
Raes V, Lombaert G, Keymeulen R: De Nederlandse vertaling van de handleiding voor training en afname van Europ-asi vraaggesprekken, aangepast voor België-Vlaanderen, met integratie van de Treatment Demand Indicator, Versie 2008. Gent, De Sleutel Dienst Wetenschappelijk Onderzoek, 2008.
40.
McLellan AT, Luborsky L, Woody GE, O'Brien CP: An improved diagnostic evaluation instrument for substance abuse patients. The Addiction Severity Index. J Nerv Ment Dis 1980;168:26-33.
41.
McLellan AT, Cacciola JC, Alterman AI, Samuel H, Rikoon SH, Carise D: The Addiction Severity Index at 25: origins, contributions and transitions. Am J Addict 2006;15:113-124.
42.
Verdejo-Garcia AJ, Lopez-Torrecillas F, Aguilar de Arcos F, Perez-Garcia M: Differential effects of MDMA, cocaine, and cannabis use severity on distinctive components of the executive functions in polysubstance users: a multiple regression analysis. Addict Behav 2005;30:89-101.
43.
Wechsler D: WAIS-III, Nederlandstalige bewerking, technische handleiding. Lisse, Swets and Zeitlinger, 2000.
44.
Ringe WK, Saine KC, Lacritz LH, Hynan LS, Cullum CM: Dyadic short forms of the Wechsler adult intelligence scale-III. Assessment 2002;9:254-260.
45.
Kooij JJ, Buitelaar JK, van den Oord EJ, Furer JW, Rijnders CA, Hodiamont PP: Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychol Med 2005;35:817-827.
46.
Murphy K, Barkley RA: Prevalence of DSM-IV symptoms of ADHD in adult licensed drivers: implications for clinical diagnosis. J Atten Disord 1996;1:147-161.
47.
Sheehan DV, Lecrubier Y, Sheehan KH, et al: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59:22-33.
48.
Patton JH, Stanford MS, Barratt ES: Factor structure of the Barratt impulsiveness scale. J Clin Psychol 1995;51:768-774.
49.
Eagle DM, Baunez C, Hutcheson DM, Lehmann O, Shah AP, Robbins TW: Stop-signal reaction-time task performance: role of prefrontal cortex and subthalamic nucleus. Cereb Cortex 2008;18:178-188.
50.
Wittmann M, Leland DS, Paulus MP: Time and decision making: differential contribution of the posterior insular cortex and the striatum during a delay discounting taks. Exp Brain Res 2007;179:643-653.
51.
Crunelle CL, Veltman DJ, van Emmerik-van Oortmerssen K, Booij J, van den Brink W: Impulsivity in adult ADHD patients with and without cocaine dependence. Drug Alcohol Depend 2013;129:18-24.
52.
de Wit H: Impulsivity as a determinant and consequence of drug use: a review of underlying processes. Addict Biol 2009;14:22-31.
53.
Audrain-McGovern J, Rodriguez D, Epstein LH, Cuevas J, Rodgers K, Wyleyto EP: Does delay discounting play an etiological role in smoking or is it a consequence of smoking? Drug Alcohol Depend 2009;103:99-106.
54.
Perry JL, Larson EB, German JP, Madden GJ, Carroll ME: Impulsivity (delay discounting) as a predictor of acquisition of IV cocaine self-administration in female rats. Psychopharmacology (Berl) 2005;178:193-201.
55.
Robles E, Huang BE, Simpson PM, McMillan DE: Delay discounting, impulsiveness, and addiction severity in opioid-dependent patients. J Subst Abuse Treat 2011;41:354-362.
56.
Preller KH, Ingold N, Hulka LM, Vonmoos M, Jenni D, Baumgartner MR, Vollenweider FX, Quednow BB: Increased sensorimotor gating in recreational and dependent cocaine users is modulated by craving and attention-deficit/hyperactivity disorder symptoms. Biol Psychiatry 2013;73:225-234.
57.
Wodushek TR, Neumann CS: Inhibitory capacity in adults with symptoms of attention deficit/hyperactivity disorder (ADHD). Arch Clin Neuropsychol 2003;18:317-330.
58.
Barkley RA: Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 1997;121:65-94.
59.
