Assessing Internalizing Symptoms and Their Relation with Levels of Impairment: Evidence-Based Cutoffs for Interpreting Inventory of Depression and Anxiety Symptoms (IDAS-II) Scores.

Tests and scales measuring psychological disorders should provide information about how scores relate to other constructs such as quality of life or functional impairment. Such information is necessary to allow that their scores contribute to clinical decision making. The current study analyzes the clinical utility of the Spanish version of the Inventory for Depression and Anxiety Symptoms (IDAS-II) to discriminate between different levels of functional impairment and identify the IDAS-II scales that contribute most to explaining impairment. The total sample (N = 1390) consists of two subsamples: a community sample of the general population (n = 1072) selected by random sampling; and a sample of patients (n = 318) from public and private mental health services. The Spanish IDAS-II for measuring internalizing symptoms and WHODAS 2.0 for measuring impairment were administered to all participants. All scales show statistically significant higher scores in the patient sample, with Cohen's d effect sizes values greater than 0.30, except for well-being (d = 0.19). The cutoff values and their confidence intervals do not overlap with the means of either the community or patient sample. AUC values for most of the scales are above .70, except for appetite gain, ordering, euphoria, cleaning, and well-being. Multiple linear regression model using IDAS-II scales explain 57.1% of the variance of the WHODAS 2.0 (F 12.1377 = 155.305; p < .001). Cutoff values provided allow us to reliably differentiate between the patients and community samples. Spanish IDAS-II scores show greater sensitivity and specificity in detecting those with greater impairment. General Depression, Lassitude, Panic and Claustrophobia contribute to impairment in a greater extent. Knowledge of which symptoms are most related with impairment, allows healthcare providers to improve treatment planning based on empirical evidence.

Cocaine use disorder criteria in a clinical sample: an analysis using Item Response Theory, factor analysis, and network analysis.

Background: The conceptualization of substance use disorders (SUDs) was modified in successive editions of the DSM. Dimensionality and inclusion/exclusion of several criteria was studied using various analytic approaches.Objective: The study aimed to deepen our knowledge of the interrelationships between the diagnostic criteria for cocaine use disorder (CUD), applying three different analytical techniques: factor analysis, Item Response Theory (IRT) models, and network analysis.Methods: 425 (85.4% male) outpatients were evaluated for CUD using the Substance Dependence Severity Scale. Confirmatory Factor Analysis, 2-parameter logistic model (IRT) and network analysis were applied to analyze the relationships between the diagnostic criteria.Results: The results show that "legal problems" criterion is not congruent with the CUD measure on three analyses. Also, network analysis suggests the usefulness of the "craving" criterion. The criterion "quit/control" is the one that presents the best centrality indices and expected influence, showing strong relationships with the criteria of "craving," "tolerance," "neglect roles" and "activities given up."Conclusions: Network analysis appears to be a useful and complementary technique to factor analysis and IRT for understanding CUD. The "quit/control" criterion emerges as a central criterion to understand CUD.

Initial orientation vs maintenance of attention: Relationship with the severity of dependence and therapeutic outcome in a sample of cocaine use disorder patients.

The visual probe paradigm allows for evaluating attentional bias (AB), distinguishing between approach vs avoidance patterns of attention and assessing two different processes when the exposure time to images is manipulated: initial orienting and maintenance of attention. The present study aimed to analyze the predictive capacity of these two processes for substance use disorder severity and therapeutic outcomes of patients with cocaine use disorder in treatment. The sample consisted of 70 outpatients who were starting treatment at a public service. AB was evaluated using a task based on the visual probe (VP) paradigm with images presented under two conditions: 200 ms vs 1000 ms. Cocaine and alcohol use disorder severity, craving, retention in treatment and relapse in consumption were recorded. Cocaine AB in the 1000 ms condition was negatively correlated with the cocaine use disorder severity (r = -0.26), whilst a positive correlation was found between cocaine craving and cocaine AB (r = 0.29). Alcohol use disorder severity negatively correlated with cocaine AB in the 200 ms condition (r = -0.24). Logistic regression analysis revealed that, after controlling for gender, age, and substance use disorder severity, cocaine AB in the 200 ms condition predicted dropout and relapse. Our results suggest that patients who adhere to treatment and remain abstinent tend to show avoidance in the 200 ms condition, with effect sizes of r = 0.29 and 0.30 respectively. The results suggest that training in avoidance strategies could be a valuable way of maintaining adherence and abstinence, as well as improving control of craving.

