ABSTRACT
BACKGROUND: We aimed to explore the association between baseline executive functioning and treatment outcome in Therapeutic Communities (TCs). METHODS: We used a longitudinal descriptive design: a baseline neuropsychological assessment was performed within the first 30 days of treatment in TCs. Once participants finished or abandoned treatment, the information about time of stay in treatment was computed for each individual. The study was conducted across six TCs located in the region of Andalusia (Spain): Cartaya, Almonte, Mijas, Los Palacios, La Línea, and Tarifa. Participants were 131 patients with cocaine dependence who initiated and finished treatment in TCs between January 2009 and December 2010 (2 years). Cognitive assessment was composed of general measures of executive functioning: Letter Number Sequencing (working memory) and Similarities (reasoning), and executive tasks sensitive to ventromedial prefrontal cortex dysfunction, including the Delis-Kaplan Stroop test (inhibition/cognitive switching), the Revised-Strategy Application Test (strategy application/multitasking), and the Iowa Gambling Task (decision-making). The outcome measure was retention, defined as time in TC treatment (number of days). RESULTS: Poor executive functioning significantly predicted shorter treatment retention in cocaine dependent individuals on TC residential treatment (14% of explained variance). Reduced performance on the R-SAT, a multitasking test taxing the ability to develop and apply the best strategy to organize multiple sub-routine tasks in order to achieve a long-term goal, was the most powerful predictor of treatment retention. CONCLUSIONS: Self-regulation deficits predict the capacity to remain in residential treatment among cocaine dependents.
Subject(s)
Cocaine-Related Disorders/psychology , Executive Function , Social Control, Informal , Adult , Cocaine-Related Disorders/therapy , Cognition , Decision Making , Female , Humans , Longitudinal Studies , Male , Memory, Short-Term , Middle Aged , Neuropsychological Tests , Substance Abuse Treatment CentersABSTRACT
Objetivos: Estimación de la prevalencia del trastorno por déficit de atención e hiperactividad (TDAH) del adulto en una muestra de dependientes de cocaína y evaluación de la utilidad de los síntomas de funcionamiento ejecutivo de Barkley para diferenciar entre pacientes dependientes de cocaína con y sin TDAH. Métodos: Diseño observacional transversal. Se evaluó un total de 70 sujetos dependientes de cocaína que ingresaron para tratamiento en una comunidad terapéutica. Los sujetos seleccionados fueron citados para una entrevista cara a cara entre los días 15.º y 20.º del ingreso. Se utilizó una técnica de muestreo consecutivo no aleatorio. Se reclutó a los sujetos según acudían a la comunidad terapéutica y cumplían los criterios de selección. El instrumento de medida empleado para diagnosticar TDAH en la edad adulta fue la Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID). Los trastornos psiquiátricos comórbidos fueron evaluados según criterios DSM-IV-TR mediante la versión española de la entrevista Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV). Para la evaluación del "funcionamiento ejecutivo" empleamos el Current Behavior Scale Self-Report de Russell A. Barkley. Resultados: La prevalencia de TDAH observada en nuestra muestra fue del 14,3 % (intervalo de confianza [IC] 95 %: 6,1-22,5). Las puntuaciones medias en todos los ítems de la escala de Barkley son superiores en el grupo de pacientes diagnosticados de TDAH y dependencia a la cocaína, en comparación con los sujetos que sólo presentan dependencia a la esta sustancia, con diferencias estadísticamente significativas. Conclusiones: La prevalencia observada de TDAH en nuestra muestra fue elevada y se sitúa dentro del rango de las encontradas por otros autores en muestras similares. Los datos del estudio apoyan la teoría de Barkley en esta población (AU)
Objectives: Estimation of the prevalence of adult attention-deficit/hyperactivity disorder (ADHD) in a sample of cocaine users treated in a therapeutic community and evaluation of the usefulness of Barkley executive function symptoms in differentiating cocaine-dependent patients with and without ADHD. Methods: A transversal observation design was used. A total of 70 cocaine-dependent subjects who were admitted for treatment in a therapeutic community were assessed. Non-random consecutive sampling was used, recruiting the subjects as they arrived at the therapeutic community and met the selection criteria. Subjects included in the study were given an appointment for a face-to-face interview from 15 to 20 days after admission. The measurement instrument used for diagnosing adult ADHD was Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID). Comorbid psychiatric disorders were evaluated according to DSM-IV-TR criteria using the Spanish version of the Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV). For assessment of the "executive function", we used the Current Behavior Scale Self-Report by Russell A. Barkley. Results: The prevalence of ADHD observed in our sample was 14.3 % (confidence interval [CI] 95 %: 6.1-22.5). The mean scores on all the items on the Barkley scale are higher in the group of cocaine-dependent patients diagnosed with ADHD than for subjects who were cocaine-dependent only by a statistically significant difference. Conclusions: The high prevalence of ADHD observed in our sample was within the range found by other authors in similar samples. The study data support Barkley's theory in this population (AU)
