Motivational factors modulate left frontoparietal network during cognitive control in cocaine addiction.

Cocaine addiction is characterized by alterations in motivational and cognitive processes involved in goal-directed behavior. Recent studies have shown that addictive behaviors can be attributed to alterations in the activity of large functional networks. The aim of this study was to investigate how cocaine addiction affected the left frontoparietal network during goal-directed behavior in a stop-signal task (SST) with reward contingencies by correct task performance. Twenty-eight healthy controls (HC) and 30 abstinent cocaine-dependent patients (ACD) performed SST with monetary reward contingencies while undergoing a functional magnetic resonance imaging scan. The results showed that the left frontoparietal network (FPN) displayed an effect of cocaine addiction depending on reward contingencies rather than inhibition accuracy; and, second, we observed a negative correlation between dependence severity and the modulation of the left FPN network by the monetary reward in ACD. These findings highlight the role of the left FPN in the motivational effects of cocaine dependence.

Reward Contingencies Improve Goal-Directed Behavior by Enhancing Posterior Brain Attentional Regions and Increasing Corticostriatal Connectivity in Cocaine Addicts.

The dopaminergic system provides the basis for the interaction between motivation and cognition. It is triggered by the possibility of obtaining rewards to initiate the neurobehavioral adaptations necessary to achieve them by directing the information from motivational circuits to cognitive and action circuits. In drug addiction, the altered dopamine (DA) modulation of the meso-cortico-limbic reward circuitry, such as the prefrontal cortex (PFC), underlies the disproportionate motivational value of drug use at the expense of other non-drug reinforcers and the user's loss of control over his/her drug intake. We examine how the magnitude of the reward affects goal-directed processes in healthy control (HC) subjects and abstinent cocaine dependent (ACD) patients by using functional magnetic resonance imaging (fMRI) during a counting Stroop task with blocked levels of monetary incentives of different magnitudes (€0, €0.01, €0.5, €1 or €1.5). Our results showed that increasing reward magnitude enhances (1) performance facilitation in both groups; (2) left dorsolateral prefrontal cortex (DLPFC) activity in HC and left superior occipital cortex activity in ACD; and (3) left DLPFC and left putamen connectivity in ACD compared to HC. Moreover, we observed that (4) dorsal striatal and pallidum activity was associated with craving and addiction severity during the parametric increases in the monetary reward. In conclusion, the brain response to gradients in monetary value was different in HC and ACD, but both groups showed improved task performance due to the possibility of obtaining greater monetary rewards.

[Efficacy of oxcarbazepine treatment in patients diagnosed with cocaine abuse/dependence]. / Utilidad del tratamiento con oxcarbacepina en pacientes con diagnostico de trastorno por abuso/dependencia de cocaina.

UNLABELLED: To assess the efficacy of oxcarbazepine in the treatment of cocaine addiction and its influence on impulsivity and craving in cocaine addicts. METHODOLOGY: A prospective, observational and clinical study was conducted in patients diagnosed with cocaine abuse/dependence (DSM IV criteria), monitoring supervised treatment with oxcarbazepine for 12 weeks. SAMPLE: 30 patients (aged 18 or over) voluntarily undergoing treatment at an Addictive Behaviors Unit (UCA). Patients were selected randomly after providing explicit authorization and informed consent. RESULTS: Abstinence rate increased, reaching 100% of participants that remained in compliance throughout the 12-week period (60% of those who started the treatment). Negative results in the urine test for cocaine detection also increased, reaching 90.9% of those in treatment at week 8. Treatment with oxcarbazepine was seen to produce a statistically significant reduction in craving and impulsivity after 4, 8 and 12 weeks, with respect to baseline measures at the start of treatment. The craving index correlates with reduction in cocaine use. CONCLUSIONS: Oxcarbazepine is effective in reducing impulsivity and craving in relation to cocaine. Thus, we recommend high initial doses of oxcarbazepine in patients with high impulsivity prior to treatment.

Utilidad del tratamiento con oxcarbacepina en pacientes con diagnóstico de trastorno por abuso/dependencia de cocaína / Efficacy of oxcarbazepine treatment in patients diagnosed with cocaine abuse/dependence

Evaluamos la eficacia de la Oxcarbacepina en el tratamiento de la adicción a cocaína, y su influencia sobre la impulsividad y el craving en cocainómanos. Metodología. Estudio clínico observacional prospectivo de pacientes diagnosticados de abuso/dependencia de cocaína (criterios DSM IV) en tratamiento con Oxcarbacepina en Seguimiento de 12 semanas. Muestra. 30 pacientes mayores de edad que manifestaron voluntad de tratar en una Unidad de Conductas Adictivas (UCA). La selección se realizó al azar previa petición de autorización y consentimiento informado. Resultados. A lo largo del seguimiento la tasa de abstinencia va aumentando hasta alcanzar al 100% de la muestra que se mantiene en tratamiento a los 3 meses (60% de los que iniciaron tratamiento). Progresivamente van aumentando los resultados en urino análisis negativos hasta alcanzar un 90,9% en la semana 8, de los que están en tratamiento. En nuestro estudio, a pesar de las limitaciones relativas altamaño de la muestra, y el porcentaje (40%) de abandonos al inicio del tratamiento, encontramos que mediante el tratamiento con Oxcarbacepina se producen descensos estadísticamente significativos del craving y la impulsividad a las 4, 8 y 12 semanas, respecto de la medida basal al inicio del tratamiento. La disminución del craving presenta el correlato conductual del descenso en el consumo. Conclusiones. La oxcarbacepina se muestra eficaz en la reducción de la impulsividad y también sobre el craving de cocaína. Recomendamos dosis iniciales elevadas en aquellos de pacientes con mayor impulsividad al inicio de tratamiento