TDAH en pacientes con adicción a sustancias: análisis de la prevalencia y de los problemas relacionados con el consumo en una muestra atendida en un servicio de tratamiento ambulatorio / ADHD in patients with drug addiction: analysis of prevalence and consumption-related problems in a sample treated in an outpatient drug addiction service

La comorbilidad existente entre los trastornos por uso de sustancias y el trastorno por déficit de atención e hiperactividad ha sido constatada por diversos autores. El objetivo de este trabajo es analizar la prevalencia de TDAH y la severidad de éstos en comparación con pacientes sin TDAH en una muestra de pacientes atendidos en los servicios ambulatorios de drogodependencias. Material y métodos. La muestra está formada por 162 pacientes del Servicio Provincial de Drogodependencias de Huelva. El instrumento de evaluación de severidad del trastorno TUS fue la entrevista semi-estructurada EuropASI, y las puntuaciones en calidad de vida se obtuvieron administrando el TECVASP. En el screening de TDAH se empleó la ASRS 1.1. Resultados. La prevalencia de TDAH fue del 27,8% en la muestra de pacientes. La prevalencia entre consumidores de alcohol fue del 33,3%, entre consumidores de cocaína del 42,2%, entre consumidores de cannabis del 48,9% y entre consumidores de heroína del 13,3%. Los pacientes con TDAH tuvieron una peor calidad de vida y mostraron una mayor severidad en el perfil de consumo de drogas, relaciones familiares y sociales y estado psiquiátrico. Conclusiones. Los resultados encontrados ponen de manifiesto la conveniencia de una evaluación minuciosa por parte del clínico, en vista de las complicaciones que un diagnóstico potencialmente dual pueda suponer en términos de gravedad del consumo, dificultades sociales y severidad del estado psiquiátrico en general (AU)

Existing comorbidity between substance use disorders and attention-deficit/hiperactivity disorder has been noted for several authors. The aim of this paper is to analyze the prevalence and severity of ADHD compared to patients without ADHD in a sample of patients treated in an outpatient drug addiction services. Material and methods. Sample is composed of 162 patients from Drug Abuse Services of Huelva (Spain). The assessment tool for the severity of SUD was the semi-structured interview EuropASI. The quality of life scores were obtained by administering the TECVASP. For the screening of ADHD it was used the ASRS 1.1. Results. ADHD prevalence was 27.8% in the total sample. Prevalence among alcohol consumers was 33.3%, among cocaine consumers was 42.2%, among cannabis consumers was 48.9%, and heroin consumers showed a 13.3%. ADHD patients showed worse quality of life, and greater severity in drug profile, social and familiar relationships and psychiatric statement. Conclusions. The results obtained underscore the convenience of a detailed evaluation from therapist. It should be considered the complications of a potential dual diagnosis in terms of gravity of consumption, social difficulties and severity of general psychiatric statement (AU)

Aplicación de un modelo politómico de TRI al test ASSIST para el estudio de sus propiedades métricas / Application of a IRT polytomous model to ASSIST test for the study of psychometric properties

La cocaína es, tras el cannabis, la sustancia de comercio ilegal más consumida en Europa y España. Su uso está fundamentalmente vinculado a los contextos recreativos de ocio y a jóvenes-adultos, quienes son reticentes a contactar con los servicios asistenciales, acudiendo a estos cuando desarrollan problemas graves. Por ello, resulta necesario disponer de herramientas de cribado que ayuden a la detección temprana de problemas relacionados con el consumo de cocaína. Objetivo. El objetivo de este trabajo es analizar las propiedades psicométricas de la versión auto-aplicada on line del test de cribado ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Método. La muestra está formada por 1176 consumidores de cocaína que cumplimentaron el ASSIST on line. Las propiedades psicométricas serán estudiadas empleando el Modelo del Crédito Parcial, dentro de la familia de la Teoría de la Respuesta al Ítem (TRI). Resultados. En términos generales, se observa un adecuado ajuste de los datos al modelo. No obstante, se aprecia un funcionamiento deficiente de las categorías de respuesta. Igualmente, se aprecia un desplazamiento de la posición de los ítems en el continuo con respecto a las personas, siendo deficientemente medidas las personas con niveles bajos de riesgo asociado al consumo. Conclusiones. El análisis del ASSIST desde la perspectiva de la TRI ha mostrado algunas deficiencias de este test cuando se aplica sobre este tipo de muestra consumidora de cocaína. A pesar de una calibración de los ítems adecuada, se proponen mejoras que permitan reducir el error de medida en las personas que presentan niveles bajos de riesgo asociado al consumo de cocaína (constructo) y modificaciones respecto a las alternativas de respuestas (AU)