Aron AR, Dowson JH, Sahakian BJ, Robbins TW: Methylphenidate improves response inhibition in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry 2003;54:1465-1468.
60.
Bekker EM, Overtoom CC, Kooij JJ, Buitelaar JK, Verbaten MN, Kenemans JL: Disentangling deficits in adults with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 2005;62:1129-1136.
61.
Lijffijt M, Kenemans JL, Verbaten MN, van Engeland H: A meta-analytic review of stopping performance in attention-deficit/hyperactivity disorder: deficient inhibitory motor control? J Abnorm Psychol 2005;114:216-222.
62.
Nigg JT: Is ADHD a disinhibitory disorder? Psychol Bull 2001;127:571-598.
63.
Ossmann JM, Mulligan NW: Inhibition and attention deficit hyperactivity disorder in adults. Am J Psychol 2003;116:35-50.
64.
Fillmore MT, Rush CR, Marczinski CA: Effects of d-amphetamine on behavioral control in stimulant abusers: the role of prepotent response tendencies. Drug Alcohol Depend 2003;71:143-152.
65.
Potter AS, Newhouse PA: Effects of acute nicotine administration on behavioral inhibition in adolescents with attention-deficit/hyperactivity disorder. Psychopharmacology 2004;176:182-194.
66.
McClernon FJ, Kollins SH, Lutz AM, Fitzgerald DP, Murray DW, Redman C, Rose JE: Effects of smoking abstinence on adult smokers with and without attention deficit hyperactivity disorder: results of a preliminary study. Psychopharmacology 2008;197:95-105.
67.
Powell J, Dawkins L, Davis RE: Smoking, reward responsiveness, and response inhibition: tests of an incentive motivational model. Biol Psychiatry 2002;51:151-163.
68.
Sonuga- Barke EJS: Psychological heterogeneity in AD/HD; a dual pathway model of behaviour and cognition. Behav Brain Res 2002;130:29-36.
69.
Bickel WK, Jarmolowicz DP, Mueller ET, Koffarnus MN, Gatchalian KM: Excessive discounting of delayed reinforcers as a trans-disease process contributing to addiction and other disease-related vulnerabilities: emerging evidence. Pharmacol Ther 2012;134:287-297.
70.
Castellanos FX, Sonuga-Barke EJS, Scheres A, Di Martino A, Hyde C, Walters JR: Varieties of attention-deficit/hyperactivity disorder-related intra-individual variability. Biol Psychiatry 2005;57:1416-1423.
71.
Klein C, Wendling K, Huettner P, Ruder H, Peper M: Intra-subject variability in attention-deficit hyperactivity disorder. Biol Psychiatry 2006;6:1088-1097.
72.
Williams BR, Strauss EH, Hultsch DF, Tannock R: Reaction time performance in adolescents with attention deficit/hyperactivity disorder: evidence of inconsistency in the fast and slow portions of the RT distribution. J Clin Exp Neuropsychol 2007;29:277-289.
73.
Vergara-Moragues E, González-Saiz F, Lozano OM, Betanzos Espinosa P, Fernández Calderón F, Bilbao-Acebos I, Pérez García M, Verdejo García A: Psychiatric comorbidity in cocaine users treated in therapeutic community: substance-induced versus independent disorders. Psychiatry Res 2012;200:734-741.
74.
Moeller FG, Dougherty DM, Barratt ES, Schmitz JM, Swann AC, Grabowski J: The impact of impulsivity on cocaine use and retention in treatment. J Subst Abuse Treat 2001;21:193-198.
75.
Washio Y, Higgins ST, Heil SH, McKerchar TL, Badger GJ, Skelly JM, Dantona RL: Delay discounting is associated with treatment response among cocaine-dependent outpatients. Exp Clin Psychopharm 2011;19:243-248.
76.
Dias G, Mattos P, Coutinho G, Segenreich D, Saboya E, Ayrão V: Agreement rates between parent and self-report on past ADHD symptoms in an adult clinical sample. J Atten Disord 2008;12:70-75.
77.
Weafer J, Milich M, Fillmore MT: Behavioral components of impulsivity predict alcohol consumption in adults with ADHD and healthy controls. Drug Alcohol Depend 2011;113:139-146.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.