To assess the efficacy of oxcarbazepine in the treatment of cocaine addiction and its influence on impulsivity and craving incocaine addicts. Methodology. A prospective, observational and clinical study was conducted in patients diagnosed with cocaine abuse/dependence (DSM IV criteria), monitoring supervised treatment with oxcarbazepine for 12 weeks. Sample. 30 patients (aged 18 or over) voluntarily under going treatment at an Addictive Behaviors Unit (UCA). Patients were selected randomly after providing explicit authorization andinformed consent. Results. Abstinence rate increased, reaching 100% of participants that remained in compliance throughout the12-week period (60% of those who started the treatment). Negative results in the urine test for cocaine detection also increased, reaching 90.9% of those in treatment at week 8.Treatment with oxcarbazepine was seen to produce astatistically significant reduction in craving and impulsivity after 4, 8 and 12 weeks, with respect to baseline measures at the start of treatment. The craving index correlates with reduction in cocaine use. Conclusions. Oxcarbazepine is effective in reducing impulsivity and craving in relation to cocaine.Thus, we recommend high initial doses of oxcarbazepine inpatients with high impulsivity prior to treatment

El tratamiento del tabaquismo en los centros de drogodependencias y unidades de conductas adictivas / The treatment of smokers in the centers of drug abuse dependence and centers of addictive behaviors

En los últimos años los Centros de Drogodependencias y Adicciones tienen una nueva demanda de tratamiento, la de las personas con dependencia de la nicotina. En este artículo se presentan tres experiencias prácticas del trabajo que estamos realizando con fumadores en el Centro de Atención a las Drogodependencias de Zaragoza, en la Unidad de Drogodependencias y Adicciones de Córdoba y en la Unidad de Conductas Adictivas, Area 2, de Castellón. Los tratamientos los llevamos a cabo tanto en personas que son usuarias de dichos centros (personas con dependencia del alcohol, heroína, cocaína, marihuana, etc.), como con personas que son remitidas a dichos centros, o bien otras experiencias en donde acudimos a Centros de Atención Primaria para llevar en los mismos el tratamiento de los fumadores. Los tratamientos que estamos llevando a cabo se basan en protocolos de tratamiento eficaces, tenemos una importante demanda de tratamientos para dejar de fumar y los resultados son adecuados. Si sigue la tendencia actual, en los próximos años continuará incrementándose la demanda de este tipo de tratamiento (AU)

In the last years the Centers of Drug Abuse and Addictions in Spain have a new treatment demand, people with nicotine dependence. In this article three practical experiences are presented that are carrying out with smokers in the Centro de Atención a las Drogodependencias of Zaragoza, Unidad de Drogodependencias y Adicciones of Córdoba, and Unidad de Conductas Adictivas, Area 2, of Castellón, in Spain. The treatments was applied in patients of this centers (persons with alcohol dependence, heroine dependence, cocaine dependence, marijuana, etc.), like with people that are derived at our centers. In other cases we go to the Centers of Primary Care to apply in this centers the treatment to the patients smokers. The treatments that we are carrying out are based on effective treatment protocols. We have an important demand of treatments to stop smoke and the results are good. If it follows the current tendency, in the next years it will continue increasing the demand of this treatment type (AU)

Registro del consumo de bebidas alcohólicas mediante la unidad de bebida estándar. Diferencias geográficas / Standard Drinking Unit as a measure of alcohol consumption in Sapin. Regional differences

Realizamos un estudio para determinar el valor de la Unidad de Bebida Estándar del estado español, entendida como el contenido medio en alcohol de una consumición habitual con el objetivo de facilitar el registro de consumos de bebidas alcohólicas. Primero describimos la metodología empleada en la investigación de campo y los resultados obtenidos incidiendo en las diferencias regionales para la UBE dentro del territorio español. El valor de la UBE española se establece en 10 g que equivalen al contenido medio de alcohol de una consumición de vino o cerveza y a media de destilados. Las diferencias geográficas halladas dibujan un mapa que resulta familiar en las encuestas de consumo y venta de bebidas alcohólicas. La UBE más elevada se encuentra en el norte para descender en dirección al sur geográfico con niveles mínimos en Extremadura y Andalucía. El nivel medio de la UBE por autonomías se mantiene alrededor de los 10 gramos reflejando las mayores variaciones en los valores máximos y mínimos. El cálculo de los consumos alcohólicos mediante la UBE de 10 g contribuye a facilitar el trabajo clínico en atención primaria y en las intervenciones preventivas y además fortalece el rigor de las encuestas epidemiológicas (AU)