Cocaine is, second after cannabis, the most used illegal drug in Europe and Spain. Its use is primarily linked to recreational nightlife settings and young adults who are reluctant to contact with health services and draw on these when they develop serious drug problems. Therefore, screening tools are needed to help early detection of problems related to cocaine use. Aim. The aim of this paper is to analyse the psychometric properties of an online self-applied version of ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Method. The sample consisted of 1176 cocaine users who completed the ASSIST online. The psychometric properties are studied using the Partial Credit Model, within the family Item Response Theory (IRT). Results. In general terms, the degree to which the test response data are as expected from the model is good. However, ASSIST test shows a poor fit of the response categories. Similarly, the relative positions of the items on the continuum imply poor measurement of people with low levels of risk associated with drug use. Conclusion. ASSIST analysis from the perspective of IRT has showed some shortcomings in this test when applied to this type of sample of cocaine users. Despite good item calibration, several improvements to reduce the measurement error in people with low levels of risk associated with cocaine use (construct) and changes in responses categories are proposed (AU)

Self-regulation and treatment retention in cocaine dependent individuals: a longitudinal study.

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.

Análisis de las diferencias en el perfil y patrón de consumo de drogas de hombres y mujeres que asisten a fiestas rave / Analysis of the differences in the profile and drug use patterns between male and female who attend raves

Objetivo. Estudios poblacionales muestran un consumo diferencial de drogas entre hombres y mujeres. Algunos trabajos han apuntado hacia las raves como una cultura andrógina donde las diferencias de género se diluyen. No obstante, las evidencias empíricas sobre el patrón diferencial según género en este contexto son escasas. Este estudio tiene como objetivo analizar las diferencias en el patrón de consumo de drogas y el perfil sociodemográfico de hombres y mujeres que asisten a fiestas rave. Material y método. Se entrevistó a 252 asistentes a fiestas rave en Andalucía (España). Se administró un cuestionario en el que se recogía información sobre el patrón de consumo de 15 drogas distintas y el perfil sociodemográfico. Resultados. Los resultados muestran un elevado consumo y policonsumo de drogas entre los participantes, no encontrándose diferencias significativas en el patrón de consumo y el perfil sociodemográfico según el género. Como media, los hombres han consumido alguna vez 9,9 drogas frente a 9,5 las mujeres. En el último mes, 7,3 frente a 6,9, y en la última rave, 5 frente a 4,9. Conclusiones. Al contrario de lo que sucede en la población general, donde la prevalencia de consumo de drogas de los hombres es superior a la de las mujeres, este trabajo no ha encontrado diferencias significativas en el patrón de consumo entre ambos géneros. Este hecho debe ser considerado para el diseño de estrategias preventivas de reducción de riesgos y daños en este colectivo (AU)

Objective. Population studies show differential drug consumption between male and female. Some studies point to rave as an androgynous culture, where gender differences disappear. Nonetheless, in this context, empirical evidences on differential patterns of drug use by gender are scarce. The purpose of this study is to analyze differences in drug use patterns and sociodemographic profile between male and female who attend raves. Material and method. Two hundred and fifty-two people who went to raves in Andalucía (Spain) were interviewed. It was administered a questionnaire to collect information on use patterns of 15 different drugs and sociodemographic profile. Results. Results show a high substance and polysubstance use between ravers. No significant differences by gender were found in drug use patterns or sociodemographic profile. The average number of drug consumed for male "some time in their lives" were 9.9, versus 9.5 for female. In the last month, 7.3 versus 6.9, and last rave, 5 versus 4.9. Conclusions. Opposite to what it happens in general population, where drug use prevalence of male is higher than female, this study haven´t found significant differences by gender. This fact must be considered in order to design risk and harm reduction preventive strategies (AU)

Diagnóstico del trastorno por déficit de atención e hiperactividad (TDAH) en pacientes adultos con dependencia de cocaína: utilidad de los nuevos síntomas de funcionamiento ejecutivo de Barkley / Diagnosing adult attention-deficit/hyperactivity disorder in patients with cocaine dependence: usefulness of new Barkley executive function symptoms

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)